Restorative Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK.
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
Int Endod J. 2021 Dec;54(12):2256-2275. doi: 10.1111/iej.13628. Epub 2021 Sep 21.
To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis.
An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤ .2 were selected for backwards likelihood ratio logistic modelling.
In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam.
Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines.
调查英国初级保健牙医在龋齿暴露后及出现不可逆性牙髓炎的附加症状和体征时，对活髓治疗（VPT）的态度和方法。
通过公共资助的（NHS）地方牙科委员会、企业牙科服务提供者、专业协会和社交媒体，公开分发电子问卷。主要针对 NHS 从业者和混合及私人从业者，以及社区和军队牙科官员和牙科治疗师。参与者被问及与几种临床情况相关的问题，使用描述性统计方法分析回答。使用 χ 检验和连续 Bonferroni 校正来探索变量，包括薪酬方法、从业者类型（牙医/治疗师）、研究生资格、毕业地点和获得资格后的年限。选择具有相关性 p≤.2 的变量进行向后似然比逻辑回归建模。
共有 648 名初级保健从业者被纳入分析。在直接牙髓盖髓术中，氢氧化钙（CH）的使用最为频繁（398/600；66.3%），硅酸钙水泥（CSC）的使用频率较低（119/600；19.8%）。222/599 名（37.1%）从业者使用橡皮障。对于有不可逆性牙髓炎症状的牙齿，有 65/613 名（10.6%）牙医选择了明确的活髓切除术进行治疗。提供明确活髓切除术的主要障碍是缺乏培训（602/612；98.4%）。回归分析表明，NHS 从业者是使用 CH 进行 DPC、紧急预约时间较短、有限的放大倍数和不使用橡皮障的良好预测因子。非英国毕业的从业者更有可能选择 CSC，适当地控制牙髓出血，进行适当的术后评估，并使用橡皮障。
从业者在材料选择、无菌和病例选择等方面偏离了循证指南。在初级保健中提供可预测的 VPT 还存在其他一些挑战，包括缺乏时间和获得放大倍数的机会。在 NHS 实践中，这些问题最为明显，可能会加剧现有的社会健康不平等。在英国本科课程中可能存在不一致的地方，因为没有证据表明从业年限与所采用的技术之间存在关联，而且非英国毕业的从业者和有研究生学历的牙医更遵循循证 VPT 指南。
