Dentists' variability in restorative decisions, microscopic and radiographic caries depth

Area of Science:

• Dentistry
• Radiology
• Public Health

Background:

• Dental caries diagnosis relies on radiographic interpretation.
• Variability in radiographic interpretation can impact treatment decisions.

Purpose of the Study:

• To assess the influence of perceived caries depth on dentists' restorative decisions.
• To quantify the relationship between radiographic interpretation, true caries depth, and restorative actions.

Main Methods:

• 17 dentists evaluated 5168 approximal tooth surfaces using bitewing radiographs.
• Radiographic interpretations were compared against true caries depth determined by microscopy.
• Regression analyses estimated variability in restorative decisions linked to radiographic and microscopic caries depth.

Main Results:

• Significant variation existed in dentists' restorative and depth perception decisions.
• Perceived radiographic caries depth explained 50% of the variability in restorative decisions (range 29%-69%).
• True microscopic caries depth explained only 18% of the variability, with high rates of false positive/negative decisions.

Conclusions:

• Dentists' perception of caries depth from bitewing radiographs is a major factor in restorative decisions.
• This perception's influence is substantial but highly variable among individual dentists.
• Radiographic interpretation plays a significant, albeit inconsistent, role in managing approximal dental caries.