Evidence-practice gap for dental sealant application: results from a dental practice-based research network in Japan

Abstract

Purpose: The study aims were: (i) to examine dentist practice patterns regarding treatment recommendations for dental sealants; and (ii) to identify characteristics associated with this recommendation.

Methods: The study was performed using a cross-sectional questionnaire survey (Clinicaltrials.gov registration number NCT01680848). Participants were Japanese dentists (n = 282) recruited from the Dental Practice-based Research Network Japan. Three clinical photographs of the occlusal surface of a mandibular first molar were presented, portraying increasing depths of cavitation in a 12-year-old patient with high caries risk. Sealants would be an appropriate treatment in all three scenarios. We asked about the treatment decision for each case. We then performed multiple logistic regression analyses to evaluate associations between the decision to recommend sealants, and dentist, patient and practice characteristics.

Results: Responses were obtained from 189 dentists (response rate = 67%). In the hypothetical scenarios, dentists' recommendations for sealants for the 12-year-old patient varied from 16% to 26% across the three hypothetical clinical scenarios. Multiple logistic regression analysis indicated that dentist agreement with the efficacy of assessment for caries risk showed a significant association with the percentages of patients receiving sealants.

Conclusions: Dentist practice patterns for sealant treatment recommendation show changes that are dependent on caries severity. The dentists' recommendations for sealants for the 12-year-old patient were low for all three selected scenarios, based on indications for sealants in the American Dental Association guidelines. Recommending a sealant showed a significant relationship with the dentist having a higher agreement with efficacy of caries risk assessment.

Keywords: Dental sealant; clinical epidemiology; dental practice patterns; evidence-based dentistry; evidence-practice gap; practice-based research.

© 2016 FDI World Dental Federation.

Figures

Figure 1.

Level of lesion severity/depth of occlusal lesion. Reprinted from Espelid et al., with permission. Question 1: Please circle the letters which correspond to the treatment codes you would recommend for each of the three cases. You may circle more than one treatment code per case: Suppose the patient is a 12-year-old child with no relevant medical history. The patient is in your office today for the first time for a routine visit. She has five restorations and moderate plaque. A rubber dam cannot be used. Treatment codes: (a) No treatment today, follow the patient regularly, (b) in-office fluoride, (c) recommend non-prescription fluoride, (d) prescription for fluoride, (e) use sealant or unfilled resin over tooth, (f) chlorhexidine treatment, (g) minimal drilling and sealant, (h) minimal drilling and preventive resin restoration, (i) air abrasion and a sealant, (j) air abrasion and preventive resin restoration, (k) amalgam restoration, (l) composite restoration, (m) indirect restoration.