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Hummel R, den Boer J, Barendse M, van der Heijden G, van der Sanden W, Bruers J. The relationship between self-reported preventive and curative orientations of dentists and oral healthcare services provided to Dutch young patients: An observational study. PLoS One 2024; 19:e0306403. [PMID: 38968302 PMCID: PMC11226104 DOI: 10.1371/journal.pone.0306403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024] Open
Abstract
The aims of this study were to investigate the relationship between self-reported preventive and curative orientations of general dental practitioners (GDPs) and the oral healthcare services (OHS) they provided to patients under 18-years-old. And in addition, to determine which patient, GDP, and dental practice characteristics predicted the provision of preventive and curative care. GDPs in the Netherlands using dental software program Exquise (>2,000) were invited to participate in this study voluntarily. Participants completed a web-based questionnaire on characteristics of themselves, their dental practices, and on 20 hypothetical clinical situations concerning caries management. Based on their responses GDPS were classified for their preventive orientation, and their curative orientation. Data on the OHS provided to their young patients over the period 2013-2017 were automatically extracted from the patient files. Based on the annual frequency of provided care to regular patients over a period of 4 or 5 years, this was converted into 3 longitudinal care patterns regarding prevention and 3 longitudinal care patterns regarding curative care. Multinomial logistic regression analyses were conducted with a multilevel approach to correct for dental practices. The 37 participating GDPs provided data for 16,229 young patients. There was not a significant relationship between self-reported preventive orientations and preventive care patterns. The self-reported middle curative orientation was a predictor of the care pattern 'curative treatment(s) in 1 year' (OR 1.23 compared to nu curative treatments; 95% CI 1.02-1.48). The self-reported high curative orientation was a predictor of 'curative treatments in several years' (OR 1.90; 95% CI 1.27-2.85). Common characteristics predicting (p<0.05) both regular preventive care and curative treatments in several years were patient related: age 4-9 and 10-12, low-income neighborhood, 5 years included in study. GDP and dental practice related predictors were: the GDP could fulfill the care demand by working overtime, small dental practice (≤2,000 patients), and practice policy on the provision of care to young patients. This showed that the variation in provided care was partly supplier-driven instead of patient-centered.
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Affiliation(s)
- Riet Hummel
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Zilveren Kruis, Zeist, The Netherlands
| | - Joost den Boer
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- KNMT, Royal Dutch Dental Association, Utrecht, The Netherlands
| | - Mariska Barendse
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Geert van der Heijden
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wil van der Sanden
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Josef Bruers
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- KNMT, Royal Dutch Dental Association, Utrecht, The Netherlands
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Sá G, Braga MM, Junior JM, Ekstrand K, Ribeiro M, Bönecker M. The professional perception of the International Caries Classification and Management System (ICCMS): a pragmatic randomised clinical trial. Br Dent J 2024:10.1038/s41415-024-7510-9. [PMID: 38902437 DOI: 10.1038/s41415-024-7510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 06/22/2024]
Abstract
Introduction The International Caries Classification and Management System (ICCMS) was developed to standardise caries diagnosis, risk assessment and treatment decisions based on overall evidence. To evaluate its criteria in practice, a clinical trial assessed professionals' perceptions of two caries management systems.Methods A perception questionnaire was administered to two groups: one using ICCMS criteria and the other based on professional experience criteria (non-ICCMS group). The online questionnaire included quantitative scale questions to measure effort and satisfaction and two open-ended questions to collect the positive and negative perceptions of dentists by using either criteria system. The questionnaires were administered six months after the study's implementation.Results Both groups showed high levels of effort and satisfaction. Professionals using ICCMS reported more positive perceptions by citing improved diagnosis (71.4%) and standardised patient care (43%). However, they also noted negative aspects, such as increased number of questionnaires and records (58%), longer clinical sessions (43%) and higher rates of patient absenteeism (29%).Conclusion Professionals who used the ICCMS had a positive outlook on the system, with benefits seen in diagnosis and patient monitoring. However, there is room for improvement in terms of automation and simplification to enhance the professional use of the system in the clinical setting.
