Dentists' Treatment Decisions Concerning Restorations in Adult Patients in North Norway: A Cross-Sectional Tromsø 7 Study

Abstract

Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study.

Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40-93 years) were included. Based on FDI's clinical criteria for the evaluation of restorations - 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners' opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed.

Results: The participants' DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists.

Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty.

Keywords: Cross-sectional study; Minimal invasive dentistry; Repair; Replace; Restoration.

Fig. 1.

Population included in the study. *Edentulous patients (N = 108) have been excluded.

Fig. 2.

Number of treatment choices repair/replace based on indications for re-treatment. Percentage at the bottom of the columns are calculated from the 3,006 re-treatment suggestions (FDI evaluation criteria after Hickel et al. [18] 2010).

Fig. 3.

Suggested number of treatment actions for each of the 17 dentists. All the dentists assessed 243 patients. Dentist #2 assessed only 109 patients. There were significant differences between the dentists but no significant difference regarding dentist’s sex nor age (p < 0.05). The figure can be interpreted as a measure of the dentists’ willingness to perform operative dentistry (eagerness to operative treatment) in comparison to the other colleagues. It should be noted that the patients are randomly distributed among the dentists.

Fig. 4.

Mean DMFT per age group.

Fig. 5.

Number of assessed patients per 5 years age intervals (blue columns). Number of treatment suggestions per age group shown in orange columns (accumulated number of treatment suggestions within the respective age groups).