Objective : To quantify the: (1) correlation between reported restorative threshold and actual clinically-documented caries depths at which “The Dental Practice-Based Research Network” (DPBRN; www.DentalPBRN.org) practitioner-investigators (p-i) intervened surgically; (2) differences between approaches used with occlusal vs. proximal surfaces; and (3) characteristics associated with a less-conservative clinical threshold than reported (restorations placed at shallower depths than stated threshold).
Methods : 182 practitioner-investigators from all 5 DPBRN regions completed an Enrollment Questionnaire, an Assessment of Caries Diagnosis and Caries Treatment Questionnaire (which provided the “reported” threshold), and recorded treatment information on 50 consecutive dental restorations done to treat caries on previously un-restored tooth surfaces (the “actual” threshold). The unit of analysis for this study was the p-i. 6,854 primary caries lesions from 4,127 patients were recorded. P-is were classified into 3 groups based on the relation between reported and actual threshold: the same, less-conservative, and more-conservative, separately for occlusal and proximal caries. Groups were further analyzed using multiple logistic regression to determine factors associated with a less-conservative caries approach.
Results : The “less conservative” p-is group was larger for occlusal caries (70%) than for proximal caries (21%). 34% of p-is were in the “more conservative” group for proximal caries and only 8% for occlusal caries. 64 p-is (35%) were in the same group for both occlusal and proximal caries with 36 p-is (20%) in the “less conservative” and 9 p-is (5%) in the more conservative categories. No practitioner variables showed significant association with a “less conservative” group in joint modeling. Practice type, region, and workload were jointly associated with the less conservative approach (p=0.002).
Conclusion : A significant difference existed between reported and actual caries restorative thresholds for most p-is. A clear understanding of this difference and its predictors will help practitioners improve the quality of dental care they provide. Support: U01-DE-16746, U01-DE-16747, F32-DE-18592.