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Affiliation(s)
- Gabriela Sá
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil.
| | - Mariana Minatel Braga
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
| | | | - Kim Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Matheus Ribeiro
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
| | - Marcelo Bönecker
- School of Dentistry, Universidade de São Paulo (USP), Department of Paediatric Dentistry, São Paulo, SP, Brazil
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Pillai S, Rohani K, Macdonald ME, Al-Hamed FS, Tikhonova S. Integration of an evidence-based caries management approach in dental education: The perspectives of dental instructors. J Dent Educ 2024; 88:69-81. [PMID: 37822041 DOI: 10.1002/jdd.13388] [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: 03/17/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE/OBJECTIVES Evidence-based caries management (EBCM) has developed into an internationally recognized tool for integration of comprehensive non-surgical caries treatment in dental education. However, uptake of the EBCM approach remains uneven across Canadian dental schools. Our project sought to understand how dental instructors perceive the challenges and solutions to the integration of the EBCM approach in undergraduate clinical education. METHODS Using a qualitative descriptive design, we recruited a purposeful sample of clinical instructors supervising undergraduate dental students in caries-related dental care. Semi-structured, online interviews focused on the main characteristics of EBCM. Interviews were analyzed using the awareness, desire, knowledge, ability, and reinforcement (ADKAR) change management model to understand challenges with EBCM implementation in undergraduate education. The analysis process started with verbatim transcription; then, transcripts were coded deductively based on the interview guide and the ADKAR model domains, and inductively to generate emergent codes. Finally, thematic analysis was used to develop themes and subthemes. RESULTS We interviewed 11 dental instructors with a wide range of clinical experience. Our results show that participants had sufficient awareness regarding the need for the EBCM approach and portrayed a strong desire to participate in bringing curricular changes. Knowledge and ability of participants depended on their training, experience, and involvement in continuing education courses. A lack of standardized caries management practices, less chairside time, and poor remuneration for instructors were major barriers in EBCM clinical implementation. Potential solutions suggested included providing continuing education courses, credits for students for non-surgical caries management, and remunerating instructors for implementation. CONCLUSIONS In conclusion, most participants were aware of the need for a substantive change toward EBCM and demonstrated the desire to participate and improve its implementation. Our analysis showed that to facilitate full integration of the EBCM approach into the undergraduate dental clinics, organizational focus needs to be placed on the individual's knowledge and ability, with tailored efforts toward reinforcement.
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Affiliation(s)
- Sangeeth Pillai
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Kimia Rohani
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | | | - Svetlana Tikhonova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
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Timms L, Rodd H, Deery C, Brocklehurst P, Marshman Z. 'You just don't have the time to keep bringing them back, bringing them back': the experience of primary care dental professionals in England when treating young children with carious teeth. Br Dent J 2023:10.1038/s41415-023-6229-3. [PMID: 37666984 DOI: 10.1038/s41415-023-6229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 05/04/2023] [Indexed: 09/06/2023]
Abstract
Introduction Caries in the primary dentition affects around one-quarter of children in England. There is uncertainty and varying practice regarding the management of these children within NHS primary dental care. Silver diamine fluoride (SDF) is an approach that is not well-adopted nationally. This study aims to explore the factors affecting treatment choices for caries management in young children within primary dental care, including the use of SDF.Methods Semi-structured interviews were carried out via video conferencing with general dental practitioners and therapists working in NHS primary care. The topic guide covered factors which influence the management of caries in primary teeth, with SDF-specific questions. These were transcribed verbatim and analysed using thematic analysis.Results A total of 13 interviews were conducted with dental professionals working across Yorkshire and the East Midlands. Decision-making for caries management was dependent on inter-related factors, which also influenced SDF use. Treatment decisions were taken on a case-by-case basis, but were influenced by the child, their parents, the dental professional and service factors, along with the clinical technique.Conclusion Many individual- and system-level factors influence treatment decisions for early childhood caries. However, issues relating to remuneration and governance appear to be specific barriers to adoption of SDF in primary dental care.
