How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM‐B analysis

Abstract

Objective:The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. Methods: A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed.Results: All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41).Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. Conclusion:Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

Caries Lesion Assessment Using 3D Virtual Models by Examiners with Different Degrees of Clinical Experience

“…The study by Abreu-Placeres et al had an interesting approach with data from students, university educators, and dentists from outside the academic environment regarding the management of carious risk and carious lesions. Since students and educators reported "performing 'Caries detection and assessment' 2D behaviors" more frequently than other dentists, the idea that there is a delay outside universities in the adoption of evidence-based dental medicine but also of differences in the training of doctors emerges [32]. Thus, there is a need to implement national, large-scale dental public health programs that include prevention programs and have, as a starting point, the training of all professionals in standardized systems for detecting and managing early carious lesions.…”

Evaluation of a novel caries detecting oral rinse

“…Current caries detection is normally performed by visual-tactile examination [1][2][3]. However, this is subjective in nature and has limited sensitivity, and tactile probing with a dental explorer can risk cavitation of otherwise remineralizable lesions [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…These limitations of the visual-tactile and radiographic caries detection and diagnosis have led to efforts to facilitate objective detection of dental caries, such as laser or light-induced fluorescence, transillumination, electrical impedance, bioluminescence, and others [17,18]. While these methods, in conjunction with visual inspection and comprehensive caries risk analysis, can assist in improving treatment decisions, and ultimately, patient outcomes, caries diagnosis leading to effective treatment decisions remains a challenge for the profession [1,[19][20][21][22].…”

Frequency of Dental Caries in Undergraduate Dental Students

“…Dental caries are five times more prevalent than asthma and seven times more prevalent than hay fever in Pakistan, troubling outcomes for the country's oral health 9 . Due to poor dental hygiene habits, increased sugar intake, and a lack of knowledge about fluoride additives, it is currently a major issue for community health in emerging nations [10][11][12][13] . Therefore, it is not surprising that the WHO is calling for commitments for continuous improvement in oral and dental health 14 .…”

“…Since it has been in use for almost 80 years, the Decayed, Missing, Filled (DMF) index is widely acknowledged as the important indicator of caries experience in dental epidemiology 12 . The index used for teeth is known as DMFT, and scores for each individual can range from 0 to 28 or 32.…”