Relationship between epidemiologic coronal caries assessments and practitioners' treatment recommendations in adults

Caries incidence determinations in adults reflect dentists' treatment decisions as well as epidemiologists' caries assessments because many patients receive treatment between the two assessments that are required to determine incidence. Yet knowledge of the relationship between epidemiologically assessed caries and practitioners' treatment recommendations is poor. In this study, the proportions of practitioners recommending treatment for a tooth, and the reasons for those recommendations, were compared across teeth grouped by their caries status as determined from an epidemiologic assessment. On average, for a tooth deemed carious by epidemiologic assessment, a mean of almost 90% of examining practitioners recommended treatment. Most but not all of these recommendations for treatment of teeth with epidemiologically determined caries were for caries-related reasons. Among teeth classified as sound by epidemiological assessment, the mean proportion of dentists recommending treatment was 11%. For restored, non-carious teeth a mean of 35% of examining dentists recommended treatment. Across all noncarious teeth, 25% of all treatment recommendations were related to caries. The mean patient F increment (number of newly filled surfaces) that would result from treatment recommendations practitioners indicated as being associated with caries was slightly less than one-half of the total F increment. Thus, F increments may substantially overestimate caries incidence.