School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK.
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
BMC Oral Health. 2020 Mar 4;20(1):64. doi: 10.1186/s12903-020-1051-7.
The lack of evidence for the effective management of carious lesions in children's primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals' (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry.
Overall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis.
Participants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children.
RCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials.
由于缺乏针对儿童乳牙龋齿有效管理的证据，这给牙科专业人员和患者带来了不确定性。可能的方法包括常规和生物管理，以及最佳实践预防，以及仅最佳实践预防。FiCTION 试验评估了这些方法的有效性，其中包括一项定性研究，探讨了牙科专业人员（DPs）在提供不同治疗方案方面的经验。本文报告了 DPs 在 FiCTION 中如何管理患有龋齿的儿童，以及这与他们日常牙科实践的关系。
来自英国四个地区的 FiCTION 培训牙科手术的 31 名 DPs 参与了关于他们对三种治疗方案（龋齿常规管理和预防（C + P）、龋齿生物管理和预防（B + P）或单独预防（PA））的经验的半结构化访谈。分析采用了借鉴社会实践理论（SPT）的理论框架。
参与者讨论了对三种技术的有效性和熟悉程度的看法。C + P 方案比较熟悉，但一些参与者对传统修复的有效性提出了质疑。B + P 方案的熟悉程度存在差异，但一旦 DPs 了解了这些技术，他们就认为这些技术是有效的。预防措施虽然比较熟悉，但被描述为无效。DPs 每天都要管理患有龋齿的儿童，他们会根据以往的经验和对儿童的了解，为每个儿童提供他们认为最合适的治疗方法。随机分组破坏了这些正常的选择。一些 DPs 报告说，他们为了以特定方式治疗患者而偏离了试验方案。参与者重视循证牙科，并期望利用 FiCTION 的结果来指导未来的实践。他们预计将继续使用全套治疗方案，并根据个别儿童的情况选择合适的策略。
RCT 是在日常牙科实践的背景下进行的。DPs 运用经验和人际知识，为患者的最佳利益行事。临床试验中的随机分组可能会给 DPs 带来紧张的来源，这对未来试验中确保个人均衡性具有影响。
