Evidence-practice gap in treatment recommendations for proximal caries among Brazilian dentists

TAGLIAFERRO, Elaine Pereira da Silva; RILEY III, Joseph L.; GILBERT, Gregg H.; SILVA, Silvio Rocha Correa da; ROSELL, Fernanda Lopez; VALSECKI JUNIOR, Aylton; GORDAN, Valeria Veiga

doi:10.1590/1981-86372023002920220099

Elaine Pereira da Silva TAGLIAFERRO Correspondence to: EPS Tagliaferro. E-mail: elaine.tagliaferro@unesp.br.

conceptualization (equal)

data curation (lead)

funding acquisition (equal)

methodology (equal)

project administration (equal)

supervision (equal)

writing - original draft (lead)

writing - review & editing (equal)

Universidade Estadual Paulista - UNESP, Faculdade de Odontologia, Departamento de Odontologia Social. Rua Humaitá, 1680, Centro, 14801-903, Araraquara, SP, Brasil.

http://orcid.org/0000-0001-6225-6915

Joseph L. RILEY III

conceptualization (equal)

formal analysis (equal)

methodology (equal)

writing - original draft (equal)

writing - review & editing (equal)

University of Florida, College of Dentistry. Gainesville, FL, EUA.

http://orcid.org/0000-0003-1815-975X

Gregg H. GILBERT

conceptualization (equal)

methodology (equal)

writing - original draft (equal)

writing - review & editing (equal)

University of Alabama at Birmingham, School of Dentistry, Department of Clinical & Community Sciences. Birmingham, AL, EUA.

http://orcid.org/0000-0003-2017-625X

Silvio Rocha Correa da SILVA

conceptualization (equal)

writing - original draft (equal)

writing - review & editing (equal)

Universidade Estadual Paulista - UNESP, Faculdade de Odontologia, Departamento de Odontologia Social. Rua Humaitá, 1680, Centro, 14801-903, Araraquara, SP, Brasil.

http://orcid.org/0000-0002-0227-8896

Fernanda Lopez ROSELL

conceptualization (equal)

writing - original draft (equal)

writing - review & editing (equal)

Universidade Estadual Paulista - UNESP, Faculdade de Odontologia, Departamento de Odontologia Social. Rua Humaitá, 1680, Centro, 14801-903, Araraquara, SP, Brasil.

http://orcid.org/0000-0002-6270-9168

Aylton VALSECKI JUNIOR

conceptualization (equal)

writing - original draft (equal)

writing - review & editing (equal)

Universidade Estadual Paulista - UNESP, Faculdade de Odontologia, Departamento de Odontologia Social. Rua Humaitá, 1680, Centro, 14801-903, Araraquara, SP, Brasil.

http://orcid.org/0000-0002-1776-0925

Valeria Veiga GORDAN

conceptualization (equal)

methodology (equal)

writing - original draft (equal)

writing - review & editing (equal)

University of Florida, College of Dentistry. Gainesville, FL, EUA.

http://orcid.org/0000-0003-0381-5996

Correspondence to: EPS Tagliaferro. E-mail: elaine.tagliaferro@unesp.br.

Assistant editor: Luciana Butini Oliveira

Level 1 (E1)	Level 2 (E2)	Level 3 (D1)	Level 4 (D2)	Level 5 (D3)
Low-risk patient scenario. The patient is a 30-year old female with no relevant medical history. She has no complaints and is in your office today for a routine visit. She has been attending your practice on a regular basis for the past six years.
5% (n=10)	30% (n=64)	54% (n=115)	10% (n=21)	1% (n=3)
High-risk patient scenario. The patient has 12 teeth with existing dental restorations, heavy plaque, and calculus, multiple Class V white spot lesions, and is not missing any teeth.
16% (n=35)	55% (n=117)	27% (n=57)	2% (n=4)	<1% (n=1)

