Australian Dentists Research Articles

Australian Dentists' Knowledge of the Consequences of Interpretive Errors in Dental Radiographs and Potential Mitigation Measures.

Dental radiographs, typically taken and interpreted by dentists, are essential for diagnosis and effective treatment planning. Interpretive errors in dental radiographs, stemming from failures of visual and cognitive processes, can affect both patients and clinicians. This survey aimed to assess the dental practitioners' perceptions of the consequences of these errors and potential measures to minimize them. This online anonymized survey assessed Australian dental practitioners' perceptions of the consequences of these errors and potential mitigation measures using ranking, Likert scale, and open-ended questions. The data were analyzed using descriptive statistics and bivariate analysis. Participants identified undertreatment (72%) and legal implications (82%) as the most significant consequences of interpretive errors, whereas severe harm to patients was deemed the least likely. Dental practitioners placed a greater emphasis on maintaining a high level of competence and the well-being of their patients. Utilizing high-quality images (63.9%) and appropriate radiographs (59.7%) were identified as the most effective measures to minimize interpretive errors. Participants showed hesitancy regarding the reliance on machine learning as a clinical decision-making tool. The survey provides valuable practical insights into the consequences and targeted measures to minimize the occurrence of interpretive errors. Efforts to minimize interpretive errors should address patient safety and practitioners' concerns about professional reputation and business viability. The study also suggests further research into the role of machine learning algorithms in reducing interpretive errors in dentistry.

The current attitudes and practices of dentists in Australia towards composite repair: A cross-sectional survey study.

Whether to replace or repair a composite restoration is controversial and varies among clinicians. This study was designed to collect information on the attitudes and practices of Australian dentists towards composite repair. An electronic 16-item questionnaire was distributed online on Australian clinicians' dental forum with a URL address and instructions on completing the survey. The questionnaire remained accessible for 2 months. The data collected were analysed statistically using descriptive, average rank, Pearson chi-square and Kruskal-Wallis tests at α = 0.05. Repair of composite restorations was a widely accepted treatment modality among surveyed dentists. Despite this, approximately half of clinicians reported the prognosis of repaired restorations to be worse when compared to replacement. The most cited indications for repair were partial loss or fracture of the restoration, while the most common reason for repair was because this treatment modality was more conservative in terms of tooth structure removal. Most important patient factor influencing decision to repair composite restoration was caries risk of the patient (n = 50). Most significant situational factor to consider in decision whether to repair was previous (failed) attempts to repair (n = 74). The most important tooth level factor was the proximity of restoration to pulp (mean statistic rank 2.22). The most common composite surface treatment employed by participants bonding to old composite was acid etching (n = 87), and the main reason participants employed their chosen surface treatment was based on personal experience (n = 72). The repair of composite restorations was a commonly performed procedure that is well accepted but may still be viewed as an inferior treatment to replacement by many Australian dentists. Most dentists agreed on indications for repair restorations and surface conditioning techniques, but there was wide variation in opinions overall. Due to the lack of high-quality evidence regarding composite repair techniques, dentists tend to rely on personal experience to guide their clinical decisions.

Treatment options used in the management of people with temporomandibular disorders by Australian dentists and physiotherapists.

Studies documenting the treatments used by dentists in the management of temporomandibular disorders (TMDs) have been undertaken in some countries; however, no such research has been conducted in Australia. No similar studies have been documented for physiotherapists. The aim of the study was to determine the treatment options and referral patterns used by Australian dentists and physiotherapists in managing people with TMDs. Prospective nationwide online questionnaires targeting Australian dentists and physiotherapists were created for Australian dentists and physiotherapists. Seventy-eight respondents (27 dentists; 51 physiotherapists) completed all questions in the questionnaires. Sixty respondents reported actively treating people with TMDs. The treatment options used most frequently by dentists included advice and education, oral appliances, physical agents such as moist heat and medications. The treatment options most frequently used by physiotherapists included manual therapy, exercises, electrophysical agents and advice and education. Referrals were most frequently made to dentists and physiotherapists with experience and/or expertise in managing people with TMDs and to general dentists. Commonly used treatment options were mostly conservative, reversible and evidence-based. More responses are required to draw conclusions representative of Australian dentists and physiotherapists in the management of people with TMDs.

