el-Mowafy O M, Lewis D W
Faculty of Dentistry, University of Toronto.
J Can Dent Assoc. 1994 Apr;60(4):305-10, 313-6.
One-half of the dentists in general practice in Ontario were randomly selected for a survey in June 1992 to determine their practices and decision-making regarding some aspects of restorative dentistry. Using patient scenarios to describe clinical situations, respondents stated the threshold at which a restoration should be placed in various tooth surfaces of persons of different ages, according to the severity of the carious lesion and the usual restorative procedure for different case situations. A total of 1,276 (52 per cent) dentists responded to a detailed mail questionnaire. Data were entered into a personal computer (PC) and analyzed using frequencies and chi-square with the SPSS/PC+ statistical package. Multivariate analyses were undertaken to examine what characteristics of dentists independently explained variations in their usual restorative procedures for approximal and occlusal caries. With approximal lesions, as seen on bitewing radiographs, 60 per cent of the dentists indicated that they would place a restoration in a 12 year old with an enamel lesion that had not reached the dentino-enamel junction, whereas with 30- and 55-year-old patients, 28 and 20 per cent, respectively, would do so. At each patient age, there was a tendency for significantly younger dentists to restore enamel-only lesions more often than other dentists (p < .01). Variations in proposed treatment for an adult patient with above average oral hygiene, but with a small (1-1.5 mm diameter) occlusal cavity that had penetrated through the dentino-enamel junction, were also observed. In this case, 23 per cent of the dentists would prepare a conventional cavity extending to include all fissures, and restore the tooth with amalgam or composite; 45 per cent would prepare a cavity just larger than the outline of the lesion and restore it in the same way; 32 per cent would prepare a small cavity and place a preventive resin restoration. Significant differences in cavity design were also observed between graduates of the University of Toronto and the University of Western Ontario with respect to restoring approximal carious lesions. A number of the dentists' characteristics were significantly associated (p < .01) with these variations in procedures. These included the dentists' gender, year and university education and type of practice. The documentation and explanation of these large variations in restorative practices have important implications for continuing dental education.
1992年6月，安大略省一半的普通牙科医生被随机挑选出来参与一项调查，以确定他们在修复牙科某些方面的执业情况和决策方式。通过患者病例来描述临床情况，受访者根据龋损的严重程度以及不同病例情况的常规修复程序，指出了在不同年龄人群的各种牙面上应进行修复的阈值。共有1276名（52%）牙医回复了一份详细的邮寄问卷。数据被录入个人电脑（PC），并使用频率和卡方检验，借助SPSS/PC+统计软件包进行分析。进行多变量分析以检验牙医的哪些特征能独立解释他们在邻面龋和咬合面龋常规修复程序上的差异。对于咬翼片上显示的邻面龋损，60%的牙医表示，他们会给一名12岁患有尚未累及牙本质 - 釉质交界的釉质龋损的患者进行修复，而对于30岁和55岁的患者，这一比例分别为28%和20%。在每个患者年龄组中，明显更年轻的牙医比其他牙医更倾向于对仅为釉质龋损的情况进行修复（p < 0.01）。对于一名口腔卫生状况高于平均水平，但有一个直径较小（1 - 1.5毫米）且已穿透牙本质 - 釉质交界的咬合面龋洞的成年患者，在提议的治疗方式上也存在差异。在这种情况下，23%的牙医会制备一个延伸至包括所有裂隙的常规龋洞，并用汞合金或复合树脂进行修复；45%的牙医会制备一个仅比龋损轮廓稍大的龋洞并以同样方式修复；32%的牙医会制备一个小龋洞并进行预防性树脂修复。在修复邻面龋损方面，多伦多大学和西安大略大学的毕业生在龋洞设计上也存在显著差异。许多牙医的特征与这些修复程序的差异显著相关（p < 0.01）。这些特征包括牙医的性别、毕业年份、大学教育背景和执业类型。对这些修复实践中巨大差异的记录和解释对继续牙科教育具有重要意义。