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Affiliation(s)
- Laura Timms
- School of Clinical Dentistry, University of Sheffield, United Kingdom.
| | - Helen Rodd
- Consultant in Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, United Kingdom
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, United Kingdom
| | - Paul Brocklehurst
- Consultant in Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, United Kingdom
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, United Kingdom
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de Moura RC, Santos PS, dosSantos Matias PM, Vitali FC, Hilgert LA, Cardoso M, Massignan C. Knowledge, attitudes, and practice of dentists on Minimal Intervention Dentistry: a systematic review and meta-analysis. J Dent 2023; 132:104484. [PMID: 36958696 DOI: 10.1016/j.jdent.2023.104484] [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: 11/13/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES To evaluate the knowledge, attitudes, and practice (KAP) of dentists on Minimal Intervention Dentistry (MID). DATA Cross-sectional studies that analyzed KAP outcomes on MID principles were included. SOURCES Eight databases (Cochrane, DOSS, Embase, LILACS, PsycINFO, PubMed, Scopus, and Web of Science) and the grey literature were searched on January 2022. STUDY SELECTION Two independent reviewers selected the included studies, initially by screening titles and abstracts and, finally, by full-text reading. The methodological quality of studies was assessed by using the Joanna Briggs Institute Critical Assessment Checklist for Prevalence Studies. Proportion meta-analysis was conducted using a random effect model for data analysis. Cochran's Q test was used to assess the heterogeneity and the I² statistic for evaluation of true variation due to heterogeneity. RESULTS Of 2,079 studies initially identified, twelve were included in the systematic review. Twenty-four statements about MID were included in the meta-analysis, based on data from ten studies (n=1728 participants). The pooled proportion of knowledge on MID was 75.66% (95%CI: 69.33 - 81.48; p<0.01; I²: 97%; Tau2: 0.0456) and of attitudes and practice was 47.95% (95%CI: 38.55 - 57.43; p<0.01; I²: 98%; Tau2: 0.0743). The higher prevalences rates were in the "knowledge" field, and the lowest was in "attitudes and practice". CONCLUSIONS The findings suggest that the knowledge of dentists on MID topics is acceptable, and the attitudes and practices need improvements. The studies lacked uniformity in methods and there is still a need for more studies to elucidate the KAP of dentists worldwide. CLINICAL SIGNIFICANCE Understanding the cognizance and the way oral healthcare professionals are treating dental caries is the first step to expanding the minimal intervention evidence into a dental practice. The final goal is to change the practice and make Minimal Intervention Dentistry the standard of care for dental caries worldwide. REGISTRATION PROSPERO CRD42021257518.
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Affiliation(s)
| | | | | | | | | | - Mariane Cardoso
- Department of Dentistry, Federal University of Santa Catarina, Brazil
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Nagarkar S, Loguercio AD, Perdigão J. Evidence-based fact checking for selective procedures in restorative dentistry. Clin Oral Investig 2023; 27:475-488. [PMID: 36607490 DOI: 10.1007/s00784-022-04832-z] [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: 08/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence. MATERIALS AND METHODS A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included. RESULTS Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs. CONCLUSIONS A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence. CLINICAL RELEVANCE This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes.
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Affiliation(s)
- Sanket Nagarkar
- Park Dental Group, Minneapolis, MN, USA.,Department of Restorative Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Alessandro D Loguercio
- School of Dentistry, Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Jorge Perdigão
- Division of Operative Dentistry, Department of Restorative Sciences, University of Minnesota, 515 SE Delaware St, 8-450 Moos Tower, Minneapolis, MN, 55455, USA.
