Lacuna entre a evidência e a prática nas recomendações de tratamento para cárie proximal entre dentistas brasileiros

TAGLIAFERRO, Elaine Pereira da Silva; RILEY III, Joseph L.; GILBERT, Gregg H.; SILVA, Silvio Rocha Correa da; ROSELL, Fernanda Lopez; VALSECKI JUNIOR, Aylton; GORDAN, Valeria Veiga

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Sumário

ORIGINAL • Rev Gaúch. Odontol. 71 • 2023 • https://doi.org/10.1590/1981-86372023002920220099 copiar

Lacuna entre a evidência e a prática nas recomendações de tratamento para cárie proximal entre dentistas brasileiros

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Pouco se sabe se as decisões de tratamento dos dentistas brasileiros para lesões cariosas proximais são comparadas às recomendações atuais baseadas em evidências, portanto, é necessário um melhor entendimento para fechar qualquer potencial lacuna entre a evidência e a prática.

Purpose:

Este estudo transversal teve como objetivo quantificar a lacuna entre a evidência e a prática na decisão de tratamento das lesões cariosas proximais e identificar os fatores associados a essa lacuna entre a evidência e a prática.

Methods:

Cirurgiões-dentistas brasileiros (n=214) de Araraquara, Estado de São Paulo, preencheram um questionário sobre suas características odontológicas e clínicas e uma versão traduzida do “Assessment of Caries Diagnosis and Caries Treatment” da U.S. National Dental Practice-Based Research Network. Cinco imagens radiográficas de lesões cariosas proximais em cenários de pacientes de baixo risco e alto risco foram usadas. Associações entre recomendações de tratamento e lesão, dentista e características da prática foram testadas (p<0,05).

Results:

As lesões confinadas ao esmalte seriam restauradas por 35% e 71% dos dentistas nos cenários de pacientes de baixo risco e alto risco, respectivamente, sugerindo uma lacuna entre a evidência e a prática substancial, dado que a intervenção cirúrgica das lesões do esmalte não é consistente com as evidências atuais. O limiar de profundidade da lesão para recomendar uma restauração permanente diferiu entre os cenários de pacientes de baixo risco e alto risco (p<0,001). Características específicas do dentista/prática (sexo do dentista, graduado em uma faculdade pública, pós-graduação, uso da avaliação de risco de cárie) foram significativamente associadas à lacuna entre a evidência e a prática, mas a magnitude dessas diferenças não foi importante.

Conclusions:

uma lacuna entre a evidência e a prática substancial na decisão de tratamento de lesões cariosas proximais foi encontrada para a amostra como um todo, mesmo quando os cenários clínicos apresentavam pacientes de baixo risco. Estratégias globais são necessárias para fechar essa lacuna entre a evidência e a prática.

Termos de indexação
Tomada de decisões; Cárie dentária; Padrões de prática odontológica

Level 1 (E1)	Level 2 (E2)	Level 3 (D1)	Level 4 (D2)	Level 5 (D3)
Low-risk patient scenario. The patient is a 30-year old female with no relevant medical history. She has no complaints and is in your office today for a routine visit. She has been attending your practice on a regular basis for the past six years.
5% (n=10)	30% (n=64)	54% (n=115)	10% (n=21)	1% (n=3)
High-risk patient scenario. The patient has 12 teeth with existing dental restorations, heavy plaque, and calculus, multiple Class V white spot lesions, and is not missing any teeth.
16% (n=35)	55% (n=117)	27% (n=57)	2% (n=4)	<1% (n=1)

Level of intervention		E1	E2	D1	D2/3	Significance
Gender of the dentist
	Male (83)	7%	30%	48%	15%	.269^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Female (130)	3%	30%	58%	9%
Type of dental school graduation
	Public (163)	2%	30%	56%	14%	.045^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Private (50)	12%	28%	48%	12%
Post-graduate degree
	Yes (53)	0%	23%	60%	17%	.047^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (160)	6%	33%	52%	9%
Years since dental school graduation? (missing = 1)
	1-10 (60)	3%	33%	50%	13%	.366^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	11-20 (50)	4%	26%	58%	12%
	21-30 (63)	5%	24%	62%	10%
	31 or greater (39)	8%	41%	41%	10%
Practice model type^C
	Private practice exclusively (119)	7%	31%	52%	10%	.504^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Public service exclusively (47)	0%	21%	66%	13%
	Combination of public service and private practice (43)	5%	35%	47%	14%
Percent of patients peds (missing = 2)
	<40% (185)	5%	31%	52%	12%	.609^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	40% or greater (26)	3%	25%	64%	8%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	2%	43%	43%	12%	.309^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (32)	9%	28%	56%	6%
	50-74% (42)	5%	24%	62%	10%
	75-99% (42)	3%	19%	62%	17%
	100% (46)	7%	33%	50%	11%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (55)	4%	36%	44%	16%	.569^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (31)	3%	28%	58%	11%
	50-74% (25)	8%	18%	70%	5%
	75-99% (35)	3%	32%	51%	14%
	100% (42)	7%	35%	49%	9%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (75)	6%	23%	59%	13%	.293
	No (128)	5%	36%	50%	10%

