Patients’ preferences for management of deep occlusal, initial occlusal and root carious lesions

Abstract

Introduction: Evidence-based dentistry is a threefold method of working as a dentist. The threefold method is clinical experience, evidence-based research and patients’ preferences. The purpose of this study was to investigate patient’s preferences for management of different carious lesions; initial occlusal carious lesions, deep occlusal carious lesions, and root carious lesions, and if there was any relationship between patient’s preferences and their characteristics.

Methods: This cross-sectional study consisted of a questionnaire and case vignettes. The questionnaire included questions about gender, age, population in home town, dental history, modified dental anxiety score and the ten-item personality score. The case vignettes consisted of description of two management options for each of three types of carious lesions: stepwise excavation and selective excavation for deep occlusal carious lesions, fissure sealant and fluoride/hygiene regimen for initial occlusal carious lesions, and filling and fluoride/hygiene- regimen for root carious lesions. We used convenient sampling to recruit participants at Pingvinhotellet, a hotel dedicated for patients and next of kin, at the University Hospital in North of Norway in Tromsø. There were 168 persons who were asked to participate, and 147 persons responded to case vignettes and questionnaires. Out of these 7 answers were excluded, which gave us 140 answers to analyze. The response rate was 88%. The results were analyzed using univariable and a multivariable binary logistic regression analysis. Results: There were 65 men and 75 women that participated in the study. Out of them, 75 (53,6%) respondents preferred selective excavation and 65 (46,4%) preferred stepwise excavation when presented to the vignettes describing deep occlusal carious lesion. There were 86 (61,4%) respondents that preferred fissure sealant and 54 (38,6%) that preferred fluoride/hygiene regimen when presented to the vignettes describing initial occlusal carious lesion. There were 91 (65%) of the respondents that preferred filling and 49 (35%) that preferred fluoride varnish/ hygiene regimen when presented to the vignettes describing root carious lesion. For initial occlusal carious lesions, the multivariable binary logistic regression analysis showed that there was a statistically significant association between not having the same dentist or dental hygienist for three years or more versus having the same dentist for 3 years or more, and preference for fluoride varnish/hygiene regimen (OR 2.644, 95%CI 1.112- 6.287). For root carious lesions, the analysis showed that the personality trait “agreeable” test was statistical significantly associated with the preference of operative management alternative (OR 0.562, 95%CI 0.358- 0.882). In addition, there was a statistically significant association between preference of fluoride varnish/hygiene regimen and having a PhD academic degree versus primary school education (OR 10.620, 95%CI 1.062- 106.170).

Conclusion: Regarding deep occlusal carious lesions, participants equality preferred both management option, while for initial occlusal and root carious lesions almost two third of the participants preferred more invasive management options, fissure sealing and filling, respectively. There was a statistically significant association between the preferred management of initial occlusal carious lesions; preferring fluoride varnish/hygiene regimen and not having the same dentist for three years or more. It was also a significant association between the preferred management of root carious lesions; preference of the filling associated with having the personality trait “agreeable”. Also, for root carious lesions there was a significant association between preferring fluoride varnish/hygiene regimen and having a PhD academic degree. The results in this study may open up for a connection and a dialogue with a patient and this may lead to let the patient feel that they are participating in the decision-making of management of different types of carious lesions, which in itself is an important part of practicing evidence-based dentistry. There is a need for more qualitative design research in order to understand which patient characteristics are important in decision making. In addition, there is a need for more research to find out if and which management associated factors are important to people to find their preferences for a particular management.