The COVID-19 Pandemic and Dental Professionals' Infection Risk Perception: An International Survey.

A global survey among dentists was used to identify the various impacts of the COVID-19 pandemic on this professional group. Special attention was given to perception and assessment of infection risk. From May to August 2020, the questionnaire was delivered in 36 countries by respective research groups and was completed by 52,491 dental professionals. The survey was designed as a cross-sectional survey based on a previously standardized questionnaire. This study focuses on the part of the questionnaire that deals with the perception of the infection risk of COVID-19 by dentists and their patients. A logistic regression model was used, which consisted of four Likert items as response options and the additional self-reported routine or emergency treatment as the dependent variable. Analysis by continent found that European and Asian dentists were particularly likely to be infected at work (OR = 1.45 95%CI = 1.02/1.84 and OR = 2.68, 95%CI = 1.45/3.22, respectively), while it was likely that Australian dentists did not feel particularly at risk due to low infection rates. Three quarters of Americans treated only emergencies during this survey period, while Europeans (64.71%) and Asians (66.67%) provided mostly routine care. This could affect the Europeans' confidence that they would not be able to protect themselves from infections in the long-term. The COVID-19 pandemic and its impact on dental professionals' infection risk perception is determined by the geographical origin of dentists. This study shows that, especially in high-incidence countries, infection risk perception was higher when dentists tried to provide routine dental procedures to their patients. Dental professionals can offer themselves and their patients good protection by maintaining high standards of hygiene. However, their concerns should be taken seriously and the dental professionals' group that is of great importance for oral health care and prevention, should not be neglected in the future, even in the event of emerging pandemics.

Australian dentists’ knowledge and attitude towards HPV infection

Australian dentists’ knowledge and attitude towards HPV infection

Diagnostic and treatment preferences for cracked posterior teeth.

Longitudinal cracks in teeth are common and often present challenges in diagnosis and management. This study investigated the preferred diagnostic process and treatment modalities for these cracked teeth. Dentists currently registered with Dental Board of Australia and practising within Australia were invited to complete an online Qualtrics-based survey on their perspectives on the presentations, diagnosis, and treatment preferences for cracked teeth. Of respondents, 56.8% chose to place an indirect cuspal-coverage restoration on an asymptomatic cracked vital tooth. When the tooth was mildly cold sensitive, direct cuspal-coverage restoration was favoured (64.9%), while 36.8% preferred placing an orthodontic band in a tooth with biting pain. Respondents had higher odds of recommending indirect restoration when CAD-CAM milling was available on-site or magnification was routinely used, regardless of presenting symptoms. Almost half (46.8%) preferred to extract if the tooth undergoing root canal treatment had a crack with a 5 mm probing pocket depth. Most (71.4%) demonstrated a poor understanding of cracked tooth biomechanics. Australian dentists varied in their diagnostic and treatment preferences for cracked teeth, reflecting a need for more well-controlled clinical studies in the diagnostic process, clinical biomechanics and treatment modalities for these teeth. © 2023 Australian Dental Association.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: An Australian survey.

Background/AimTraumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines.MethodologyA link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student’s T test or one‐way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%.ResultsA total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self‐reported knowledge.ConclusionsThe overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas.

"We will have to learn to live with it": Australian dentists' experiences during the COVID-19 pandemic.

