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Imparato JCP, Moreira KMS, de Oliveira SCM, da Silva SREP, Raggio DP. Selective Caries Removal: A Case Report with 21-Year Follow-Up. Case Rep Dent 2024; 2024:3166087. [PMID: 39036059 PMCID: PMC11260509 DOI: 10.1155/2024/3166087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Dental caries remains the most prevalent chronic disease globally, and its management should adhere to the principles of minimal intervention dentistry. This study reports a series of successful cases involving the selective removal of carious tissue in permanent molars, with follow-up periods of up to 21 years. Six permanent molars with severe and deep carious lesions were treated with selective caries removal and restored with high-viscosity glass ionomer cement. Clinical examination revealed that the teeth were free from pain and sensitivity. Follow-up assessments were conducted at 7 and 21 years posttreatment. Treatment success was defined by the absence of clinical and radiographic signs, symptoms of pulp alterations, and lesion arrest. Successful minimally invasive approaches were observed with selective removal of carious tissue and maintenance of pulp vitality for up to 21 years.
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Affiliation(s)
- José Carlos Pettorossi Imparato
- Graduate Program in Pediatric DentistryInstitute and Research Center São Leopoldo MandicSao Leopoldo Mandic Faculty, Campinas, SP, Brazil
| | - Kelly Maria Silva Moreira
- Graduate Program in Pediatric DentistryInstitute and Research Center São Leopoldo MandicSao Leopoldo Mandic Faculty, Campinas, SP, Brazil
| | | | | | - Daniela Prócida Raggio
- Orthodontics and Pediatric Dentistry DepartmentUniversity of São Paulo, São Paulo, SP, Brazil
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Musson D, Buchanan H, Nolan M, Asimakopoulou K. Barriers and facilitators to using an objective risk communication tool during primary care dental consultations: A Theoretical Domains Framework (TDF) informed qualitative study. J Dent 2024; 142:104853. [PMID: 38244908 DOI: 10.1016/j.jdent.2024.104853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Objective risk communication tools can supplement clinical judgement and support the understanding of potential health risks. This study used the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementing a risk communication aid within primary care dental consultations. METHODS Dentists (N = 13), recruited via a dental practice database and through professional contacts were interviewed using a TDF-informed semi-structured interview schedule. Data were analysed inductively and deductively coding the themes using the TDF. RESULTS Eight theoretical domains (environmental context and resources; beliefs about consequences; goals; memory, attention, and decision processes; optimism; reinforcement; social influences and behavioural regulation) and thirteen sub-themes were identified. Insufficient resources and patient factors were commonly encountered barriers and led to increasing pressure to prioritise other tasks. Whilst dentists had a favourable view towards a risk communication aid and acknowledged its benefits, some were sceptical about its ability to facilitate behaviour change. Self-monitoring strategies and colleague support facilitated tool usage. CONCLUSIONS This study identified six barriers and seven facilitators to implementing a risk communication tool within primary care dental settings. Dentists appreciated the value of using a risk communication tool during dental consultations, although some required further support to integrate the tool into practice. CLINICAL SIGNIFICANCE Our findings provide a sound theoretical base for interventions aimed at facilitating patient behaviour change through the use of risk communication in dentistry. Further research should apply behavioural science to support the implementation of the tool in clinical practice.
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Affiliation(s)
- Danielle Musson
- University of Nottingham, School of Medicine, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom.
| | - Heather Buchanan
- University of Nottingham, School of Medicine, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom
| | | | - Koula Asimakopoulou
- Faculty of Dentistry Oral & Craniofacial Sciences, Kings College London, Centre for Host-Microbiome Interactions, London, United Kingdom
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Ortega-Verdugo P, Warren JJ, Gaeth GJ, Carter K, Kateeb E, Kolker JL, Shane DM. Assessing the Acceptability of Less Invasive Caries Removal Techniques for treating Deep Carious Lesions: A Conjoint Survey among Dentists Practicing in a Midwestern American State. Caries Res 2023; 57:243-254. [PMID: 37699363 DOI: 10.1159/000533658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/09/2023] [Indexed: 09/14/2023] Open
Abstract
This study identified factors that influence dentists' decisions regarding less invasive caries removal techniques such as stepwise removal (SW) and selective removal (SE) using a marketing research technique, conjoint analysis. A survey was sent to 1,434 dentists practicing in Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SW/SE in hypothetical clinical scenarios. The scenarios were carefully created by conjoint design and included three relevant attributes: depth of lesion, hardness of carious dentin, and patient age. Descriptive and conjoint analyses were performed to assess trade-offs between these attributes, using SPSS. The study revealed that depth of lesion was the most important factor in the dentists' decisions (49 importance value) when choosing a SW to treat a deep carious lesion, followed by hardness of carious dentin and patient age (21 importance value). For the SE group, depth of the lesion was also the predominant factor when selecting a treatment. The study also identified that a high proportion of dentists (24.9%) indicated they would never consider using SW or SE under any circumstances. Our survey showed that depth of lesion was the most important reason to select a less invasive caries removal method. The high proportion of dentists indicating they would never consider selective caries removal (SE) techniques suggests that these less invasive options are underutilized.