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Maldupa I, Slepcova O, Vidulskane I, Brinkmane A, Senakola E, Uribe SE. COVID-19 as an opportunity for minimally-invasive dentistry: a national cross-sectional survey. BMC Oral Health 2022; 22:394. [PMID: 36096784 PMCID: PMC9465652 DOI: 10.1186/s12903-022-02432-7] [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: 02/28/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background During the COVID19 pandemic, the Latvian government issued first absolute restrictions (elective treatments prohibited, only emergency care) and later relative restrictions (preference for non-aerosol-generating procedures (AGP) and emergency care) on dental care. This study aims to assess the impact of these restrictions on the decision made by Latvian dentists about caries treatment. Methods A Survey-based cross-sectional study was used. A minimum sample size of 174 dentists was estimated for national representativeness (N = 1524). The questionnaire was developed by experts and sent three times via email to Latvian dentists from July to September 2020 and was also delivered in printed form at two national conferences in September and October 2020. Descriptive statistics were calculated. Results We received 373 completed questionnaires, with a total response rate of 24.5%. Under the recommendation to reduce AGP for the treatment of uncomplicated caries, 10% of the dentists stated that they would stop attending, 54% would only attend emergencies, and 36% would attend as usual. Under prohibition, the percentages are 15%, 74%, and 11%, respectively. Regarding the type of treatment, more than 75% would opt to proceed with selective caries removal for both primary and permanent teeth and 10% for extraction. Conclusion Latvian dentists are willing to treat patients with caries during the pandemic and state that they prefer to use non- or minimally invasive and less aerosol-generating methods for caries treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02432-7.
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Affiliation(s)
- Ilze Maldupa
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Olga Slepcova
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Ilona Vidulskane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Anda Brinkmane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Egita Senakola
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Sergio E Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia. .,School of Dentistry, Universidad Austral de Chile, Valdivia, Chile. .,Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia.
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Nascimento MM, Ribeiro AP, Delgado AJ, Cassiano L, Caraballo M, Roulet JF, Geraldeli S, Pereira P, Ottenga ME, Dilbone DA. Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study. Oper Dent 2020; 45:581-588. [PMID: 32516382 DOI: 10.2341/19-221-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. SUMMARY In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient's caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.
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Abstract
Despite evidence strongly supporting use of non-invasive or minimally invasive procedures in caries management, there is still a large gap between evidence-based recommendations and application of these concepts in practice, with the practice of dentistry still largely dominated by invasive procedures in the US. This paper describes efforts in education and clinical practice in the US in the last decade to promote evidence-based cariology strategies, which support a minimum intervention dentistry (MID) philosophy. These include, for example: a competency-based core cariology curriculum framework which has been developed and disseminated. National education accreditation standards supporting caries management are likely to soon be changed to support assessment of best evidence in cariology. There are several ongoing efforts by organised dentistry and other groups involving dental educators, researchers and clinical practitioners to promote cariology concepts in practice, such as the development of evidence-based clinical practice guidelines for caries management by the American Dental Association. Within each of these strategies there are challenges, but also opportunities to expand the implementation of MID in the US, which create optimism for future improvements over time.
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Tikhonova S, Jessani A, Girard F, Macdonald ME, De Souza G, Tam L, Eggert F, Nguyen‐Ngoc C, Morin N, Aggarwal N, Schroth RJ. The Canadian Core Cariology Curriculum: Outcomes of a national symposium. J Dent Educ 2020; 84:1245-1253. [DOI: 10.1002/jdd.12313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | - Abbas Jessani
- College of Dentistry University of Saskatchewan Saskatoon Saskatchewan Canada
- Schulich School of Medicine & Dentistry University of Western Ontario London Ontario Canada
| | - Felix Girard
- Faculty of Dentistry Université de Montréal Montreal Quebec Canada
| | | | - Grace De Souza
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
| | - Laura Tam