Level of intervention		E1	E2	D1	D2/3	Significance
Gender of the dentist
	Male (83)	7%	30%	48%	15%	.269^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Female (130)	3%	30%	58%	9%
Type of dental school graduation
	Public (163)	2%	30%	56%	14%	.045^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Private (50)	12%	28%	48%	12%
Post-graduate degree
	Yes (53)	0%	23%	60%	17%	.047^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (160)	6%	33%	52%	9%
Years since dental school graduation? (missing = 1)
	1-10 (60)	3%	33%	50%	13%	.366^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	11-20 (50)	4%	26%	58%	12%
	21-30 (63)	5%	24%	62%	10%
	31 or greater (39)	8%	41%	41%	10%
Practice model type^C
	Private practice exclusively (119)	7%	31%	52%	10%	.504^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Public service exclusively (47)	0%	21%	66%	13%
	Combination of public service and private practice (43)	5%	35%	47%	14%
Percent of patients peds (missing = 2)
	<40% (185)	5%	31%	52%	12%	.609^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	40% or greater (26)	3%	25%	64%	8%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	2%	43%	43%	12%	.309^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (32)	9%	28%	56%	6%
	50-74% (42)	5%	24%	62%	10%
	75-99% (42)	3%	19%	62%	17%
	100% (46)	7%	33%	50%	11%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (55)	4%	36%	44%	16%	.569^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (31)	3%	28%	58%	11%
	50-74% (25)	8%	18%	70%	5%
	75-99% (35)	3%	32%	51%	14%
	100% (42)	7%	35%	49%	9%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (75)	6%	23%	59%	13%	.293
	No (128)	5%	36%	50%	10%

Level of intervention		E1	E2	D1	D2/3	Significance
Gender of dentist
	Male (84)	21%	55%	23%	1%	.048^a
	Female (130)	13%	54%	30%	3%
Type of dental school graduation
	Public (164)	14%	59%	25%	3%	.173^a
	Private (33)	24%	42%	32%	2%
Post-graduate degree
	Yes (53)	4%	59%	32%	6%	.011^a
	No (161)	21%	53%	24%	1%
Years since graduation
	1-10 (60)	13%	53%	28%	5%	.146^b
	11-20 (51)	16%	59%	26%	0%
	21-30 (63)	11%	59%	27%	3%
	31 or greater (39)	31%	46%	23%	0%
Practice type
	Private practice exclusively (120)	18%	54%	26%	3%	.697^a
	Public Health exclusively (47)	17%	45%	34%	4%
	Combination of public service and private practice (43)	12%	67%	21%	0%
Percent of patients peds (missing = 2)
	<40% (185)	17%	55%	25%	2%	.164^b
	40% or greater (26)	11%	51%	35%	3%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	29%	47%	22%	2%	.014^b
	25-49% (32)	21%	59%	16%	3%
	50-74% (43)	5%	70%	26%	0%
	75-99% (42)	14%	38%	43%	5%
	100% (46)	11%	61%	26%	2%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (56)	18%	66%	14%	2%	.071^b
	25-49% (36)	17%	56%	28%	0%
	50-74% (40)	10%	58%	28%	5%
	75-99% (37)	14%	54%	30%	3%
	100% (43)	23%	35%	40%	2%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (71)	16%	44%	38%	3%	.046
	No (129)	17%	60%	20%	2%

Risk sensitivity Index		Delay intervention to a later stage (dentine) with high-risk patient (+1)	No change in treatment decision (0)	Delay intervention to a later stage (dentine) with low-risk patient (-1)	Significance
		(n = 6)	(n = 127)	(n = 80)
Gender of dentist
	Male (83)	1%	35%	64%	.385^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Female (130)	4%	39%	57%
Type of dental school graduation
	Public (163)	1%	38%	61%	.040^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Private (50)	8%	36%	56%
Post-graduate degree
	Yes (53)	0%	45%	55%	.183^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (161)	4%	35%	61%
Years since graduation (missing = 1)
	1-10 (60)	5%	40%	55%	.670^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	11-20 (51)	0%	34%	66%
	21-30 (63)	5%	35%	60%
	31 or greater (39)	0%	41%	59%
Practice model type ^C
	Private practice exclusively (119)	3%	40%	56%	.882^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Public Health exclusively (47)	2%	30%	68%
	Combination of public service and private practice (43)	2%	37%	61%
Percent of patients peds (missing = 2)
	<40% (175)	3%	35%	62%	.130^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	40% or greater (36)	3%	50%	47%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	0%	33%	67%	.017^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (32)	6%	22%	72%
	50-74% (43)	5%	36%	60%
	75-99% (42)	2%	41%	57%
	100% (46)	2%	52%	46%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (56)	0%	31%	69%	.007^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (36)	3%	28%	69%
	50-74% (40)	5%	43%	53%
	75-99% (37)	5%	35%	60%
	100% (43)	2%	54%	44%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (75)	6%	36%	59%	.219^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (128)	2%	41%	58%

[1] Correspondence to: EPS Tagliaferro. E-mail: elaine.tagliaferro@unesp.br.

Brasil

Brasil

Evidence-practice gap in treatment recommendations for proximal caries among Brazilian dentists

Lacuna entre a evidência e a prática nas recomendações de tratamento para cárie proximal entre dentistas brasileiros

ABSTRACT

Objectives:

Methods:

Results:

Conclusion: