Dental Practitioners' Skill Confidence, Arousal, and Filling Quality Under Time Pressure: Analyses of Objective...

Objectives: To examine whether domain-specific confidence is associated with filling quality and self-reported arousal under time pressure, and whether self-assessed and externally assessed filling quality agree. Methods: In a randomised controlled laboratory experiment, 42 dentists and dental students were assigned to use either the conventional incremental technique or the bulk-fill base technique to fill three cavities. Participants completed practice, timing, and time pressure trials. The baseline skill confidence of the participants was assessed and categorised as high or low. Self-assessed filling quality and self-reported arousal were assessed, and filling quality was also evaluated externally. Results: Under time pressure, there was no significant difference in the overall filling quality, incorporating occlusal underfilling and approximal surface quality, between the bulk-fill base and the conventional incremental techniques; however, time pressure increased the proportion of teeth with ≥1 mm occlusal underfilling. Dentists reported higher skill confidence than students for both techniques. The only significant difference in externally assessed filling quality between high- and low-confidence participants occurred under time pressure with the conventional technique: low-confidence participants had more fillings with good quality than high-confidence participants. Regardless of confidence level, arousal increased significantly under time pressure, especially within the conventional incremental group. Low-skill-confidence participants reported higher overall arousal than those with high-skill confidence. Self-assessed and externally assessed quality of the fillings were not associated. Conclusions: Neither skill confidence nor self-assessed filling quality reliably reflected externally assessed filling quality. Although neither skill confidence nor the use of the bulk-fill base technique affected quality, both appeared to reduce time-pressure-related arousal.