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
| | | | | | - Nathalie Morin
- Faculty of Dentistry McGill University Montreal Quebec Canada
| | - Neha Aggarwal
- Faculty of Dentistry McGill University Montreal Quebec Canada
| | - Robert J. Schroth
- Dr. Gerald Niznick College of Dentistry University of Manitoba Winnipeg Manitoba Canada
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Ricucci D, Siqueira JF, Rôças IN, Lipski M, Shiban A, Tay FR. Pulp and dentine responses to selective caries excavation: A histological and histobacteriological human study. J Dent 2020; 100:103430. [PMID: 32673638 DOI: 10.1016/j.jdent.2020.103430] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The present study investigated the histobacteriological condition of human carious dentine, and the histological response of dental pulps after selective caries excavation to firm dentine and cavity restoration with adhesive procedures. METHODS Twelve vital teeth with medium/deep occlusal caries from 12 patients were scheduled for extraction. The patients gave consent to have caries removed selectively and the cavity restored with adhesive procedures prior to extraction. Caries excavation was achieved using burs and sharp hand excavators until "leathery" or "firm" dentine was encountered. After extraction, the teeth were completely-demineralised, processed for light microscopy, serial-sectioned and stained with haematoxylin and eosin staining for histological examination of dentine characteristics and pulpal responses. Additional sections were stained with Taylor-modified Brown and Brenn technique for histobacteriological examination of bacteria infiltration of the dentinal tubules and dental pulp. RESULTS The 12 teeth showed varying degrees of tertiary dentine formation. Chronic inflammatory cell infiltrates were identified in the pulp of all specimens and appeared as scattered inflammatory cells or exiguous localised accumulations. Capillaries were heavily congested with erythrocytes and polymorphonuclear leukocytes. A large amount of stainable bacteria was observed in the dentine subjacent to the cavity floor in all specimens. CONCLUSIONS The present study demonstrated that "leathery" or "firm" carious dentine is infected. The remnant bacteria in the dentine provoked subclinical pulpal inflammation over the entire evaluation period. The presence of potentially-arrested caries does not necessarily mean that bacterial infection is absent or under control. CLINICAL SIGNIFICANCE Knowledge on the pulpal response to active caries and the inflammatory responses associated with bacteria ingress into dentine is paramount in helping clinicians make an informed, rational choice based on biologically-robust principles.
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Affiliation(s)
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Amal Shiban
- Department of Restorative Dental Science, Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA.
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12
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Le Clerc J, Gasqui MA, Laforest L, Beaurain M, Ceinos R, Chemla F, Chevalier V, Colon P, Fioretti F, Gevrey A, Kérourédan O, Maret D, Mocquot C, Özcan C, Pelissier B, Pérez F, Terrer E, Turpin YL, Arbab-Chirani R, Seux D, Doméjean S. Knowledge and opinions of French dental students related to caries risk assessment and dental sealants (preventive and therapeutic). Odontology 2020; 109:41-52. [PMID: 32472405 DOI: 10.1007/s10266-020-00527-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES A national questionnaire study was performed to document knowledge and opinions of French dental students (FDSs) about minimal intervention (MI) in dentistry especially caries risk assessment (CRA) and dental sealants (DSs). MATERIALS AND METHODS A questionnaire was administered to the fifth-year dental FDSs (n = 1370) from the 16 French dental schools. Descriptive and statistical analyses were performed. RESULTS The response rate was 84.5%. A large majority of respondents (87.8%) linked MI with minimally invasive dentistry and 77.4% considered MI as a concept based on prevention. About 80% stated they use CRA in clinical practice, mostly without any specific form. If 80.4% of the respondents would base their treatment plans on CRA, only 55.1% would regularly plan preventive regimens according to individual risk level. However, while 96.6% declared they perform preventive DSs, only 44.3% considered therapeutic sealants as a routine treatment. Although 75.1% of FDSs stated that they had sufficient learning and training related to CRA, 55.9% thought that they need further education about preventive and therapeutic DSs. CONCLUSION Although FDSs seem to be aware of the importance of CRA and preventive strategies, this study shows the need to harmonize the teaching in cariology according to the latest European recommendations. CLINICAL RELEVANCE A national questionnaire study showed variability towards knowledge and opinions of FDSs related to MI in cariology. This may impact care provisions in their future professional life showing the urgent need to harmonize the teaching of MI in cariology in France.
