Agreement among dentists' restorative treatment planning thresholds for primary occlusal caries, primary proximal caries, and existing restorations: findings from The National Dental Practice-Based Research Network

Abstract

Objectives: The aim of this study was to quantify the agreement among individual National Dental Practice-Based Research Network dentists' self-reported treatment decisions for primary occlusal caries, primary proximal caries, and existing restorations.

Methods: Five hypothetical clinical scenarios were presented: primary occlusal caries; primary proximal caries; and whether three existing restorations should be repaired or replaced. We quantified the probability that dentists who recommended later restorative intervention for primary caries were the same ones who recommended that existing restorations be repaired instead of replaced.

Results: Dentists who recommended later restorative treatment of primary occlusal caries and proximal caries at a more-advanced stage were significantly more likely to recommend repair instead of replacement. Agreement among dentists on a threshold stage for the treatment of primary caries ranged from 40 to 68%, while that for repair or replacement of existing restorations was 36 to 43%.

Conclusions: Dentists who recommended repair rather than replacement of existing restorations were significantly more likely to recommend later treatment of primary caries. Conversely, dentists who recommended treatment of primary caries at an earlier stage were significantly more likely to recommend replacement of the entire restoration. Between-dentist agreement for primary caries treatment was better than between-dentist agreement for repair or replacement of existing restorations.

Clinical implications: These findings suggest consistency in how individual dentists approach the treatment of primary caries and existing restorations. However, substantial variation was found between dentists in their treatment decisions about the same teeth.

Keywords: Decision-making; Health services research; Primary caries; Restoration repair/replacement.

Fig. 1. Occlusal caries

Reprinted with permission of the Norwegian Dental Journal.

Fig. 2. Proximal caries

Reprinted with permission of the Norwegian Dental Journal.

Fig. 3. Maxillary incisor existing restoration

Reprinted with permission of Quintessence Publishing Co Inc, Chicago.

Fig. 4. Maxillary cuspid existing restoration

Reprinted with permission of Quintessence Publishing Co Inc, Berlin.

Fig. 5. Mandibular molar existing restoration

Courtesy of Dr. Ivar Mjör.