School of Dentistry, School of Public Health, Faculty of Health Sciences,Aarhus University, Bartholins Alle 2, Aarhus, Denmark.
Acta Odontol Scand. 2010 Mar;68(2):65-79. doi: 10.3109/00016350903530786.
This aim of this paper is to spur a discussion of the direction of caries-lesion detection activities in clinical dental practice. It is argued that since the dental clinician's caries-related decision making is a script-matching enterprise in which clinical decisions are made on the basis of 'this-lesion-needs-this-kind-of-treatment' reasoning, the methods and strategies employed for caries lesion detection should accommodate this fact. This may be done by employing a clinical visual-tactile method for caries lesion detection that evaluates the two aspects that are crucial for appropriate caries management: lesion activity and surface integrity. The use of diagnostic methods that do not assess these features directly but involve assumptions about activity status and surface integrity should be avoided. This includes the use of bite-wing radiography for the detection of approximal caries lesions, as it may be shown that plain reliance on radiographs leads to considerable overtreatment. If clinical dentistry is to retain its status as a profession committed to doing good, changes in diagnostic practices along these lines are warranted.
本文旨在探讨临床牙科中龋病损检测活动的方向。有人认为，由于牙科临床医生的龋病相关决策是一种脚本匹配的过程，即临床决策是基于“这个病变需要这种治疗”的推理做出的，因此用于龋病损检测的方法和策略应该适应这一事实。这可以通过采用临床视觉触觉方法来检测龋病损，该方法评估了对龋病管理至关重要的两个方面：病变活性和表面完整性。应避免使用不直接评估这些特征但涉及对活动状态和表面完整性的假设的诊断方法。这包括使用咬翼片放射摄影来检测邻面龋病损，因为已经表明，单纯依赖放射摄影会导致大量过度治疗。如果临床牙科要保持其作为致力于做好事的专业的地位，那么沿着这些方向改变诊断实践是有必要的。