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Affiliation(s)
- Justine Le Clerc
- Univ Rennes, CHU Rennes (pôle Odontologie), CNRS, ISCR (Institut des Sciences Chimiques de Rennes), UMR 6226, Rennes, France
| | - Marie-Agnès Gasqui
- UFR d'Odontologie, Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon 1, Lyon, France
| | | | | | - Romain Ceinos
- Université Côte d'Azur, UFR d'Odontologie, Nice, France.,Hôpital St Roch, Pôle Odontologie, CHU, Nice, France.,UMR 7268, Anthropologie bio-culturelle, Droit Éthique et Santé (ADES), Aix-Marseille Université, Marseille, France
| | - Florence Chemla
- Faculté de Chirurgie Dentaire - Université Paris Descartes, Paris, France.,Service de médecine Buccodentaire de l'hôpital Charles Foix, APHP, Paris, France
| | - Valérie Chevalier
- UFR d'Odontologie, UBO, Brest, France.,CHRU de Brest, Brest, France.,Institut de Recherche Dupuy de Lome, UMR CNRS 6027, Brest, France
| | - Pierre Colon
- Université de Paris, Faculté Dentaire, Hôpital Rothschild, AP-HP, Paris, France.,Univ Lyon, Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne, France
| | - Florence Fioretti
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires des Hôpitaux Universitaires, UMR INSERM 1260, Strasbourg, France
| | | | - Olivia Kérourédan
- Université de Bordeaux, UFR des Sciences Odontologiques, Bordeaux, France.,Service de Médecine Bucco-dentaire, CHU de Bordeaux, Bordeaux, France.,INSERM, Bioingénierie Tissulaire, U1026, Bordeaux, France
| | - Delphine Maret
- UFR d'Odontologie, CHU, Laboratoire AMIS, UMR 5288 CNRS, Toulouse, France
| | - Caroline Mocquot
- Université de Paris, Faculté Dentaire, Hôpital Rothschild, AP-HP, Paris, France.,Univ Lyon, Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne, France
| | - Canan Özcan
- UFR d'Odontologie, Université de Reims Champagne-Ardenne, Reims, France
| | | | - Fabienne Pérez
- UFR d'Odontologie, CHU, Univ Nantes, PHU 4 OTONN, Nantes, France
| | - Elodie Terrer
- UFR d'Odontologie, Aix-Marseille Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | | | - Reza Arbab-Chirani
- UFR d'Odontologie, UBO, Brest, France.,CHRU de Brest, Brest, France.,LaTIM UMR 1101 INSREM, Brest, France
| | - Dominique Seux
- UFR d'Odontologie, Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Lyon 1, Lyon, France
| | - Sophie Doméjean
- UFR d'Odontologie, Centre de Recherche en Odontologie Clinique EA 4847, Univ Clermont Auvergne, Clermont-Ferrand, France. .,Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France.
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13
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Chai B, Tay B, Chow C, Fuss J, Krishnan U. Treatment preferences for deep caries lesions among Australian dentists. Aust Dent J 2020; 65:83-89. [PMID: 31773749 DOI: 10.1111/adj.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a global disparity in managing deep caries lesions and evidence-based strategies are not always followed. The aim of this study was to gain insight into current practices of Australian dentists for deep caries management and to determine their procedural and materials choices. METHODS An online questionnaire was sent to 1988 randomly selected practitioners across Australia asking their choice of treatment in a tooth showing symptoms of reversible pulpitis and deep caries. A total of 255 (12.6%) practitioners responded. RESULTS About 85% of respondents chose selective caries removal to selective removal (SR) while 15% chose non-selective removal to hard dentine. Respondents whose preferred approach was SR had greater odds in believing that incomplete caries removal alone would not have any effect on pulp vitality (OR = 5.20) and had greater odds of thinking that peripheral seal was more important than other factors (OR = 3.50). They also had lesser odds of believing that placing a liner would reduce postoperative sensitivity (OR = 0.269) and lesser odds of thinking that removal of all bacteria or carious dentine was important when placing a restoration (OR = 0.196). CONCLUSION Most Australian dentists reported practising evidence-based carious tissue removal strategies and accepted the concept of selectively leaving carious dentine under a sealed restoration.
