6 Characteristics of Enamel Lesion Restorations Placed by Dental PBRN Dentists

Wednesday, March 21, 2012: 2:30 p.m. - 4 p.m.
Presentation Type: Oral Session
J.L. FELLOWS1, V.V. GORDAN2, G.H. GILBERT3, D.B. RINDAL4, V. QVIST5, M.S. LITAKER3, P.L. BENJAMIN6, H. FLINK7, A. FALCK8, D. PIHLSTROM9, N. JOHNSON10, and T. DPBRN COLLABORATIVE GROUP11, 1Kaiser Permanente Center for Health Research, Portland, OR, 2College of Dentistry, University of Florida, Newberry, FL, 3Dept. of General Dental Sciences, University of Alabama at Birmingham, Birmingham, AL, 4Research Foundation, HealthPartners, Minneapolis, MN, 5Dept. of Cariology & Endodontics, University of Copenhagen, Copenhagen N, Denmark, 6Private Practice, Miami, FL, 7Centre for Clinical Research, Uppsala University, Västerås, Sweden, 8Private Practice, Lysekil, Sweden, 9Permanente Dental Associates, Portland, OR, 10University of Minnesota, Robbinsdale, MN, 11University of Alabama at Birmingham, Birmingham, AL
Objective: To test the hypothesis that dentist/practice and patient characteristics are associated with restorative treatment of carious enamel lesions. 

Method: DPBRN dentists enrolled 50 consecutive restorations placed on previously unrestored adult tooth surfaces, up to four per patient. The DPBRN comprises dental practices mainly from five regions: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia. Patient and restoration characteristics were collected during the visit. Dentist/practice information was obtained from previous surveys. Preoperative depths were diagnosed with methods routinely used in each practice for previously unrestored occlusal and/or proximal surfaces. Analysis of variance and logistic regression were done using generalized estimating equations to assess dentist/practice and patient predictors of enamel lesion restorations, accounting for clustering within practitioner and patient.

Results: 229 practitioner-investigators placed 5,532 restorations involving an occlusal surface and 4,166 involving a proximal surface in 4,397 patients; 1,447 included both occlusal and proximal surfaces (95% of eligible restorations were enrolled). About 13% of occlusal and 6% of proximal caries lesions were confined to the enamel based on preoperative assessment (p<.0001). DPBRN region, patient age, and patient sex (proximal only) were significantly associated with the percentage of enrolled enamel lesions (p-values <0.05). The percentage of enrolled lesions limited to enamel varied by DPBRN region from 20% to 3% for occlusal lesions, and 12% to 1% for proximal lesions. Dentists in the southeast US regions had the highest percentage of enamel lesions restored. Other patient and dentist/practice characteristics were not related to enamel lesion enrollment.

Conclusion: The significant differences in the percentage of enrolled enamel lesions between DPBRN regions, and lack of association with indicators of patient caries risk and other dentist/practice characteristics, suggest that the external environment (e.g., patient preferences, reimbursement model) has a substantial influence on dentists’ treatment decisions. Support: U01-DE-16746, U01-DE-16747.

This abstract is based on research that was funded entirely or partially by an outside source: National Institute for Dental and Craniofacial Research, U01-DE-16746, U01-DE-16747

Keywords: Caries, Epidemiology, Health services research and Practice-based research