J Am Dent Assoc. 2019 Sep;150(9):755-765. doi: 10.1016/j.adaj.2019.03.024. Epub 2019 Jul 16.
The authors explore Iowa dentists' agreement with the International Caries Classification and Management System (ICCMS) in the nonsurgical management of initial carious lesions in patients at low, moderate, and high caries risk and identify factors related to their agreement.
Electronic surveys were mailed to 916 actively practicing dentists who are alumni of the College of Dentistry at The University of Iowa. Questions included clinical scenarios that used text, clinical photographs, and radiographic images of initial carious lesions. Dentists were asked what type of treatment they would recommend. Treatment options included no treatment, nonsurgical treatment, or surgical treatment. Logistic regression analyses were used to assess associations among agreement with ICCMS, characteristics of the dentist's practice, and patients' caries risk level.
A total of 138 Iowa dentists responded to the survey. Agreement with ICCMS regarding nonsurgical management of initial carious lesions for patients at low, moderate, and high risk levels were 73%, 59%, and 51% respectively. Compared with their counterparts, dentists who agreed with the recommendations for nonsurgical treatment were more likely to dry the teeth during caries detection (95% confidence interval [CI], 1.02 to 12.67, P = .0468), use magnification (95% CI, 1.16 to 7.17, P = .0225) for caries detection, have graduated less than 20 years ago (P = .0024), practice in public health settings (P = .0089), and perform a caries risk assessment (95% CI, 1.10 to 4.29, P = .0262).
Dentists who dry teeth, use magnification for caries detection, graduated in the past 20 years, practice in a public health setting, and perform a caries risk assessment were significantly more likely to make decisions that were consistent with the guidelines of the ICCMS.
Knowledge of evidence-based options personalized for a patient's risk status is essential for applying the best management of initial caries lesions.
作者探讨了爱荷华州牙医在非手术治疗低、中、高龋风险患者的初始龋损方面对国际龋分类和管理系统（ICCMS）的认同，并确定了与其认同相关的因素。
向 916 名爱荷华大学牙科学院的在职牙医校友发送了电子调查。问题包括使用初始龋损的文本、临床照片和放射图像的临床场景。牙医被要求推荐哪种治疗方法。治疗方案包括不治疗、非手术治疗或手术治疗。使用逻辑回归分析评估了与 ICCMS 的一致性、牙医实践特征和患者龋病风险水平之间的关联。
共有 138 名爱荷华州牙医对调查做出了回应。在低、中、高风险水平下，牙医对初始龋损非手术治疗的 ICCMS 认同率分别为 73%、59%和 51%。与对照组相比，认同非手术治疗建议的牙医更有可能在龋病检测时干燥牙齿（95%置信区间[CI]，1.02 至 12.67，P=.0468），使用放大设备（95%CI，1.16 至 7.17，P=.0225）进行龋病检测，毕业时间不到 20 年（P=.0024），在公共卫生机构执业（P=.0089），并进行龋病风险评估（95%CI，1.10 至 4.29，P=.0262）。
干燥牙齿、使用放大设备进行龋病检测、毕业于过去 20 年、在公共卫生机构执业、进行龋病风险评估的牙医更有可能做出与 ICCMS 指南一致的决策。
了解针对患者风险状况个性化的循证选择对于应用初始龋病病变的最佳管理至关重要。
