Doméjean-Orliaguet S, Léger S, Auclair C, Gerbaud L, Tubert-Jeannin S
CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, Clermont-Ferrand, France.
J Dent. 2009 Nov;37(11):827-34. doi: 10.1016/j.jdent.2009.06.012. Epub 2009 Jun 27.
Little is known about how dentists implement caries management and provide restorative dental services in everyday practice. This study explored whether or not recent concepts in caries management were implemented in practice by private practitioners. The influence of patient and practitioner characteristics on the provision of restorative dental services was also investigated through multidimensional analyses.
A sample of French general private dental practitioners was asked to record the characteristics of 35 preventive or restorative treatments made on vital permanent teeth. The data collection form was designed to explore dentists' attitudes towards caries management and their use of minimally invasive therapies.
Twenty-six practitioners recorded the characteristics of 921 treatments performed on 457 patients. Results indicate that participants rarely performed non-invasive treatments. They used an inappropriate detection tool, as most of decisions to treat were based on visual inspection frequently associated with probing. Multidimensional analysis showed that dentists provided different restorative treatments depending on patient characteristics, with minimally invasive, esthetic restorations preferentially performed for healthy, young and well-insured patients. Restorative treatments and detection tools also varied markedly among practitioners. These variations in service patterns were not related to a specific patient profile in each dental practice.
Results indicate that recent concepts in caries management have not yet been adopted in everyday practice. Patient and dentist characteristics influence the provision of restorative dental services. Decision-making in caries management not only depends on pathophysiology but also seems to be influenced by many other factors.
对于牙医在日常实践中如何实施龋病管理以及提供牙齿修复服务，我们了解甚少。本研究探讨了私人执业牙医在实践中是否采用了最新的龋病管理理念。还通过多维度分析研究了患者和执业者特征对牙齿修复服务提供的影响。
选取了一组法国普通私人执业牙医，要求他们记录对恒牙进行的35项预防性或修复性治疗的特征。数据收集表旨在探究牙医对龋病管理的态度及其对微创治疗的使用情况。
26名执业者记录了对457名患者进行的921项治疗的特征。结果表明，参与者很少进行非侵入性治疗。他们使用了不恰当的检测工具，因为大多数治疗决策是基于经常与探查相结合的目视检查。多维度分析表明，牙医根据患者特征提供不同的修复治疗，对于健康、年轻且参保良好的患者，优先进行微创、美观的修复。修复治疗和检测工具在执业者之间也有显著差异。这些服务模式的差异与每个牙科诊所的特定患者概况无关。
结果表明，最新的龋病管理理念尚未在日常实践中得到采用。患者和牙医的特征会影响牙齿修复服务的提供。龋病管理中的决策不仅取决于病理生理学，似乎还受到许多其他因素的影响。