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Affiliation(s)
- Paula Ortega-Verdugo
- Section of Public and Population Health, The University of California, Los Angeles, California, USA
| | - John J Warren
- Department of Preventive and Community Dentistry, College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Gary J Gaeth
- College of Business, University of Iowa, Iowa City, Iowa, USA
| | - Knute Carter
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Elham Kateeb
- Oral Health Research and Promotion Unit, Al-Quds University, Jerusalem, Palestine
| | - Justine L Kolker
- College of Dentistry and Dental Clinics, Operative Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Dan M Shane
- Department of Health Management and Policy, Iowa City, Iowa, USA
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Abreu-Placeres N, Newton JT, Avila V, Garrido LE, Jácome-Liévano S, Pitts NB, Ekstrand KR, Ochoa EM, Martignon S. How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM-B analysis. Community Dent Oral Epidemiol 2023; 51:265-273. [PMID: 35229897 DOI: 10.1111/cdoe.12735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. METHODS A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed. RESULTS All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. CONCLUSION Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.
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Affiliation(s)
- Ninoska Abreu-Placeres
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
- Biomaterials and Dentistry Research Center (CIBO-UNIBE), Research and Innovation Department, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Jonathon Tim Newton
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Viviana Avila
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Luis E Garrido
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santo Domingo, Dominican Republic
| | - Sofia Jácome-Liévano
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Nigel B Pitts
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Kim R Ekstrand
- Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilia M Ochoa
- Dental School, Universidad Cooperativa de Colombia, Envigado, Colombia
- Dental School, Universidad de Antioquia, Medellín, Colombia
| | - Stefania Martignon
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
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Sommerfeldt W, Gellert P, Müller A, Götze N, Göstemeyer G. Older patients' perception of treating root caries with silver diamine fluoride - a qualitative study based on the Theoretical Domains Framework. J Dent 2023; 130:104408. [PMID: 36626976 DOI: 10.1016/j.jdent.2022.104408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Caries treatment with silver diamine fluoride (SDF) is effective, but often leads to irreversible tooth discoloration. This study aimed to investigate older patients' perceptions of root caries treatment with SDF and to identify factors that influence their decision process. METHODS Fifteen interviews were conducted in older patients (mean, min/max: 83, 71/92 years) with root caries experience, following a semi-structured interview-guide based on the domains of the Theoretical Domains Framework (TDF) including three case vignettes of SDF treatment. Transcripts of the interviews were used to perform deductive and inductive content analysis along the TDF and Capability-Opportunity-Motivation-Behavior model (COM-B) to assess influential factors. RESULTS All TDF domains and behavior determinants of the COM-B were covered, identifying twenty-two barriers, facilitators and conflicting themes. Main barriers for consenting to SDF treatment were patients' perceptions of permanent staining of visible root caries lesions, as well as preconceptions about those of others and lack of knowledge about root caries and SDF. Main facilitators were trust in advice given by dentists, especially regarding new treatment options, that aesthetics were less important in non-visible areas and the importance of tooth preservation and feasibility of treatments when immobile or in need of care. CONCLUSION Permanent discoloration is an important barrier to older patients' acceptance of SDF treatment for visible root caries. However, patients appear to accept SDF treatment under certain conditions, including less visible lesions or in comparison to more invasive treatment options. CLINICAL SIGNIFICANCE Our findings contribute to understanding both barriers and facilitators when treating root caries in older patients with SDF.
