Variations in dentists’ thresholds for restorative treatment of active non-cavitated carious lesions: a multinational cross-sectional study

IF 5.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of dentistry Pub Date : 2025-09-05 DOI:10.1016/j.jdent.2025.106092

Ömer Hatipoğlu , Nessrin Taha , Mohmed Isaqali Karobari , Thiyezen Abdullah Aldhelai , Daoud M. Ayyad , Ahmed A. Madfa , Jose Martin-Cruces , Rafael Fernández-Grisales , Maira Kopbayeva , Wen Yi Lim , Suha Alfirjani , Kacper Nijakowski , Tanvi Deepak shah , Eftychia Pappa , Silvana Jukić Krmek , Novaldy Wahjudianto , Azhar Iqbal , Imran Zainal Abidin , Martha Gallegos Intriago , Yasmine Elhamouly , Fatma Pertek Hatipoğlu

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引用次数: 0

Abstract

Objectives

To assess patterns across 21 countries in dentists’ thresholds for initiating operative treatment of active non-cavitated carious lesions and to evaluate the influence of caries risk, clinician characteristics, and geographic variation on decision-making in accordance with current guidelines.

Methods

A cross-sectional, vignette-style web-based survey was conducted between June and October 2023 across 21 countries. A standardized questionnaire, comprising theoretical radiographic scenarios of occlusal and approximal active non-cavitated carious lesions at four progressive stages (E1,E2,EDJ,D1), was distributed to general dentists and specialists. Respondents selected the radiographic threshold at which they would initiate invasive treatment for patients with low and high caries risk. Guideline-concordant benchmarks were predefined as D1 for low-risk and EDJ/D1 for high-risk; any earlier choice was coded as overtreatment. Cumulative-link mixed models estimated determinants of thresholds; guideline concordance was summarized descriptively.

Results

A total of 3680 dentists provided 7360 valid responses. High caries risk significantly predicted earlier intervention (occlusal OR= 0.34; approximal OR= 0.38, p < 0.001). Female dentists and restorative specialists were more conservative, while age showed no significant effect. Overall guideline adherence was low (22.7 % in low-risk and 32.7 % in high-risk scenarios). Substantial inter-country variation was observed; Bangladesh and Portugal showed highest adherence, while Kazakhstan and Colombia demonstrated overtreatment tendencies.

Conclusions

Despite global promotion of minimally invasive dentistry, overtreatment of enamel lesions remains widespread. Addressing systemic, educational, and policy-level barriers is essential to improve adherence to evidence-based, risk-informed caries management.

Clinical significance

This multinational study highlights substantial variability and premature intervention in caries management across countries. Identifying patterns of overtreatment and guideline discordance informs dental education and policy, emphasizing the urgent need to reinforce minimally invasive, risk-based strategies in clinical practice across participating countries.

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牙医对活动性非空化龋齿病变恢复性治疗阈值的差异：一项跨国横断面研究。

目的：评估21个国家牙医开始对活动性非空化龋齿病变进行手术治疗的阈值模式，并根据现行指南评估龋齿风险、临床医生特征和地理差异对决策的影响。方法：在2023年6月至10月期间，在21个国家进行了横断面、小短文式的网络调查。一份标准化的调查问卷，包括四个进展阶段（E1,E2，EDJ,D1）的咬合和近似活动性非空化龋齿病变的理论放射学情景，分发给普通牙医和专科医生。受访者选择放射学阈值，在该阈值下，他们将对低风险和高风险的患者进行侵入性治疗。与指南一致的基准被预定义为低风险的D1和高风险的EDJ/D1；之前的任何选择都被认为是过度治疗。累积链接混合模型估计阈值的决定因素；对指南一致性进行描述性总结。结果：共有3680名牙医提供了7360份有效回复。结论：尽管微创牙科在全球范围内得到推广，但牙釉质病变的过度治疗仍然普遍存在。解决系统、教育和政策层面的障碍对于提高对循证、风险知情的龋齿管理的依从性至关重要。临床意义：这项跨国研究强调了各国龋齿管理的实质性差异和过早干预。识别过度治疗模式和指南不一致为牙科教育和政策提供信息，强调在参与国的临床实践中加强微创、基于风险的战略的迫切需要。

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来源期刊

Journal of dentistry 医学-牙科与口腔外科

CiteScore

7.30

自引率

11.40%

发文量

349

审稿时长

35 days

期刊介绍： The Journal of Dentistry has an open access mirror journal The Journal of Dentistry: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The Journal of Dentistry is the leading international dental journal within the field of Restorative Dentistry. Placing an emphasis on publishing novel and high-quality research papers, the Journal aims to influence the practice of dentistry at clinician, research, industry and policy-maker level on an international basis. Topics covered include the management of dental disease, periodontology, endodontology, operative dentistry, fixed and removable prosthodontics, dental biomaterials science, long-term clinical trials including epidemiology and oral health, technology transfer of new scientific instrumentation or procedures, as well as clinically relevant oral biology and translational research. The Journal of Dentistry will publish original scientific research papers including short communications. It is also interested in publishing review articles and leaders in themed areas which will be linked to new scientific research. Conference proceedings are also welcome and expressions of interest should be communicated to the Editor.