Level of intervention		E1	E2	D1	D2/3	Significance
Gender of dentist
	Male (84)	21%	55%	23%	1%	.048^a
	Female (130)	13%	54%	30%	3%
Type of dental school graduation
	Public (164)	14%	59%	25%	3%	.173^a
	Private (33)	24%	42%	32%	2%
Post-graduate degree
	Yes (53)	4%	59%	32%	6%	.011^a
	No (161)	21%	53%	24%	1%
Years since graduation
	1-10 (60)	13%	53%	28%	5%	.146^b
	11-20 (51)	16%	59%	26%	0%
	21-30 (63)	11%	59%	27%	3%
	31 or greater (39)	31%	46%	23%	0%
Practice type
	Private practice exclusively (120)	18%	54%	26%	3%	.697^a
	Public Health exclusively (47)	17%	45%	34%	4%
	Combination of public service and private practice (43)	12%	67%	21%	0%
Percent of patients peds (missing = 2)
	<40% (185)	17%	55%	25%	2%	.164^b
	40% or greater (26)	11%	51%	35%	3%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	29%	47%	22%	2%	.014^b
	25-49% (32)	21%	59%	16%	3%
	50-74% (43)	5%	70%	26%	0%
	75-99% (42)	14%	38%	43%	5%
	100% (46)	11%	61%	26%	2%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (56)	18%	66%	14%	2%	.071^b
	25-49% (36)	17%	56%	28%	0%
	50-74% (40)	10%	58%	28%	5%
	75-99% (37)	14%	54%	30%	3%
	100% (43)	23%	35%	40%	2%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (71)	16%	44%	38%	3%	.046
	No (129)	17%	60%	20%	2%

Risk sensitivity Index		Delay intervention to a later stage (dentine) with high-risk patient (+1)	No change in treatment decision (0)	Delay intervention to a later stage (dentine) with low-risk patient (-1)	Significance
		(n = 6)	(n = 127)	(n = 80)
Gender of dentist
	Male (83)	1%	35%	64%	.385^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Female (130)	4%	39%	57%
Type of dental school graduation
	Public (163)	1%	38%	61%	.040^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Private (50)	8%	36%	56%
Post-graduate degree
	Yes (53)	0%	45%	55%	.183^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (161)	4%	35%	61%
Years since graduation (missing = 1)
	1-10 (60)	5%	40%	55%	.670^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	11-20 (51)	0%	34%	66%
	21-30 (63)	5%	35%	60%
	31 or greater (39)	0%	41%	59%
Practice model type ^C
	Private practice exclusively (119)	3%	40%	56%	.882^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	Public Health exclusively (47)	2%	30%	68%
	Combination of public service and private practice (43)	2%	37%	61%
Percent of patients peds (missing = 2)
	<40% (175)	3%	35%	62%	.130^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	40% or greater (36)	3%	50%	47%
When you examine patients to determine if they have a caries lesion on a proximal (mesial or distal) surface, on a posterior tooth, on what percent of these patients do you use radiographs to help diagnose the lesion?
	0-24% (51)	0%	33%	67%	.017^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (32)	6%	22%	72%
	50-74% (43)	5%	36%	60%
	75-99% (42)	2%	41%	57%
	100% (46)	2%	52%	46%
For what percent of patients do you give individualized caries preventive regimen? (missing = 2)
	0-24% (56)	0%	31%	69%	.007^b b Somer’s d was used for testing for a significant association between two ordinal variables.
	25-49% (36)	3%	28%	69%
	50-74% (40)	5%	43%	53%
	75-99% (37)	5%	35%	60%
	100% (43)	2%	54%	44%
Do you assess caries risk for individual patients in any way (missing = 10)
	Yes (75)	6%	36%	59%	.219^a a Person’s Chi-square was used for testing for a significant association between two categorical variables.
	No (128)	2%	41%	58%

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[1] Correspondence to: EPS Tagliaferro. E-mail: elaine.tagliaferro@unesp.br.