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Affiliation(s)
- Wiebke Sommerfeldt
- Department of Operative, Preventive and Pediatric Dentistry, Charité Centre for Dental Medicine, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nirina Götze
- Department of Operative, Preventive and Pediatric Dentistry, Charité Centre for Dental Medicine, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany
| | - Gerd Göstemeyer
- Department of Operative, Preventive and Pediatric Dentistry, Charité Centre for Dental Medicine, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany.
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Natal KH, Machado TG, Bracco F, Lemos LI, Vigano ME, Machado GM, Yampa-Vargas JD, Raggio DP, Mendes FM, Imparato JCP, Lucena EHG, Cavalcanti YW, Silva CI, Souza Filho GL, Macedo MCS, Carrer FCA, Braga MM. Using information and communication technologies (ICTs) to solve the repressed demand for primary dental care in the Brazilian Unified Health System due to the COVID-19 pandemic: a randomized controlled study protocol nested with a before-and-after study including economic analysis. BMC Oral Health 2022; 22:112. [PMID: 35392886 PMCID: PMC8988474 DOI: 10.1186/s12903-022-02101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. METHODS Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system. Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. DISCUSSION This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).
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Affiliation(s)
- Karina Haibara Natal
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Thais Gomes Machado
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Fabiana Bracco
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Luiz Ivan Lemos
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Maria Eduarda Vigano
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Gabriela Manco Machado
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Jhandira Daibelis Yampa-Vargas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | - José Carlos Pettorossi Imparato
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil
| | | | | | | | | | | | | | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP, 05508000, Brazil.
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Gomez-Rossi J, Schwartzkopff J, Müller A, Hertrampf K, Abraham J, Gassmann G, Schlattmann P, Göstemeyer G, Schwendicke F. Health policy analysis on barriers and facilitators for better oral health in German care homes: a qualitative study. BMJ Open 2022; 12:e049306. [PMID: 35351692 PMCID: PMC8966571 DOI: 10.1136/bmjopen-2021-049306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework. DESIGN Qualitative correlational study to evaluate a national intervention programme. SETTING Primary healthcare in two care homes in rural Germany. PARTICIPANTS Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists. INTERVENTIONS Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF. RESULTS 860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health. PRIMARY OUTCOME A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents. SECONDARY OUTCOMES Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants. CONCLUSIONS Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.
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Affiliation(s)
- Jesus Gomez-Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charite University Medical Center 3 Dental Oral and Maxillary Medicine, Berlin, Germany
| | | | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charite University Medical Center 3 Dental Oral and Maxillary Medicine, Berlin, Germany
| | - Katrin Hertrampf
- Department of Oral and Maxillofacial Surgery, Kiel University, Kiel, Germany
| | - Jens Abraham
- University Halle, Martin Luther University Halle-Wittenberg Institute of Health and Nursing Sciences, Halle, Germany
| | - Georg Gassmann
- Dentalhygiene & Präventionsmanagement, Europaische Fachhochschule, Bruhl, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics and Data Science - Universitätsklinikum Jena, Germany, Jena, Germany
| | - Gerd Göstemeyer
- Department for Operative and Preventive Dentistry, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Falk Schwendicke
- Zahnerhaltung, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
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Wang MC, Wu JY, Shih WY. A scoping review of intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework. Eur J Oral Sci 2021; 130:e12841. [PMID: 34935210 DOI: 10.1111/eos.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
The aim of this study was to review the intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework (TDF). We identified relevant papers from the review of Cooper et al., and these papers came from both the original inclusion and exclusion article lists. We also modified and updated their search strategies (2013 - April 2019). The 53 included papers reported on 79 interventions (experimental groups = 57 interventions, control groups = 22 interventions). Most of the papers used three to nine domains (average = 5.6) in their experimental interventions, and the most commonly used domains were 'knowledge,' 'skills,' 'social influences,' and 'environmental context and resources.' Considering the complexity of intervention components in one programme, there is no one specific domain or domain set that can determine the success of behavioural interventions. The design of future programmes should be guided by a complex intervention methodology. However, the best combination set might not exist, and the choice of domains should depend on local context or resources. This study can be used as a resource for identifying previous papers, which have used the same domains.
