To fill or not to fill: a qualitative cross-country study on dentists’ decisions in managing non-cavitated proximal caries lesions
Received: 10 October 2017
Accepted: 26 March 2018
Published: 6 April 2018
Abstract
Background
This study aimed to identify
barriers and enablers for dentists managing non-cavitated proximal
caries lesions using non- or micro-invasive (NI/MI) approaches rather
than invasive and restorative methods in New Zealand, Germany and the
USA.
Methods
Semi-structured interviews
were conducted, focusing on non-cavitated proximal caries lesions
(radiographically confined to enamel or the outer dentine). Twelve
dentists from New Zealand, 12 from Germany and 20 from the state of
Michigan (USA) were interviewed. Convenience and snowball sampling were
used for participant recruitment. A diverse sample of dentists was
recruited. Interviews were conducted by telephone, using an interview
schedule based on the Theoretical Domains Framework (TDF).
Results
The following barriers to
managing lesions non- or micro-invasively were identified: patients’
lacking adherence to oral hygiene instructions or high-caries risk,
financial pressures and a lack of reimbursement for NI/MI, unsupportive
colleagues and practice leaders, not undertaking professional
development and basing treatment on what had been learned during
training, and a sense of anticipated regret (anxiety about not restoring
a proximal lesion in its early stages before it progressed). The
following enablers were identified: the professional belief that
remineralisation can occur in early non-cavitated proximal lesions and
that these lesions can be arrested, the understanding that placing
restorations weakens the tooth and inflicts a cycle of re-restoration,
having up-to-date information and supportive colleagues and work
environments, working as part of a team of competent and skilled dental
practitioners who perform NI/MI (such as cleaning or scaling), having
the necessary resources, undertaking ongoing professional development
and continued education, maintaining membership of professional groups
and a sense of professional and personal satisfaction from working in
the patient’s best interest. Financial aspects were more commonly
mentioned by the German and American participants, while continuing
education was more of a focus for the New Zealand participants.
Conclusions
Decisions on managing
non-cavitated proximal lesions were influenced by numerous factors, some
of which could be targeted by interventions for implementing
evidence-based management strategies in practice.
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