BackgroundAustralian dentists are among the frontline healthcare workers providing dental and oral health care during the COVID-19 pandemic, and therefore have been affected in multiple ways. In this study, we explore their experiences of practising and living in this pandemic.MethodsA qualitative study analysed responses of 333 Australian dentists' who participated in a survey with open-ended questions about the challenges and positive outcomes of practising during the COVID-19 pandemic. The questions were embedded in a national online survey of Australian dentists’ knowledge, preparedness and experiences conducted between March and April 2021. Data were analysed using content analysis.ResultsAustralian dentists reported their challenging experiences to be four-fold, including ‘public health orders and restrictions’, ‘Infection prevention and control measures (IPC), ‘Personal concerns about COVID-19’ and ‘Detracting opinions about COVID-19’. Conversely, they reported positive outcomes in relation to their practice during COVID-19, including ‘Awareness of and adherence to IPC practices’, ‘Teamwork and interpersonal dynamics’, ‘Decompressed workload’, ‘Perceived support’ and ‘unintended positive outcomes’.ConclusionThe COVID-19 pandemic generated several challenges for Australian dentists, but it also engendered some positive outcomes. Understanding of these can help tailor the professional support plans to address the needs and priorities of Australian dentists during the current and future pandemics.

Australian dentists' knowledge, preparedness, and experiences during the COVID-19 pandemic.

BackgroundCOVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists’ knowledge, preparedness, and experiences of managing COVID-19 in Australia.MethodsA cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021.ResultsOf the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads.ConclusionCOVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

Comparison of Dental Benzodiazepine Prescriptions From the U.S., England, and Australia From 2013 to 2018

Benzodiazepines contribute to substance use disorder and are often part of polydrug abuse, most frequently with opioids. Although dental opioid prescribing differs significantly between countries, little is known about the patterns of dental benzodiazepine prescribing. The aim of this study is to compare dental prescribing of benzodiazepines among the U.S., England, and Australia in 2013-2018. Population-level data were accessed from national data sets for each country for dental benzodiazepine prescriptions. Outcome measures of dental benzodiazepine prescribing included: (1) prescribing rates by population for each year and (2) the quantity and relative proportion of benzodiazepines by type for each country. The analysis was conducted in 2020. Between 2013 and 2018, U.S. dentists prescribed 23 times more than English dentists and 7 times more than Australian dentists by population. During the study period, the rate of dental benzodiazepine prescribing decreased in England and the U.S. but increased in Australia. Despite these trends, U.S. dental prescribing rates remained 28 times more than English dentists and 6 times more than Australian dentists in 2018 (U.S., 3.10 prescriptions/1,000 population; England, 0.11 prescriptions/1,000 population; Australia, 0.50 prescriptions/1,000 population). U.S. dentists prescribed a wider variety of benzodiazepines than English and Australian dentists. Diazepam was most commonly prescribed in all countries. In the U.S., triazolam, lorazepam, and alprazolam were next most commonly prescribed. Temazepam was next most frequent in England and Australia. Significant variation in benzodiazepine prescribing rates and types were seen among the countries. To improve patient safety, further investigation into the appropriate use and choices of benzodiazepines in dentistry is needed.

Trends in Australian dental prescribing of antibiotics: 2005-2016.

Prescribing of antibiotics by dentists for surgical prophylaxis or as an adjunct to managing dental infections is a substantial part of the overall landscape for prescribed antibiotics in health care settings. We explored trends in the antibiotic prescribing patterns of Australian dentists over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered dentists subsidized on the Pharmaceutical Benefits Scheme. Australian dentists were responsible for almost 7 million dispensed prescriptions of antibiotics over 12years; an average of 24 prescriptions per year per dentist. The most commonly prescribed antibiotic was amoxicillin, followed by amoxicillin+clavulanic acid and metronidazole. These top three antibiotics constituted more than 80% of all antibiotics prescribed and their use increased dramatically over time. There was a large increase in the prescribing of broad-spectrum antibiotics over time, most of which occurred from 2011 to 2016. Excessive prescribing of broad-spectrum antibiotics runs contrary to national antimicrobial stewardship (AMS) initiatives and guidelines. Multifaceted educational strategies are essential to align prescribing with current best practice. High-level evidence to inform clear guidelines on antibiotic prescribing in dental infections, with audit and feedback, should reduce the inappropriate use of antibiotics in dentistry.

