title: Sealants and dental caries: insight into dentists' behaviors regarding implementation of clinical practice recommendations.
abstract: BACKGROUND
  The authors conducted a qualitative study of private-practice dentists in their offices by using vignette-based interviews to assess barriers to the use of evidence-based clinical recommendations in the treatment of noncavitated carious lesions.
  
  
  METHODS
  The authors recruited 22 dentists as a convenience sample and presented them with two patient vignettes involving noncavitated carious lesions. Interviewers asked participants to articulate their thought processes as they described treatment recommendations. Participants compared their treatment plans with the American Dental Association's recommendations for sealing noncavitated carious lesions, and they described barriers to implementing these recommendations in their practices. The authors recorded and transcribed the sessions for accuracy and themes.
  
  
  RESULTS
  Personal clinical experience emerged as the determining factor in dentists' treatment decisions regarding noncavitated carious lesions. Additional factors were lack of reimbursement and mistrust of the recommendations. The authors found that knowledge of the recommendations did not lead to their adoption when the recommendation was incongruent with the dentist's personal experience.
  
  
  CONCLUSIONS
  The authors found that ingrained practice behavior based on personal clinical experience that differed substantially from evidence-based recommendations resulted in a rejection of these recommendations.
  
  
  CONCLUSIONS
  Attempts to improve the adoption of evidence-based practice must involve more than simple dissemination of information to achieve a balance between personal clinical experience and scientific evidence.
authors.affiliation: School of Dental Medicine, University of Pittsburgh, 440 Salk Hall, 3501 Terrace St., Pittsburgh, PA 15261, USA. jao4@pitt.edu
authors.forename: Jean A
authors.initials: JA
authors.lastname: O'Donnell
authors.forename: Adriana
authors.initials: A
authors.lastname: Modesto
authors.forename: Marnie
authors.initials: M
authors.lastname: Oakley
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Polk
authors.forename: Benita
authors.initials: B
authors.lastname: Valappil
authors.forename: Heiko
authors.initials: H
authors.lastname: Spallek
mesh_terms: D000328:Adult; D000368:Aged; D000571:American Dental Association; D001291:Attitude of Health Personnel; D003657:Decision Making; D003731:Dental Caries / Q000473:pathology / Q000517:prevention & control*; D003743:Dental Enamel / Q000473:pathology; D003793:Dental Restoration, Permanent / Q000379:methods; D003815:Dentists / Q000523:psychology*; D055094:Evidence-Based Dentistry; D005260:Female; D006124:Group Practice, Dental; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010895:Pit and Fissure Sealants / Q000191:economics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D019239:Practice Patterns, Dentists'; D011331:Private Practice; D012051:Reimbursement Mechanisms; D014481:United States
chemical_list: D010895:Pit and Fissure Sealants
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