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Affiliation(s)
- Min-Ching Wang
- Department of Dentistry, Taipei Municipal Wanfang Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jing-Yi Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yu Shih
- Department of Dentistry, School of Dentistry, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Takata T, Gordan VV, Gilbert GH. Web-based intervention to improve the evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2021; 115:103854. [PMID: 34688779 DOI: 10.1016/j.jdent.2021.103854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. METHODS We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. RESULTS Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: "cases where decision making for treatment and prognosis is difficult", "inadequate practice resources", "limitations on patient visit and treatment period", "discrepancy between MID and the patient's values", and "limitations on health insurance and social understanding". CONCLUSIONS These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. CLINICAL SIGNIFICANCE Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan; University of Florida College of Dentistry, P.O. Box 100415, Gainesville, FL 32610-0415, USA.
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Futoshi Sumida
- Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Tomoka Takata
- School of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Valeria V Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Buchanan H, Newton JT, Baker SR, Asimakopoulou K. Adopting the COM-B model and TDF framework in oral and dental research: A narrative review. Community Dent Oral Epidemiol 2021; 49:385-393. [PMID: 34270110 PMCID: PMC9290067 DOI: 10.1111/cdoe.12677] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Background Recent advances in the psychological understanding of health‐related behaviour have focused on producing a comprehensive framework to model such behaviour. The Capability‐Opportunity‐Motivation‐Behaviour (COM‐B) and its associated Theoretical Domains Framework (TDF) allow researchers to classify psychological and behavioural constructs in a consistent and transferable manner across studies. Aim To identify oral and dental health‐related studies that have used the TDF and/or COM‐B as frameworks to guide research and examine the ways in which these concepts have been practically used in such research. Method Narrative review of published literature. To be included, the paper had to (1) state that the TDF or COM‐B had been used and to have targeted at least one construct identified in either framework, (2) include primary empirical data, (3) focus on a behaviour directly related to oral or dental‐related health (eg brushing, applying fluoride varnish, flossing) and/or attitudes, intentions and beliefs related to the behaviour. Studies could include any research design, and participants of any age or gender and include patients, parents or dental health professionals. Findings Nine studies were identified that had drawn on the COM‐B and/or TDF as the framework for their research. Seven of the studies were based on the TDF only, with one employing both the COM‐B and Health Belief Model, and one using the TDF with COM‐B. The nine studies covered a broad range of oral health‐related behaviours including child tooth brushing, fluoride varnish application and non‐ or micro‐invasive management of proximal caries lesions. The populations in the studies included dentists, dental teams and parents of children. All studies adopted only a subset of the constructs within the TDF, often without justification. Conclusions It is encouraging that oral health researchers are adopting standardized psychological frameworks to develop their research and oral health interventions. Future work should build on the small number of studies identified in this review and consider using standardized tools to do so.
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Affiliation(s)
- Heather Buchanan
- Division of Rehabilitation, Ageing & Wellbeing, Medical School, University of Nottingham, Nottingham, UK
| | - Jonathon Timothy Newton
- Faculty of Dentistry, Oral and Craniofacial Sciences, King' College London, Guy's Hospital, London, UK
| | - Sarah R Baker
- Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Koula Asimakopoulou
- Faculty of Dentistry, Oral and Craniofacial Sciences, King' College London, Guy's Hospital, London, UK
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Implementation of COVID-19 Infection Control Measures by German Dentists: A Qualitative Study to Identify Enablers and Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115710. [PMID: 34073452 PMCID: PMC8198934 DOI: 10.3390/ijerph18115710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES COVID-19 infection control measures have been recommended for dental practices worldwide. This qualitative study explored barriers and enablers for the implementation of these measures in German dental practices. METHODS Semi-structured phone interviews were conducted in November/December 2020 (purposive/snowball sampling). The Theoretical Domains Framework (TDF) and the Capabilities, Opportunities and Motivations influencing Behaviors model (COM-B) were used to guide interviews. Mayring's content analysis was employed to analyze interviews. RESULTS All dentists (28-71 years, 4/8 female/male) had implemented infection control measures. Measures most frequently not adopted were FFP2 masks, face shields (impractical), the rotation of teams (insufficient staffing) and the avoidance of aerosol-generating treatments. Dentists with personal COVID-19 experience or those seeing themselves as a role model were more eager to adopt measures. We identified 34 enablers and 20 barriers. Major barriers were the lack of knowledge, guidelines and recommendations as well as limited availability and high costs of equipment. Pressure by staff and patients to ensure infection control was an enabler. CONCLUSIONS Dentists are motivated to implement infection control measures, but lacking opportunities limited the adoption of certain measures. Policy makers and equipment manufacturers should address these points to increase the implementation of infection control measures against COVID-19 and potential future pandemics.
