Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice

Abstract

A survey conducted in 2002 among French general dental practitioners (GPs) showed variations between treatment decisions and a tendency towards early restorative intervention for caries. The aims of the present questionnaire survey were to investigate, among a random sample of 2,000 French GPs, the management decisions for occlusal lesions in 2012 and to compare the results to those obtained in 2002. The response rate was 41.9%. The majority of the respondents (60.7%) would postpone their restorative decisions until the lesion was in the dentin, based on clinical and radiographic examinations. Almost 68% of the respondents suggested that the cavity preparation should be limited to the lesion (vs. a preparation extending to the occlusal fissure), and 81.6% chose composite as restorative material for the earliest lesion requiring restoration in a 20-year-old patient with his/her caries risk factors under control. Statistical analysis (χ² and logistic regression) showed that the management decisions were influenced by certain demographic characteristics (gender, clinical experience and participation in cariology courses). When comparing the 2002 and 2012 responses, it appears that even if French GPs still tend to intervene surgically for occlusal lesions, which could benefit from noninvasive care such as therapeutic sealants, the restorative threshold has been delayed to later stages of carious progression (p < 0.0001). Moreover, the 2012 respondents were less likely to open the fissure system than the 2002 respondents (p = 0.032), and less amalgam restorations would have been placed in 2012 (p < 0.0001). Furthermore, the results showed that the variability observed in 2002 toward caries management decisions was persisting in 2012.

Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service

“…This is in contrast with the assessment of American dental professionals [Gordan et al, 2010], in which restorative treatment of occlusal lesion located in the inner enamel and outer dentin in low caries risk individuals was recommended by more than 50 and 90% of dentists, respectively. A similar trend was reported for French dentists, where 40% indicated restorative treatment of occlusal enamel lesions [Doméjean et al, 2015]. Likewise, a systematic review on treatment decisions for occlusal lesions, including studies from 17 countries, reported that 12% of dental professionals indicated restorative treatment for occlusal lesions with enamel discoloration or cavitation without clinical or radiographic dentin involvement.…”

“…Previous studies on treatment decisions for the management of occlusal caries have shown substantial variations among dental general practitioners [Mejàre et al, 1999;Espelid et al, 2001;Bader and Shugars, 2006], particularly as to whether operative treatment is required [Gordan et al, 2010;Rindal et al, 2014;Doméjean et al, 2015]. Dentists' treatment decisions have mainly been based on caries risk assessment, clinical characteristics of the occlusal lesions [Mejàre et al, 1999;Espelid et al, 2001;Nascimento et al, 2010], and radiographic signs of caries demineralization [Makhija et al, 2014].…”

“…Different methods have been used to assess treatment decisions of dental general practitioners, ranging from scoring of extracted teeth [Pereira et al, 2009;Alomari et al, 2015], radiographs [Espelid et al, 1994;2001;Lazarchik et al, 1995], completion of precoded questionnaires with hypothetical patients and scenarios [Mejàre et al, 1999;Espelid et al, 2001;Heaven et al, 2013;Ruiz et al, 2013;Doméjean et al, 2015] to questionnaire surveys completed with patients clinically and radiographically examined in the context of the Dental Practice-Based Research Network [Gordan et al, 2010;Nascimento et al, 2010;Makhija et al, 2014].…”

Occlusal Caries Management: Preferences among Dentists in Norway

“…The second limitation which is discussed is the nature of non-validated self-reports which may not reflect the actual behaviour. The strength of this study is the relatively high response rate and the fact that the three national cross-sectional studies of 1983-2009 have reflected changes which are consistent with international trends Espelid et al, 2001;Vidnes-Kopperud et al, 2011;Doméjean et al, 2015].…”

Managing caries: the need to close the gap between the evidence base and current practice

“…7,8,42-54 For example, a French survey undertaken in 2002 showed that almost 50% of respondents would restored an occlusal lesion confined to enamel in patients with low caries risk. 45 Espelid et al showed in 1995 and 1996 that 30% of Scandinavian dentists would undertake chose restorative treatment options for lesions radiographically confined to enamel. 53 Whilst support for micro-invasive treatment, i.e.…”