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Affiliation(s)
- Byy Chai
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Byx Tay
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Cyt Chow
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - J Fuss
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - U Krishnan
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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14
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Maguire A, Clarkson JE, Douglas GV, Ryan V, Homer T, Marshman Z, McColl E, Wilson N, Vale L, Robertson M, Abouhajar A, Holmes RD, Freeman R, Chadwick B, Deery C, Wong F, Innes NP. Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT. Health Technol Assess 2020; 24:1-174. [PMID: 31928611 PMCID: PMC6983909 DOI: 10.3310/hta24010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. OBJECTIVES The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression. DESIGN This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit. SETTING This trial was set in primary dental care in Scotland, England and Wales. PARTICIPANTS Participants were NHS patients aged 3-7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis. INTERVENTIONS Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth). MAIN OUTCOME MEASURES The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period. RESULTS A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8-36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was -0.02 (97.5% confidence interval -0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval -0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis. CONCLUSIONS There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period. FUTURE WORK Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care. TRIAL REGISTRATION Current Controlled Trials ISRCTN77044005. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Maguire
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jan E Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | | | - Vicky Ryan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Robertson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Alaa Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Richard D Holmes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Barbara Chadwick
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Christopher Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Ferranti Wong
- Institute of Dentistry, Queen Mary University of London, London, UK
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15
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Alzaid H, Elagra M, Alsabeh M, Altoub N, Binhowaimel S. Caries-related treatment decisions of general dental practitioners in Riyadh, Saudi Arabia. SAUDI JOURNAL OF ORAL SCIENCES 2020. [DOI: 10.4103/sjos.sjoralsci_63_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Doméjean S, Banerjee A, Featherstone JDB. Caries risk/susceptibility assessment: its value in minimum intervention oral healthcare. Br Dent J 2018; 223:191-197. [PMID: 28798458 DOI: 10.1038/sj.bdj.2017.665] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/09/2022]
Abstract
This narrative review describes the intimate connection between minimum intervention (MI) oral healthcare and caries risk/susceptibility assessment (CRA). Indeed CRA is the corner stone of an MI care plan, allowing the determination of the appropriate interventions (non-invasive as well as invasive [restorative]) and recall consultation strategies. Various CRA protocols/models have been developed to assist the oral healthcare practitioner/team in a logical systematic approach to synthesising information about a disease that has a multifactorial aetiology. Despite the criticisms toward the lack of clear-cut validation of the proposed protocols/models, CRA still has great potential to enhance patient care by allowing the oral healthcare practitioner/team and the patient to understand the specific reasons for their caries activity and to tailor their care plans and recall intervals accordingly.
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Affiliation(s)
- S Doméjean
- Université Clermont Auvergne, UFR d'Odontologie, CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - A Banerjee
- Chair/Head of Department, Conservative &MI Dentistry, King's College London Dental Institute at Guy's Hospital, King's Health Partners, London, UK
| | - J D B Featherstone
- School of Dentistry, University of California San Francisco, San Francisco, USA
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17
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Tikhonova S, Girard F, Fontana M. Cariology Education in Canadian Dental Schools: Where Are We? Where Do We Need to Go? J Dent Educ 2018; 82:39-46. [PMID: 29292324 DOI: 10.21815/jde.018.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to document cariology education across Canadian dental schools. Ten faculty members who supervise cariology education at each of the ten Canadian dental schools were invited to participate in the study in 2016. An adapted version of the European Organization for Caries Research-Association for Dental Education in Europe cariology curriculum group questionnaire was used. Representatives of all ten dental schools completed the questionnaire, for a 100% response rate. In four schools, cariology and restorative dentistry were taught by the same department. Five schools had didactic/laboratory courses focusing primarily on cariology as well as a specific written curriculum. Six schools provided cariology-related hands-on workshops/laboratories before students started working with patients. In teaching cariology, seven institutions included dental hard tissues defects. The following caries detection methods were addressed didactically in cariology education: visual (10/10 total schools), tactile (9/10), International Caries Detection and Assessment System criteria (6/10), caries activity assessment (9/10), radiographic (10/10), and other detection tools (8/10). Seven schools charted activity of carious lesions in clinic. Only one school used the concept of caries risk assessment regularly in clinic. Clinical cariology teaching was carried out mostly by private dentists hired as clinical instructors (7/10) and faculty members involved in didactic cariology education (9/10). Calibration of faculty members for caries detection criteria was reported by only one school. The main concern reported by all institutions was the difficulty of implementing didactic instruction on cariology into clinical training. This study found that contemporary cariology concepts are in the process of being implemented in didactic education across Canadian dental schools, but all schools lacked appropriate integration of cariology education into clinical training. These findings suggest a need for harmonization of evidence-based cariology education in Canada.