Dispensing Patterns of Medicines Prescribed by Australian Dentists From 2006 to 2018 – a Pharmacoepidemiological Study

ObjectivesDentists are independent prescribers that can prescribe subsidised medicines under the Australian Pharmaceutical Benefits Scheme (PBS). It is hypothesised that increased dental prescribing can partly be accounted for by the growth in both the Australian population and the number of practising dentists. This pharmacoepidemiological study aims to determine the dispensing patterns of medications amongst dentists and to identify trends over time.Materials and methodsData on dental medications under PBS from 2006 to 2018 were accessed. All the dentist-prescribed concessional medicines dispensed at pharmacies in 2018 were included for time trend analysis. Cumulative dispensing counts and defined daily dose (DDD) per 1,000 concessional population days (DPD) were analysed for time trend analysis.ResultsOut of the 56 medications within the dental PBS schedule, the top 20 medicines had a total cumulative dispensing count of 5,058,556, which accounts for 97.4% of the total dispensing count. Eleven out of 20 medicines were antibiotics. Overall, increases were observed for seven out of 20 medicines (amoxicillin + clavulanic acid, clindamycin, ibuprofen, diazepam, oxycodone, tramadol, naproxen) in both dispensing count and trend, as expressed per DPD.ConclusionThis study highlights the increasing dispensing pattern and trends of dentist-prescribed antibiotics, opioids and benzodiazepines. Further investigation may be required to determine whether the medicine use is appropriate. In the future, this could provide new educational opportunities on the appropriate use of medicines for dentists.

221. Comparison of dental antibiotic prescribing between Australia, England, the United States and British Columbia in 2017

BackgroundAntibiotic resistance is recognised as a major public health burden. Dentists overprescribe antibiotics and prescribe for unnecessary indications. Tracking and investigating prescribing practices by healthcare professionals provides insights needed to inform targeted antibiotic stewardship interventions. It is unclear how dental antibiotic prescribing patterns differs between countries. The aim of this study was to compare antibiotic prescribing by dentists in Australia, England the United States (US) and British Columbia (BC).MethodsThis was a cross-sectional study of dispensed dental antibiotic prescriptions between January 1 and December 31, 2017, from Australia, England, US and BC. Dispensed dental antibiotic prescriptions included those from outpatient pharmacies and healthcare settings. Outcome measures included the proportion of dental antibiotic prescriptions by location and prescribing rates by population.ResultsEnglish dentists prescribed 1.6 times more antibiotics than those in Australia, and dentists in BC and US prescribed around twice more than Australian dentists. (Australia: 33.2 prescriptions/1000population; England: 53.5 prescriptions/1000population; US: 72.6 prescriptions/1000 population; BC: 65.0 prescriptions/1000 population). The types of antibiotics prescribed were similar across all countries, where penicillins were the predominant class prescribed (66.8–80.5% of antibiotic prescriptions). US dentists and dentists in BC prescribed more clindamycin compared to the dentists in other countries.ConclusionDentists in the US, England and BC prescribed at relatively higher rates than Australian dentists. The findings from this study should initiate an evaluation by dentists of their prescribing practices and responsibilities regarding their contribution towards antibiotic resistance. Further investigations can be aimed at determining country-specific factors that influence dental antibiotic prescription.DisclosuresLeanne Teoh, BDSc(Hons) BPharm(Hons), Australian Government Research Training Program Scholarship (Other Financial or Material Support, Scholarship awarded for the PhD candidature)

How well prepared are Australian dentists for retirement? A survey of practitioners aged 50 and above

To determine how financially prepared Australian dentists are for retirement. Information was collected in the Dentist Retirement Intentions Study from members of the New South Wales branch of the Australian Dental Association, all of whom were aged over 50 years. One way ANOVAs were used to test for differences between groups of variables. A forward stepwise multivariate regression identified predictors of the expected value of savings at retirement. It was found that while there was variation in preferred retirement income, there was general agreement that this preferred retirement income would be achieved. Current assets mostly totalled between dollars 250,000 and dollars 2 million (Australian dollars), with 35% of assets held in the family home. However, 7% of dentists had no net savings or were in net debt. Half the surveyed dentists predicted their savings at retirement to be more than $2 million. Superannuation was the most commonly cited predicted source of retirement funding. Most, but not all, dentists are generally well prepared for retirement. They have a significant amount of wealth, which is above that generally recommended for a comfortable living standard in retirement in Australia, they have this wealth stored in easily accessed, high return assets, and they also intend to spend this wealth on financing their retirement rather than running down their capital.

