Patient age and dentists' decisions about occlusal caries treatment thresholds

Abstract

Objectives: This study was performed to 1) quantify dentists' treatment thresholds for occlusal primary caries; 2) determine if the patient's age affects dentists' decisions to surgically treat these carious lesions; and 3) test the hypothesis that patients', dentists', and practices' characteristics are significantly associated with surgical enamel intervention.

Methods: The study used a cross-sectional design consisting of a questionnaire survey in Japan. This study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which aims to allow dentists to investigate research questions and share experiences and expertise (n=282). Participants were asked whether they would surgically intervene in a series of cases depicting occlusal caries. Each case included a photograph of an occlusal surface displaying typical characteristics of caries penetration and written descriptions of adult and pediatric patients at high caries risk.

Results: In a case of a carious lesion within inner enamel, the proportion of dentists who indicated surgical intervention was significantly higher in adult patients (48%) when compared with pediatric patients (34%; p<0.01). Logistic regression analysis showed that using a dental explorer for the diagnosis of primary occlusal caries, type of practice, practice busyness, and percentage of patients who self-pay were significantly associated with dentists' decisions to intervene surgically into the inner enamel carious lesion.

Conclusions: These findings demonstrate that more than one-third of participants chose to intervene surgically into inner enamel carious lesions, and patients' age affects dentists' decisions about when to intervene surgically (clinicaltrials.gov registration number NCT01680848).

Figure 1

Level of lesion severity/depth for occlusal lesion Questions 1 and 2: For each question, circle the letters which correspond to the treatment codes you would recommend for each of the four cases. You may circle more than one treatment code per case. 1. Suppose the patient is a 30 year old female with no relevant medical history. She has no complaints and is in your office today for a routine visit. She has been attending your practice on a regular basis for the past 6 years, and has 12 teeth with existing dental restorations, heavy plaque and calculus, multiple Class V white spot lesions, and is missing five teeth. 2. Suppose the patient is a 12-year old child with no relevant medical history. The patient is in your office today for the first time for a routine visit. She has 5 restorations and moderate plaque. A rubber dam cannot be used. Treatment codes: a. No treatment today, follow the patient regularly, b. In-office fluoride, c. Recommend non-prescription fluoride, d. Prescription for fluoride, e. Use sealant or unfilled resin over tooth, f. Chlorhexidine treatment, g. Minimal drilling and sealant, h. Minimal drilling and preventive resin restoration, i. Air abrasion and a sealant, j. Air abrasion and preventive resin restoration, k. Amalgam restoration, l. Composite restoration, m. Indirect restoration