Kakudate N, Sumida F, Matsumoto Y, Yokoyama Y, Gilbert G H, Gordan V V
Oper Dent. 2014 Sep-Oct;39(5):473-80. doi: 10.2341/13-141-C. Epub 2014 May 8.
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.
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.
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.
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).
本研究旨在1）量化牙医对咬合面原发性龋病的治疗阈值；2）确定患者年龄是否会影响牙医对这些龋损进行手术治疗的决策；3）检验患者、牙医和诊所特征与牙釉质手术干预显著相关的假设。
本研究采用横断面设计，在日本进行问卷调查。本研究对隶属于日本基于牙科实践的研究网络（JDPBRN）的门诊牙科诊所工作的牙医进行了调查，该网络旨在让牙医研究问题并分享经验和专业知识（n = 282）。参与者被问及是否会对一系列描述咬合面龋病的病例进行手术干预。每个病例都包括一张显示典型龋病渗透特征的咬合面照片，以及对高龋病风险的成年和儿童患者的书面描述。
在内层牙釉质龋损的病例中，表明会进行手术干预的牙医比例在成年患者中（48%）显著高于儿童患者（34%；p<0.01）。逻辑回归分析表明，使用牙科探针诊断原发性咬合面龋病、诊所类型、诊所繁忙程度以及自费患者的比例与牙医对内层牙釉质龋损进行手术干预的决策显著相关。
这些发现表明，超过三分之一的参与者选择对内层牙釉质龋损进行手术干预，并且患者年龄会影响牙医关于何时进行手术干预的决策（clinicaltrials.gov注册号NCT01680848）。