Financial contributions made by patients towards dispensed medicines prescribed by Australian dentists from 2006 to 2018: a cost-analysis study.

Objective This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results Cumulative PC over the study period for dental PBS prescriptions was A$28783361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2214105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59756 per year; r=0.98: P<0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic? Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add? This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners? This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule.

Dispensing patterns of emergency medicines prescribed by Australian dentists from 1992 to 2018 – a pharmacoepidemiology study

As the population ages, dentists are likely to encounter medical emergencies due to metabolic factors and polypharmacy. To date, there have been no documented studies in Australia that have analysed the prescription rate of Pharmaceutical Benefits Scheme (PBS)-funded emergency medicines for dentists. Therefore, this pharmacoepidemiology study aims to describe the dispensing patterns of emergency medicines as prescribed by dental practitioners, related to medicines covered by the Australian PBS system. Data on dental medications used for emergencies, under the PBS, from 1992 to 2018, were accessed. Cumulative dispensing counts were calculated. Data on medications that were not utilised were also collected in the form of the crude cumulative count. Out of the 56 medications on the dental PBS schedule, eight were utilised for medical emergencies, with a total of 432 prescriptions on a national level, over 27years. The commonly utilised lifesaving medicines of adrenaline, glucagon, as well as glyceryl trinitrate, had a total prescription count of 147, 88 and 27 respectively. Medicines used for opiate overdose; naloxone, had a total prescription count of one. Only one medicine (benztropine injection) for medical emergencies had a prescription count of 0. This study highlights the dispensing patterns of medicines prescribed by dentists for emergency scenarios. Although this study did not assess the appropriateness of use of the emergency medicines, further investigation may be required to ensure the future safety of patients when encountering emergency scenarios.

Dental opioid prescribing rates after the up-scheduling of codeine in Australia

The misuse of pharmaceutical opioids is a major public health issue. In Australia, codeine was re-scheduled on 1 February 2018 to restrict access; it is now only available on prescription. The aim of this study was to measure the change in dental opioid prescriptions, one year before and after the codeine re-scheduling in Australia and to assess dental prescribing rates of opioids for 2018 by population and by clinician. Data was extracted for dental opioids for the year immediately prior and after the codeine up-schedule (1 February 2017-31 January 2019) from the publicly-available national prescription database (Pharmaceutical Benefits Scheme). Descriptive statistics, T-tests and odds ratios were used to identify significant prescribing differences. Codeine, codeine/paracetamol, oxycodone and tramadol use increased significantly the year after the codeine restriction than the previous year (13.8–101.1%). Australian dentists prescribed 8.6 prescriptions/1,000 population in 2018, with codeine/paracetamol accounting for most prescriptions (96%). The significant increase in opioid prescribing highlights that Australian dentists may be contributing to the misuse of pharmaceutical opioids. Educational efforts should be targeted at the appropriate use of opioids and patient selection. Dentists should be added to the prescription monitoring system SafeScript so they can make informed decisions for patients who are potentially misusing opioids.

Association between pulp and periapical conditions and dental emergency visits involving pain relief: epidemiological profile and risk indicators in private practice in Australia.

