Abstract
This cross-sectional study aimed to determine the radiographic criteria used by final-year dental students when defining the need for restorative treatment for proximal caries, as well as investigating potentially associated factors in this therapeutic decision. A questionnaire with two schematic diagrams presenting five levels of proximal lesion penetration was administered to students attending the six private and three public dental schools in the state of Rio Grande do Sul, Southern Brazil. Absolute and relative frequencies were described and inferential statistics involving Chi-square and McNemar tests and simple logistic regression were carried out to assess variations in therapeutic decisions related to patient dentition (deciduous/permanent) and gender, age and dental school (public/private). Of the 346 dental students assessed, 28.6% (99/346) indicated restorative treatment for lesions restricted to the enamel in deciduous teeth and 38.2% (132/346) indicated the same for permanent teeth, revealing a statistically significant difference (p = 0.001). Student gender and age were not associated with the therapeutic decision; however, a significant difference between dental schools was found when comparing restorative criteria in deciduous (p < 0.001) and permanent molars (p < 0.001). The odds of restorative decision in permanent teeth when the caries lesion was restricted to the enamel was 72% higher for students graduating from private schools compared to public schools (Odds Ratio: 1.72; 95% Confidence Interval: 1.03-2.90). These data demonstrate a large variation between the therapeutic decisions regarding proximal caries reported by final-year dental students and suggest that deep reflection is needed on the part of faculty in order to provide an evidence-based education.
Highlights
For many years, therapeutic decision making in relation to proximal caries lesions was based on the radiographic aspects of the same
Considering the dichotomized outcome, observation showed that 181 final-year students (52.3%) indicated restorative treatment in both dentitions only when the lesion reached the dentine, while 66 (19.1%) suggested restorative treatment in both dentitions for lesions extending up to the dentino-enamel junction (DEJ) (Table 1)
The remaining students consisted of discordant pairs, since they indicated distinct cutoff points for each of the dentitions: 33 (9.5%) students indicated that enamel should be restored in deciduous dentition lesions, but that in the permanent dentition the lesion would have to reach the dentine to characterize immediately required restorative treatment
Summary
Therapeutic decision making in relation to proximal caries lesions was based on the radiographic aspects of the same. Following the clinical advances and the new knowledge acquired on the events that lead to a demineralization process, the related literature has contributed to basing decisions on sustainable evidence.[1,2,3] Even though several paradigmatic publications exist regarding this subject, some studies reveal that, when using the radiographic criteria, decisions appear to reflect the understanding of inevitable and rapid progress of caries lesions.[1,2,4]. Comprehension of this process by dental professors and professionals has been the object of several studies. The foundation and evolution of the decisions made by final-year students has instigated new research.[4,5,6]
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