Methods dentists use to diagnose primary caries lesions prior to restorative treatment: findings from The Dental PBRN.
OBJECTIVE
To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use.


METHODS
A total of 228 DPBRN dentists recorded information on 5676 consecutive restorations inserted due to primary caries lesions on 3751 patients. Practitioner-investigators placed a mean of 24.9 (SD=12.4) restorations. Lesions were categorised as posterior proximal, anterior proximal, posterior occlusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorised as clinical assessment, radiographs, and/or optical. Statistical analysis utilised generalised mixed-model ANOVA to account for the hierarchical structure of the data.


RESULTS
By lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p<0.0001).


CONCLUSIONS
These results - obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios - quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics.
Rindal
D Brad
DB
HealthPartners Dental Group, Minneapolis, MN, USA. Donald.B.Rindal@HealthPartners.com
Gordan
Valeria V
VV
Litaker
Mark S
MS
Bader
James D
JD
Fellows
Jeffrey L
JL
Qvist
Vibeke
V
Wallace-Dawson
Martha C
MC
Anderson
Mary L
ML
Gilbert
Gregg H
GH
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000175:diagnosis* / Q000473:pathology; D003732:Dental Caries Activity Tests; D018865:Dental Research / Q000458:organization & administration*; D005260:Female; D006124:Group Practice, Dental; D006801:Humans; D007347:Insurance, Dental; D008027:Light; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D019239:Practice Patterns, Dentists'; D011331:Private Practice; D011636:Public Health Dentistry; D011861:Radiography, Dental; D011795:Surveys and Questionnaires; D014172:Transillumination; D014481:United States; D016526:Workload