Original ContributionsCarious LesionsSurface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network
Section snippets
Methods
The results we present here were generated as a part of a larger study conducted in dental practices in the network. The network is a consortium of dental practices established to answer questions raised by dental practitioners in everyday clinical practice and to evaluate the effectiveness of strategies to prevent, manage, and treat oral diseases and conditions.17, 18
Practitioners and patients
The participants included 93 dentists from all 6 network regions. As shown in Table 1, of these 93 practitioners, 34 were women, 69 were non-Hispanic white, and 69 graduated from dental school more than 15 years before the study. There was a fairly equal distribution of practitioners per region, ranging from 13 in the Western region to 18 in the South Central region.
As shown in Table 1, 72% of the patients were 19 years or older, with a mean (standard deviation) age of 32 (17) years. More than
Discussion
Dental care has slowly evolved from a time when all carious lesions, regardless of size, were restored to today’s “early detection and management.”8 Diagnosing caries can be thought of as a process that involves 3 steps: detection, assessment of the severity, and assessment of the activity,20 which will lead to an appropriate treatment plan. Assessment of severity and activity can be established on the basis of cues such as color, feel, and luster of the lesion21 as well as the caries risk of
Conclusions
Despite the statistically significant associations between the clinical characteristics that we examined and the presence of caries extending into dentin and despite the apparent use of these characteristics by the participating practitioners, these characteristics do not seem to be strong independent predictors of dentinal caries in clinical practice. In response to the question “When you treated the lesion, what did you find?”, practitioners reported active caries extending into the dentin in
Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7th Ave South, SDB 111, Birmingham, AL 35294-0007.
References (34)
- et al.
Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists
J Dent
(1993) - et al.
The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries
J Evid Based Dent Pract
(2006) - et al.
Early treatment of incipient carious lesions: a two-year clinical evaluation
JADA
(2002) - et al.
Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: findings from The National Dental Practice-Based Research Network
JADA
(2014) - et al.
Does the cycle of rerestoration lead to larger restorations?
JADA
(1995) - et al.
The prevalence of questionable occlusal caries: findings from The Dental Practice-Based Research Network
JADA
(2012) - et al.
Restorative treatment thresholds for occlusal primary caries among dentists in the dental practice-based research network
JADA
(2010) - et al.
Purpose, structure, and function of the United States National Dental Practice-Based Research Network
J Dent
(2013) - et al.
Concordance between clinical practice and published evidence: findings from the National Dental Practice-Based Research Network
JADA
(2014) - et al.
Has occlusal caries become more difficult to diagnose?
Br Dent J
(1988)
Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars
Br Dent J
Dynamics of and diagnostic methods for detecting small carious lesions
Caries Res
Diagnostic tools and measurements: impact on appropriate care
Community Dent Oral Epidemiol
Detection of occlusal carious lesions
Gen Dent
Comparison of different methods for the diagnosis of fissure caries without cavitation
Caries Res
Dental caries in the second millennium
J Dent Educ
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Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7th Ave South, SDB 111, Birmingham, AL 35294-0007.
Dr. Shugars is a professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Dr. Gilbert is a professor, Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, AL.
Dr. Litaker is an associate professor, Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, AL.
Dr. Bader is a professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Dr. Schaffer is a private practitioner, Phoenix, AZ.
Dr. Gordan is a professor, Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, University of Florida Health Science Center, Gainesville, FL.
Dr. Rindal is a senior investigator, HealthPartners Institute, and associate dental director for research, HealthPartners Dental Group, Minneapolis, MN.
Dr. Pihlstrom is an associate director for Evidence Based Care and Oral Research, Permanente Dental Associates, Portland, OR.
Dr. Mungia is an assistant professor, Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Dr. Meyerowitz is a professor, University of Rochester, Eastman Institute for Oral Health, Rochester, NY.
The study protocol was registered at ClinicalTrials.gov (NCT02340767).
Disclosure. None of the authors reported any disclosures.
This study was supported by grant U19-DE-22516 from the National Institutes of Health.
The National Dental Practice-Based Research Network Collaborative Group comprises practitioner-investigators, faculty investigators, and staff members who contributed to this activity. Lists of these people are at http://nationaldentalpbrn.org/tyfoon/site/fckeditor/SOCL%20Collaborative%20Group_staff_revised_final.pdf and http://nationaldentalpbrn.org/tyfoon/site/fckeditor/Practitioner%20list%20for%20Decision%20Aids%20for%20the%20Management%20of%20Suspicious%20Occlusal%20Caries%20Lesions_020217_2.pdf. A website devoted to details about The National Dental Practice-Based Research Network is located at http://NationalDentalPBRN.org.
The authors extend their gratitude to The National Dental Practice-Based Research Network's practitioners who participated in the study as well as to the network’s regional coordinators (Midwest region: Tracy Shea, RDH, BSDH; Western region: Stephanie Hodge, MA; Northeast region: Christine O’Brien, RDH; South Atlantic region: Hanna Knopf, BA, Deborah McEdward, RDH, BS, CCRP; South Central region: Claudia Carcelén, MPH, Shermetria Massengale, MPH, CHES, Ellen Sowell, BA; Southwest region: Stephanie Reyes, BA, Meredith Buchberg, MPH).
Opinions and assertions contained in the study are those of the authors and are not to be construed as necessarily representing the views of the respective organizations or the National Institutes of Health.
The informed consent of all human participants who participated in this investigation was obtained after the nature of the procedures had been explained fully (protocol X140925003).