Heinikainen Mia, Vehkalahti Miira, Murtomaa Heikki
Institute of Dentistry, Department of Oral Public Health, University of Helsinki, Finland.
Int Dent J. 2002 Jun;52(3):119-24. doi: 10.1111/j.1875-595x.2002.tb00615.x.
To evaluate treatment decisions of general practitioners (GPs) and dental teachers (DTs) in cases of endodontically treated teeth and to test the hypothesis that dentists' treatment decisions are independent of their working sector and other practice characteristics.
A questionnaire based on four endodontic cases was mailed to 400 GPs and 47 DTs. The GPs were selected by stratified randomisation by gender, and main occupation (public and private sector). Others were all full-time DTs, representing clinical disciplines other than surgery and orthodontics. The endodontic cases were described in detail: one with a radiograph enclosed, three with statements on radiographic examinations. For each case, respondents chose the optimal treatment from alternatives, later reclassified as 'no therapy now' (further examination within 3-12 months), and 'active treatment' (immediate retreatment or periapical surgery).
For Case 1 (tooth 25, asymptomatic, in normal occlusion, the radiograph revealed an underfilled root canal and a crown with a post, widened periodontal ligament space around the apex but no radiolucency), active treatment was chosen more frequently by private than by public dentists (11% vs. 4%, P=0.01), but neither sector differed (P>0.05) from DTs (6%). Decisions in favour of active treatment were associated with higher share of adult patients (OR=2.8; 95%CI: 0.3, 1.0; P=0.01). Cases 2-4 showed no difference in treatment decisions by practice characteristics.
Treatment decisions by GPs and DTs were quite similar for each case and in most cases independent of the dentist's work and practice related characteristics.
评估全科医生（GPs）和牙科教师（DTs）在牙髓治疗牙齿病例中的治疗决策，并检验牙医的治疗决策与其工作部门和其他执业特征无关这一假设。
基于四个牙髓病例的问卷被邮寄给400名全科医生和47名牙科教师。通过按性别和主要职业（公共部门和私营部门）进行分层随机抽样来选择全科医生。其他人员均为全职牙科教师，代表外科和正畸以外的临床学科。详细描述了牙髓病例：一个附有X光片，三个有关于X光检查的说明。对于每个病例，受访者从备选方案中选择最佳治疗方法，随后重新分类为“现在不治疗”（在3 - 12个月内进一步检查）和“积极治疗”（立即再治疗或根尖周手术）。
对于病例1（牙齿25，无症状，咬合正常，X光片显示根管充填不足且有桩冠，根尖周围牙周膜间隙增宽但无透射区），私营部门牙医比公共部门牙医更频繁地选择积极治疗（11%对4%，P = 0.01），但两个部门与牙科教师（6%）相比均无差异（P>0.05）。支持积极治疗的决策与成年患者的较高比例相关（OR = 2.8；95%CI：0.3，1.0；P = 0.01）。病例2 - 4在治疗决策上未显示出执业特征方面的差异。
全科医生和牙科教师在每个病例中的治疗决策非常相似，并且在大多数情况下与牙医的工作和执业相关特征无关。
