Abstract
Background
With an increase in knowledge and understanding and alongside the development of materials, there has been a fundamental change in the management of dental caries. Contemporary management is governed by minimal intervention principles. The application of these principles corresponds to personalised care focused on prevention, non-invasive and micro-invasive strategies to remineralise or limit progression of early lesions and where cavitation has occurred, the provision of conservative restorative treatment.
However, the translation of minimal intervention principles into clinical practice has been limited. This has been demonstrated in previous studies by the investigation of restorative treatment thresholds - the stage of progression of a carious lesion at which a practitioner would intervene operatively. Restorative treatment thresholds have been associated with a number of practitioner and practice factors. Previous studies have focused predominantly on restorative treatment thresholds held by dentists in the management of permanent teeth in adult patients. There is little known about restorative treatment thresholds in the management of primary teeth and in the provision of care for children and adolescents.
Aim
The study aims were:
1. To examine restorative treatment decisions made by New Zealand Oral Health Practitioners in their management of dental caries affecting children and adolescents.
2. To investigate what demographic characteristics are associated with restorative treatment decisions made by New Zealand Oral Health Practitioners in their management of dental caries affecting children and adolescents.
Methods
Two sampling frames were used to identify Oral Health Practitioners registered in: Dental Therapy Practice; General Dental Practice and Paediatric, Public Health and Special Needs Dentistry. A questionnaire was distributed to 2844 practitioners using REDCap software. The questionnaire initially collected practitioner and practice demographics for each participant. Subsequent sections asked participants to select proximal and occlusal lesions for which they would recommend restorative treatment in the management of primary and permanent teeth. They also selected the preparation technique and restorative material they would use to manage the lesion they had opted to restore.
Results
A total of 638 participants responded (22.4%). Participants who had not completed any of the clinical components of the questionnaire were excluded. The sample comprised 108 dental and oral health therapists (18.7%), 434 general dental practitioners (75.1%) and 36 specialists (6.2%). The sample represented the New Zealand oral health workforce well over a range of demographic characteristics.
In the management of proximal caries in primary teeth, 17.3% of the sample selected to restore a lesion within enamel. 15.6% of the sample would restore a lesion within enamel in a permanent tooth. The majority of participants selected to restore a lesion at the outer third of dentine in primary (50.3%) and permanent teeth (47.6%). Participants most frequently selected to restore proximal lesions with a slot preparation and resin composite as a restorative material. However, there was considerable variability in the materials selected for the management of primary teeth.
In the management of occlusal lesions, 21.8% of the sample selected to restore a lesion that did not involve dentine in the management of primary teeth. This increased to 37.3% in the management of permanent teeth. The majority of participants selected to restore an occlusal lesion described clinically as an underlying dark shadow from dentine and radiographically as having a carious lesion in the outer third of dentine. In preparing a cavity to treat an occlusal lesion, 5% of the sample selected to open the whole fissure system in the management of a primary tooth. This increased to 9.6% in the management of permanent teeth. Conventional glass ionomer cement was the restorative material most commonly selected to restore occlusal lesions in primary teeth. In the management of occlusal lesions in permanent teeth, composite was selected by 64.3% of the sample. The selection of non-invasive and micro-invasive strategies to manage a questionable carious surface of a primary second molar was varied among groups.
Restorative treatment decisions demonstrated statistically significant associations with a number of practitioner and practice characteristics. A variation in judgement and a variation in perception are likely to contribute to the decisions made by the sample.
Conclusion
New Zealand Oral Health Practitioners appear to intervene early in the caries continuum when managing children and adolescents. Further regression analysis is required to eliminate confounding within the variables examined. Future research should focus on gaining a greater understanding of factors that influence restorative treatment decisions made by practitioners and the barriers they face in instituting caries management strategies based on minimal intervention principles.