Department of General Dental Practice, Kuwait University, Kuwait.
Department of Developmental and Preventive Sciences, Kuwait University, Kuwait.
Int Dent J. 2023 Apr;73(2):251-258. doi: 10.1016/j.identj.2022.06.024. Epub 2022 Jul 25.
There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children.
Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations.
For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001).
For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.
有关牙医和患者因素在龋齿管理决策过程中的作用的研究甚少。本体外研究探讨了与牙医和患者相关的因素对儿童磨牙面非龋性窝沟病变管理决策的影响。
5 名分别从事口腔公共卫生（DPH）、儿科、修复和口腔外科专业以及一名普通牙医（GDP）的调查员参与了本研究。首先，调查员被要求独立评估 175 颗非龋性恒牙的咬合面，并使用 2 名龋齿风险患者的情况选择管理建议。1 个月后，调查员接受了培训并校准了使用国际龋齿检测和评估系统（ICDAS）评分系统。然后，他们检查了相同的牙齿，记录了最高/最差 ICDAS 评分，并选择了管理建议。2 周后，调查员使用放大镜再次检查牙齿，并再次选择管理建议。对牙齿进行切片以研究龋齿的存在与管理建议之间的关系。
对于低和高龋齿风险情况，ICDAS 培训使 GDP 和儿科牙医的手术干预分别增加了 20%至 27%和 14%至 22%（P <.0001）。对于低龋齿风险情况，使用放大镜使 DPH、GDP 和口腔外科牙医的手术建议增加了 5%至 23%（P <.05）。与低龋齿风险情况相比，高龋齿风险患者的牙齿在 GDP 和儿科牙医和口腔外科牙医的所有检查条件下接受了更多的手术干预（9%至 30%）（P <.0001）。
对于磨牙面非龋性窝沟病变，提高牙医的龋齿检测技能对手术干预决策有重大影响。这也影响了针对不同龋齿风险群体推荐的治疗的适当性。
