Objective : To quantify the: (1) correlation between reported restorative threshold and actual clinically-documented caries depths at which 鈥淭he Dental Practice-Based Research Network鈥� (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 鈥渞eported鈥� threshold), and recorded treatment information on 50 consecutive dental restorations done to treat caries on previously un-restored tooth surfaces (the 鈥渁ctual鈥� 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 鈥渓ess conservative鈥� p-is group was larger for occlusal caries (70%) than for proximal caries (21%). 34% of p-is were in the 鈥渕ore conservative鈥� 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 鈥渓ess conservative鈥� and 9 p-is (5%) in the more conservative categories. No practitioner variables showed significant association with a 鈥渓ess conservative鈥� 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.