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Factors affecting clinical decision-making for the management of non-carious cervical lesions - a qualitative
Wai Ling Tse1, Johnson Chun Ming Lee1, Tong Wah Lim1
1Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.
Introduction:
Non-carious cervical lesions (NCCLs) have different aetiologies and the management of NCCLs varies on a range of factors that affects intervention strategy. The aim of this study was to elicit information from in-depth interviews with dentists to explore and identify the factors in relationship to decision to restore and management of three levels of severity of NCCLs based on clinical photos and different clinical scenarios.
Method And Material:
An interview guide was developed based on previous literature which explored participants' management under different clinical scenario (lesion depth, patient's symptoms/ concerns and patient's age) and follow up questions regarding two domains 1) management options of NCCLs 2) factors affecting decision to restore NCCLs. Nineteen dentists who were practicing in Hong Kong were intentionally selected for conducting thorough, semi-structured interviews. The interviews were audio recorded and transcribed verbatim. A thematic analysis was carried out, and the results were evaluated.
Result:
Thematic analysis showed two overarching domains, namely management options of NCCLs and factors affecting decision to restore NCCLs. The first domain analysis focused on management options of NCCLs. The identified themes were monitoring, non-restorative management and restorative treatment. The non-restorative management included patient education, oral hygiene instruction, dietary analysis and advice, desensitizing agents. The subthemes under restorative treatment included composite or RMGIC restoration, occlusal adjustment, and other treatments such as periodontal surgery and extracoronal restoration. In the second domain, three themes emerged: tooth factors (symptoms, depth of the lesion and others), patient factors (complaints, patient's age, medical and financial status), and dentist factors (background, type of practice, work experience and clinic environment).
Conclusion:
The decision to treat was mainly affected by patient's symptoms, depth of lesion, aesthetic concern. Moreover, among the participants, composite resin was the preferred material for NCCL restorations over GIC.
Clinical Significance:
This study has offered insights into Hong Kong dentists' decision-making processes for managing NCCLs within given clinical scenarios.
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