To assess the prevalence of dental emergency visits (DEV) involving pain relief and their relationship with socio-economic and clinical factors in an Australian representative sample in the primary care setting. Data on reason for visit and patient characteristics were collected from a representative random sample of Australian dentists in private practice surveyed in 2009-2010. Information regarding socio-economic (gender, age, health insurance) and clinical factors (number of teeth, number of decayed teeth, diagnosis and reason for visit [DEV, check-up, other reasons not involving pain relief]) were retrieved from compiled questionnaires. Descriptive statistics were reported, and Poisson regression models were used to assess the association between socio-economic and clinical factors and DEV. Prevalence ratio (PR) and 95% confidence interval (CI) were calculated. A total of 1148 dentists responded (67%), resulting in records from 6504 patients. The overall prevalence of DEV was 20.8%. The unadjusted analysis, according to the reason of visit, revealed the following predictors for DEV: male gender (PR=1.18; 95% CI=1.08-1.29), age 18-64years (PR=2.70; 95% CI=2.19-3.33) and over 65years (PR=2.64, 95% CI=2.10-3.32), uninsured patients (PR=1.36; 95% CI=1.24-1.49), patients with <20 teeth (PR=1.19; 95% CI=1.06-1.33), decayed teeth (PR=1.64; 95% CI=1.48-1.81). After adjustment for confounding factors (gender, age, insurance status, number of teeth and decayed teeth) apart from 'dental trauma' (PR=1.37), all remaining diagnoses had lower PR ('other' PR=0.19, 'decay' PR=0.34, 'periodontal' PR=0.51, 'failed restoration' PR=0.45) compared with 'pulp/periapical disease'. In the primary care setting, the diagnoses 'pulp/periapical' and 'dental trauma' had a stronger association with DEV compared with visits not involving relief of pain. Both socio-economic (male gender, older age and uninsured individuals) and clinical factors (tooth loss, decayed teeth, endodontic diseases and dental trauma) were identified as independent risk indicators for DEV in this population. Future public health policies should include specific preventive strategies addressing these factors, aiming to reduce the need for DEV.

Assessment of Australian Dentists' Treatment Planning Decisions Based on Diagnosis

IntroductionAn accurate diagnosis is required for the appropriate management of endodontic conditions. It is unknown whether the specific descriptive terminology used in diagnosis influences treatment decision making. The aim of this study was to determine whether treatment choices made by dentists are influenced by the diagnostic terminology used. MethodsOne hundred ninety-four dentists in Australia were recruited through the Australian Dental Association to complete an online survey regarding 14 endodontic cases. Respondents selected treatment options based on a given diagnosis and radiograph. Data were analyzed using SPSS software (Version 26; IBM Corp, Armonk, NY) and the exact McNemar test to determine if there was a difference between treatment choices for matched diagnoses with different terminology. ResultsMore dentists chose to manage irreversible pulpitis operatively when the descriptive term chronic was used compared with asymptomatic (93.3% vs 59.8%, χ12 = 57.69, P < .005). This trend was repeated when using chronic or asymptomatic to describe apical periodontitis (96.9% vs 89.7%, exact P = .004) and apical abscesses (99.0% vs 83.5%, χ12 = 104.125, P < .005). The differences between acute and symptomatic were less dramatic but still presented significant differences in treatment choices for an apical abscess described as “primary acute” or “secondary acute” compared with “symptomatic” (82.0% and 96.4% vs 93.3%, P < .05). ConclusionsDescriptive terminology, specifically the terms acute and chronic as opposed to symptomatic and asymptomatic, used in the diagnosis of endodontic conditions did influence whether clinicians chose operative management or nonoperative management. Further research is warranted to determine the extent of this influence among dentists.

Treatment preferences for deep caries lesions among Australian dentists.

There is a global disparity in managing deep caries lesions and evidence-based strategies are not always followed. The aim of this study was to gain insight into current practices of Australian dentists fordeep caries management and to determine their procedural and materials choices. An online questionnaire was sent to 1988randomly selected practitioners across Australia asking their choice of treatment in a tooth showing symptoms of reversible pulpitis and deep caries. A total of 255 (12.6%) practitioners responded. About 85% of respondents chose selective caries removal to selective removal (SR) while 15% chose non-selective removal to hard dentine. Respondents whose preferred approach was SR had greater odds in believing that incomplete caries removal alone would not have any effect on pulp vitality (OR=5.20) and had greater odds of thinking that peripheral seal was more important than other factors (OR=3.50). They also had lesser odds of believing that placing a liner would reduce postoperative sensitivity (OR=0.269) and lesser odds of thinking that removal of all bacteria or carious dentine was important when placing a restoration (OR=0.196). Most Australian dentists reported practising evidence-based carious tissue removal strategies and accepted the concept of selectively leaving carious dentine under a sealed restoration.