‘Seeing is believing’: a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden

Abstract

Aim To gain insight into the decision processes of dentists when requesting a cone beam computed tomography (CBCT) examination in endodontic settings. Methodology Fourteen dentists (eight female) 33–58 years of age (mean = 44) practising in Sweden were interviewed. Ten of the dentists were specialists in Endodontics. The absolute inclusion criterion was experience of referring patients for CBCT for endodontic reasons. The included dentists comprised a strategically selected diverse sample in terms of gender, age, work experience, educational background, location of practice, service affiliation and accessibility to CBCT. Data were obtained through semistructured interviews exposing the context of their last three self‐reported referrals. Dentists were encouraged to describe their experiences of the circumstances in their own words, aided by the interviewer's open‐ended questions. The interviews were audio‐recorded and transcribed verbatim. The text was analysed by qualitative content analysis. Results The manifest content was organized into three categories that were defined as visualization as a desire, facilitating tough decisions and allocating responsibility. Conclusion An overall theme (covering the latent content) was identified: A balance between clinical common sense and a ‘better safe than sorry’ attitude guides the use of CBCT in endodontic settings. Informants had high clinical standards, knowledge concerning radiation risks and good sense, which could compensate for their lack of knowledge of guidelines. The national radiation regulatory system was perceived to work as a slightly porous gatekeeper for over‐usage.

Cone beam computed tomography in dentistry: practitioner awareness and attitudes. A scoping review

“…Specifically, a study of Indian orthodontists found that 84% of respondents were just aware that it is not justified to use CBCT on all patients 41 . The findings of a qualitative Swedish study demonstrate a high knowledge of dentists concerning radiation exposure risk involved in CBCT use 19 . Interestingly, however, a study of endodontists in the USA found that 81.1% of respondents did not believe that CBCT delivers high radiation exposure 15 .…”

“…A total of 31 papers examined aspects of respondents’ knowledge or awareness of CBCT. Of these studies, four appear to have been well‐conducted, 10,12,19 15 were moderately robust in their findings, 1,13‐15,18,21,23,24,26,27,29,39,41,45,46 and 12 had questionable evidence due to the low strength of their methodology 16,17,20,22,28,31‐33,36‐38,40,42,43,47 …”

“…Additionally, a large proportion (62.5%) of participants were found to be uncertain of the radiation exposure doses associated with a CBCT scan 29 . Furthermore, in studies assessing practitioners’ knowledge of guidelines on CBCT use, 50% of Indian orthodontists were aware of guidelines, 41 with this poor knowledge mirrored by Swedish dentists that reported a limited knowledge of guidelines in a qualitative interview study 19 . Interestingly, 3.4% of Iranian dentists were found to use CBCT for caries diagnosis 1 …”

“…30 studies examined participants’ attitudes towards CBCT education and use in the dental setting. Of these 30 papers, two were well‐designed, 19,35 15 were adequately conducted, 1,11,13‐15,18,21,24‐27,34,39,41,44 and 12 provided questionable evidence 16,22,28,31‐33,36‐38,40,42,43 …”

Coronal restoration in root-filled and non root-filled teeth : studies on periapical status, tooth survival, subsequent treatments and treatment decisions

“…In contrast, the present study was based on the GDPs´ actual decisions, revealing the different contexts in which they occurred. Apart from one previous study (149), little is known about the impact of the context on the decisions.…”