填补还是不填补：一项关于牙医在处理非龋性近中面龋损时决策的跨国定性研究。
To fill or not to fill: a qualitative cross-country study on dentists' decisions in managing non-cavitated proximal caries lesions.
机构信息
Department for Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
出版信息
Implement Sci. 2018 Apr 6;13(1):54. doi: 10.1186/s13012-018-0744-7.
BACKGROUND
This study aimed to identify barriers and enablers for dentists managing non-cavitated proximal caries lesions using non- or micro-invasive (NI/MI) approaches rather than invasive and restorative methods in New Zealand, Germany and the USA.
METHODS
Semi-structured interviews were conducted, focusing on non-cavitated proximal caries lesions (radiographically confined to enamel or the outer dentine). Twelve dentists from New Zealand, 12 from Germany and 20 from the state of Michigan (USA) were interviewed. Convenience and snowball sampling were used for participant recruitment. A diverse sample of dentists was recruited. Interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework (TDF).
RESULTS
The following barriers to managing lesions non- or micro-invasively were identified: patients' lacking adherence to oral hygiene instructions or high-caries risk, financial pressures and a lack of reimbursement for NI/MI, unsupportive colleagues and practice leaders, not undertaking professional development and basing treatment on what had been learned during training, and a sense of anticipated regret (anxiety about not restoring a proximal lesion in its early stages before it progressed). The following enablers were identified: the professional belief that remineralisation can occur in early non-cavitated proximal lesions and that these lesions can be arrested, the understanding that placing restorations weakens the tooth and inflicts a cycle of re-restoration, having up-to-date information and supportive colleagues and work environments, working as part of a team of competent and skilled dental practitioners who perform NI/MI (such as cleaning or scaling), having the necessary resources, undertaking ongoing professional development and continued education, maintaining membership of professional groups and a sense of professional and personal satisfaction from working in the patient's best interest. Financial aspects were more commonly mentioned by the German and American participants, while continuing education was more of a focus for the New Zealand participants.
CONCLUSIONS
Decisions on managing non-cavitated proximal lesions were influenced by numerous factors, some of which could be targeted by interventions for implementing evidence-based management strategies in practice.
背景
本研究旨在确定新西兰、德国和美国的牙医在管理非龋性近中面龋损时，使用非侵入性或微侵入性（NI/MI）方法而非侵入性和修复性方法的障碍和促进因素。
方法
进行了半结构化访谈，重点关注非龋性近中面龋损（影像学局限于牙釉质或外牙本质）。从新西兰招募了 12 名牙医，从德国招募了 12 名牙医，从密歇根州（美国）招募了 20 名牙医。采用便利抽样和滚雪球抽样招募参与者。招募了不同类型的牙医。通过电话进行访谈，使用基于理论领域框架（TDF）的访谈大纲。
结果
确定了非或微侵入性管理病变的以下障碍：患者不遵守口腔卫生指导或高龋风险、财务压力和缺乏对 NI/MI 的报销、不支持的同事和实践领导者、不进行专业发展以及根据培训期间所学内容进行治疗，以及对预期后悔的担忧（在近中面病变早期没有进展之前，没有对其进行修复，感到焦虑）。确定了以下促进因素：专业信念，即再矿化可以发生在早期非龋性近中面病变中，并且这些病变可以被阻止，理解放置修复体削弱了牙齿并引发了再修复的循环，拥有最新的信息和支持性的同事和工作环境，作为由执行 NI/MI（如清洁或刮治）的有能力和熟练的牙科从业者组成的团队的一部分工作，拥有必要的资源，进行持续的专业发展和继续教育，保持专业团体的成员资格，并从为患者的最佳利益而工作中获得专业和个人满足感。德国和美国参与者更常提到财务方面，而新西兰参与者更关注继续教育。
结论
管理非龋性近中面病变的决策受到许多因素的影响，其中一些因素可以通过干预措施来针对实施基于证据的管理策略。
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