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Kakudate N, Yokoyama Y, da Silva Tagliaferro EP, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil. Oper Dent 2024; 49:127-135. [PMID: 38196080 PMCID: PMC10984213 DOI: 10.2341/23-074-c] [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] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries. METHODS We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions. RESULTS Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05). CONCLUSIONS Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.
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Affiliation(s)
- Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Elaine Pereira da Silva Tagliaferro
- Professor, Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V Gordan
- Professor and Interim Associate Dean for Research, 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
- Distinguished Professor, James R. Rosen Endowed Chair of Dental Research, & Chair, 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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Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians. Oper Dent 2023; 48:137-145. [PMID: 36745521 PMCID: PMC10792988 DOI: 10.2341/22-012-c] [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] [Accepted: 06/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics. METHODS We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists. RESULTS Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group. CONCLUSIONS In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.
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Affiliation(s)
- Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
- Visiting Professor, University of Florida College of Dentistry, Gainesville, FL, USA P.O. Box 100415, Gainesville, FL 32610-0415, USA
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V. Gordan
- Professor and Interim Associate Dean for Research, 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
- Distinguished Professor & Chair, 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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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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Evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2020; 102:103469. [PMID: 32916232 DOI: 10.1016/j.jdent.2020.103469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to 1) quantify the evidence-practice gap (EPG) between dental clinical practice and published evidence on Minimal Intervention Dentistry (MID) among dentists in Japan; and 2) examine the hypothesis that dentist characteristics have a significant association with the EPG. METHODS We conducted a cross-sectional study via use of a web-based questionnaire survey of dentists who were affiliated with the Dental Practice-based Research Network Japan (n = 297). To quantify the EPG on MID, we used a questionnaire that included 10 clinical questions or scenarios to assess concordance between dental practice and published evidence on MID. We evaluated concordance by coding responses to each question as consistent or inconsistent with the evidence. An overall concordance was then determined as percent of responses that were consistent with published evidence for 10 questions. Subsequently, multiple logistic regression analysis was conducted to examine the associations between dentist characteristics and higher overall concordance (≥median) with published evidence. RESULTS Mean and median overall dentist-level concordance were both 60 % (SD: 18, interquartile range: 50-75 %). Logistic regression analysis showed that "gender of dentist", "city population", and "frequency of obtaining evidence from the scientific journal articles in English" were significantly associated with high concordance, with odds ratios (95 % CIs) of 2.33 (1.01-5.39), 2.01 (1.02-3.96), and 2.45 (1.08-5.59), respectively. CONCLUSIONS Japanese dentists demonstrated medium concordance with published evidence, indicating that an EPG on MID exists in Japanese dental clinical practices. Dentist-specific characteristics had significant associations with high concordance with published evidence. CLINICAL SIGNIFICANCE Despite the establishment and dissemination of the concept of MID, the EPG on MID exists in Japanese dental clinical practices. A high concordance was significantly associated with the following dentist characteristics: "female dentist", "dental clinic location in a government-ordinance-designated city", and "frequently obtaining evidence from the English-language scientific journal articles".
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