Service patterns associated with coronal caries in private general dental practice

To describe the pattern of dental services associated with dental caries by level of carious lesion severity.

Data were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 2003-2004. Dentists provided service data on patients treated on a typical clinical day for patients attending with a diagnosis of dental caries.

Restorative rates were higher for insured patients, radiograph rates were higher for emergency visits, prophylaxis and topical fluoride rates were higher for non-emergency visits and at capital city locations with topical fluoride also higher for patients from higher socio-economic status areas, endodontic rates were higher for emergency visits and at non-capital city locations, while extraction rates were higher for males, uninsured patients and for emergency visits. Poisson regression models compared the rates of services from different service areas for initial and cavitated carious lesions with gross carious lesions, controlling for patient demographics, visit type, location and socio-economic status. Restorative services were provided at higher rates (P<0.05) for cavitated carious lesions (RR=2.38), radiographs were provided at lower rates for both initial (RR=0.28) and cavitated carious lesions (RR=0.31), both prophylaxis and topical fluoride services were provided at higher rates for initial carious lesions (RR=2.33 and 3.00, respectively), endodontic services were provided at lower rates for both initial (RR=0.03) and cavitated carious lesions (RR=0.07), and extractions were provided at lower rates for both initial (RR=0.23) and cavitated carious lesions (RR=0.16) compared to the reference category of gross caries.

Service patterns varied by level of carious lesion severity with initial carious lesions managed by more preventive services, cavitated carious lesions with more restorative services, gross carious lesions with more radiographic, endodontic and extraction services. However, initial carious lesions tend to be managed with restorative rather than preventive service, suggesting scope for increased management by minimum intervention approaches.