EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.

Caries risk assessment in dental practices by dentists from a Brazilian community

Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State - Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

METHODS FOR CARIES PREVENTION IN ADULTS AMONG DENTISTS FROM A BRAZILIAN COMMUNITY: Adult' caries prevention among Brazilian dentists

Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists.

OBJECTIVE

To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community.

METHODS

Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05).

RESULTS

In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents.

CONCLUSION

Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.

New methodology to evaluate bond strength of root-end filling materials

This study evaluated the bond strength of root-end filling materials to root-end cavities using a new methodology. Twenty maxillary central incisors were subjected to biomechanical preparation (#80 hand file) and sectioned transversally 2 mm short of the apex and 4 mm coronally to this point. The root cylinders were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. Two groups (n=10) were formed according to the root-end filling material: MTA and Super EBA. A gutta-percha cone (#80) was tug-backed at the limit between the canal and the root-end cavity. The cavity was filled and the gutta-percha cone was removed after complete setting of the sealer. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and run at a crosshead speed of 1.0 mm/min for pushing out the root-end filling material. Data were analyzed by ANOVA (α=5%). Super EBA (6.03±1.31) presented higher bond strength (MPa) than MTA (1.81±0.45) (p>0.05). There was a predominance of cohesive failures for Super EBA and mixed for MTA. The protocol of specimen preparation is effective and introduces a specific methodology for assessing bond strength of root-end filling materials to dentin. Among the materials, Super EBA presented the highest bond strength.