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Affiliation(s)
- Svetlana Tikhonova
- Dr. Tikhonova is Faculty Lecturer, Faculty of Dentistry, McGill University; Dr. Girard is Assistant Professor, Department of Oral Health, Faculty of Dentistry, Université de Montréal; Dr. Fontana is Professor of Cariology, School of Dentistry, University of Michigan.
| | - Félix Girard
- Dr. Tikhonova is Faculty Lecturer, Faculty of Dentistry, McGill University; Dr. Girard is Assistant Professor, Department of Oral Health, Faculty of Dentistry, Université de Montréal; Dr. Fontana is Professor of Cariology, School of Dentistry, University of Michigan
| | - Margherita Fontana
- Dr. Tikhonova is Faculty Lecturer, Faculty of Dentistry, McGill University; Dr. Girard is Assistant Professor, Department of Oral Health, Faculty of Dentistry, Université de Montréal; Dr. Fontana is Professor of Cariology, School of Dentistry, University of Michigan
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18
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St Paul A, Phillips C, Lee JY, Khan AA. Provider Perceptions of Treatment Options for Immature Permanent Teeth. J Endod 2017; 43:910-915. [DOI: 10.1016/j.joen.2017.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/17/2022]
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19
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Innes NPT, Schwendicke F. Restorative Thresholds for Carious Lesions: Systematic Review and Meta-analysis. J Dent Res 2017; 96:501-508. [PMID: 28195749 DOI: 10.1177/0022034517693605] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current evidence supports noninvasive/nonrestorative treatment of "early" carious lesions: those confined to enamel or reaching the enamel-dentin junction. The extent that dentists' thresholds for intervening restoratively have changed with this evidence is unknown. This systematic review aimed to determine dentists' and therapists' current lesion threshold for carrying our restorative interventions in adults/children and primary/permanent teeth. Embase, Medline via PubMed, and Web of Science were searched for observational studies, without language, time, or quality restrictions. Screening and data extraction were independent and in duplicate. Random-effects meta-analyses with subgroup and meta-regression analysis were performed. Thirty studies, mainly involving dentists, met the inclusion criteria. There was heterogeneity in sampling frames, methods, and scales used to investigate thresholds. The studies spanned 30 y (1983-2014), and sample representativeness and response bias issues were likely to have affected the results. Studies measured what dentists said they would do rather than actually did. Studies represented 17 countries, focusing mainly on adults ( n = 17) and permanent teeth ( n = 24). For proximal carious lesions confined to enamel (not reaching the enamel-dentin junction), 21% (95% confidence interval [CI], 15%-28%) of dentists/therapists would intervene invasively. The likelihood of a restorative intervention almost doubled (risk ratio, 1.98; 95% CI, 1.68-2.33) in high caries risk patients. For proximal lesions extending up to the enamel-dentin junction, 48% (95% CI, 40%-56%) of dentists/therapists would intervene restoratively. For occlusal lesions with enamel discoloration/cavitation but no clinical/radiographic dentin involvement, 12% (95% CI, 6%-22%) of dentists/therapists stated they would intervene, increasing to 74% (95% CI, 56%-86%) with dentin involvement. There was variance between countries but no significant temporal trend. A significant proportion of dentists/therapists said they would intervene invasively (restoratively) on carious lesions where evidence and clinical recommendations indicate less invasive therapies should be used. There is great need to understand decisions to intervene restoratively and to find implementation interventions that translate research evidence into clinical practice.
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Affiliation(s)
- N P T Innes
- 1 Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - F Schwendicke
- 2 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
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20
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Innes NPT, Frencken JE, Schwendicke F. Don't Know, Can't Do, Won't Change: Barriers to Moving Knowledge to Action in Managing the Carious Lesion. J Dent Res 2016; 95:485-6. [PMID: 27099269 DOI: 10.1177/0022034516638512] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- N P T Innes
- Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - J E Frencken
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany
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