Inconsistent decision making in dental caries diagnosis and treatment: A case-based questionnaire survey

Delayed implementation of new knowledge into clinical practice poses patient safety risks. This study investigates agreement on use of the dental caries interventions, sealing, and stepwise excavation.

A cross-sectional questionnaire survey, based on 11 constructed cases with descriptions of patient symptoms, radiographic, and clinical findings. Interrater agreement on dental caries- and pulp diagnoses and interventions were measured with Cohen's and Light's κ. The data collection period was September 28 to November 5, 2021. To explore variations in use and knowledge factors, we examined Danish dentists' attitudes toward continuing education.

Based on 243 responses, moderate interrater agreement for dental caries and pulp diagnoses and weak agreement on interventions were seen. The agreement with the gold standard for caries was moderate. No agreement was found for dental pulp diagnosis, and for interventions the agreement was weak. No pattern in agreement with the gold standard was seen in relation to case difficulty level. The majority reported knowing of and using stepwise excavation, in conflict with findings that less than half chose stepwise excavation in cases, where considered appropriate. One in four (25%) reported to be unfamiliar with sealing, and half (50%) use sealing regularly. Better access to continuing education and for universities to offer continuing education as alternatives to one-sided private market were requested.

Some patients may receive too radical treatment despite available less invasive evidence-based effective treatments. Dentists acknowledge the importance of continuing education. Easier access and perhaps more incentives for seeking out high-quality continuing education from trustworthy sources are needed.