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Müller A, Mertens SM, Göstemeyer G, Krois J, Schwendicke F. Barriers and Enablers for Artificial Intelligence in Dental Diagnostics: A Qualitative Study. J Clin Med 2021; 10:1612. [PMID: 33920189 PMCID: PMC8069285 DOI: 10.3390/jcm10081612] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
The present study aimed to identify barriers and enablers for the implementation of artificial intelligence (AI) in dental, specifically radiographic, diagnostics. Semi-structured phone interviews with dentists and patients were conducted between the end of May and the end of June 2020 (convenience/snowball sampling). A questionnaire developed along the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities and Motivations influencing Behaviors model (COM-B) was used to guide interviews. Mayring's content analysis was employed to point out barriers and enablers. We identified 36 barriers, conflicting themes or enablers, covering nine of the fourteen domains of the TDF and all three determinants of behavior (COM). Both stakeholders emphasized chances and hopes for AI. A range of enablers for implementing AI in dental diagnostics were identified (e.g., the chance for higher diagnostic accuracy, a reduced workload, more comprehensive reporting and better patient-provider communication). Barriers related to reliance on AI and responsibility for medical decisions, as well as the explainability of AI and the related option to de-bug AI applications, emerged. Decision-makers and industry may want to consider these aspects to foster implementation of AI in dentistry.
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Affiliation(s)
- Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.M.); (J.K.)
| | - Sarah Marie Mertens
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (S.M.M.); (G.G.)
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (S.M.M.); (G.G.)
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.M.); (J.K.)
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.M.); (J.K.)
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13
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Chevalier V, Le Fur Bonnabesse A, Duncan HF. Frightened of the pulp? A qualitative analysis of undergraduate student confidence and stress during the management of deep caries and the exposed pulp. Int Endod J 2020; 54:130-146. [PMID: 32867001 DOI: 10.1111/iej.13393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
AIM To evaluate sources of student confidence and stress during the management of deep carious lesions and the exposed pulp during undergraduate clinics. Further aims were to identify barriers and facilitators, which could result in educational or practical improvements in the delivery of teaching and provision of treatment in this area. METHODOLOGY A exploratory qualitative study design was used, based on recorded focus group interviews, guided by 12 predetermined questions. The discussions were transcribed verbatim and analysed by inductive qualitative content analysis. Common categories were identified to aid understanding. Forty undergraduate dental students from 4th and 5th years in Dublin Dental University Hospital participated in the study. RESULTS Student stress and confidence were multifactorial and broadly linked to specific domains: clinical procedure, academic education, clinical training, evaluation/grading, organization and equipment, vital pulp biomaterial and the patient. Most students expressed a preference for one-stage selective carious removal to soft dentine rather than potential pulp exposure in deep carious lesions, noting that although it helped to decrease their immediate stress, it also caused longer-term concern by leaving caries close to the pulp. Nevertheless, their confidence was affected by limited clinical experience of carrying out selective removal procedures in deep caries. A recurrent finding was students citing high levels of stress after pulp exposure. Feelings including anger, fear, embarrassment and denial were associated with pulp exposure during deep caries management. Generally, the students felt able to manage pulp capping procedures, but were less certain about partial pulpotomy, suggesting that although they are aware of its advantages, they were unsure about the appropriate volume of pulp tissue to remove. To reduce stress, students suggested that laboratory teaching should employ new 3-D printed solutions and clinics should establish clear consensus amongst supervising teachers about the best way to manage the exposed pulp. CONCLUSIONS Students lacked confidence as they neared the pulp and prefer selective caries removal techniques, which reduce the likelihood of pulp exposure. Students identified stressors and suggested improvements in several domains that would improve confidence. These ameliorations could lead to enhancements in student ability to perform these conservative techniques, and improve the provision of treatment in this area.
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Affiliation(s)
- V Chevalier
- Brest University Hospital, University of Bretagne Occidentale, Brest, France.,UMR CNRS 6027, IRDL, University of Bretagne Occidentale, Brest, France.,Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - A Le Fur Bonnabesse
- Brest University Hospital, University of Bretagne Occidentale, Brest, France.,LIEN, University of Bretagne Occidentale, Brest, France
| | - H F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
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