Evidence-Based Caries Management in Latin American Dental Schools: A COM-B Implementation Science Baseline Study

Adopting core cariology curricula into dental schools remains an international challenge in dental education and clinical practice. For the first time, implementation science is supporting this adoption process. Therefore, as part of the exploration phase of the Latin-American-Cariology-Curriculum-Framework implementation, this baseline Capability, Opportunity, Motivation-Behaviour (COM-B) study assessed how best-practice caries risk/lesions diagnosis and management behaviours are being performed across regional dental schools.

We administered an adapted, previously validated COM-B model caries-care best-practice questionnaire to 1,317 participants (806 final-year students and 511 clinical educators) across eight Latin American dental schools. The 56-item instrument evaluated self-reported behaviours regarding caries diagnosis and management (5-point Likert-response scale). Descriptive statistics, Welch's ANOVA, and multiple linear regression models -applied to ordinal Likert-frequency ratings treated as approximately continuous with heteroskedasticity-consistent robust standard errors (HC3), were performed.

The overall response rate was 71.1% (students: 74.8%, educators: 65.4%). Respondents reported performing these behaviours "most of the time," with averages (mean ± SD) ranging from 4.0 ± 1.0 - 4.3 ± 0.9. The most frequently reported behaviours were related to caries management, particularly "Advising on reducing free-sugar intake" and "Implementing oral hygiene behaviour change strategies" (both 4.5 ± 0.7). The least frequent behaviour was "Monitoring/watching initial inactive caries lesions" (3.7 ± 1.2). Only one dental school showed overall behaviour-frequency values below "most of the time." Within the COM-B model, capability showed the strongest association with diagnostic behaviours, whereas opportunity-resources showed the strongest association with management behaviours.

Clinical educators and final-year students from Latin American dental schools reported high baseline engagement in evidence-based caries diagnosis and management. Capability and opportunity were the COM-B components most strongly associated with these behaviours. As part of a regional implementation-science study, these findings serve as a case study of a global implementation challenge: translating evidence-based cariology principles into dental education and clinical practice.