Dentists' Clinical Decisions Often Conflict With Research

Laird Harrison

January 10, 2014

Dentists' clinical decisions conflict with evidence from research about third of the time, a new survey shows.

The study, published in the January issue of the Journal of the American Dental Association, underscores the lag in time between research findings and clinical practice.

"Documenting the gap between clinical practice and published research findings is an important, albeit sometimes uncomfortable, first step toward being able to improve quality of care and patient outcomes," write Wynne E. Norton, PhD, an assistant professor of public health at the University of Alabama at Birmingham, and colleagues.

Although previous studies have already established such a gap with regard to specific procedures, the authors wanted to measure it across multiple scenarios. For that purpose, they surveyed 591 dentists in the Dental Practice-Based Research Network, which is 1 of 3 regional networks established by a grant from the US National Institute of Dental and Craniofacial Research.

The network includes 4 main regions: Alabama/Mississippi, Florida/Georgia, Minnesota (which consists of practitioners in the Health Partners Dental Group and other community practitioners), and Permanente Dental Associates in Oregon and Washington.

The survey consisted of 5 questions about caries diagnosis and treatment, 2 questions about deep caries diagnosis and treatment, 1 question about third molar extraction, and 4 questions about restoration diagnosis and treatment.

For example, participants looked at 2 clinical photographs of unrestored occlusal surfaces of a mandibular left first molar that had some brown discoloration but no cavitation, together with a description of the patient, and stated how they would treat the surfaces.

If they answered "amalgam restoration," "composite restoration," or "indirect restoration," their responses were considered inconsistent with published evidence. In contrast, if they answered "any noninvasive restorative procedure," their responses were considered consistent with current evidence.

In the section on third molars, researchers considered the clinicians' responses to be consistent with published evidence if they chose 1 of 2 statements of philosophy: either "I recommend removal of third molars if they are asymptomatic but have a poor eruption path (e.g., full/partial impaction) or do not appear to have sufficient space for eruption," or "I recommend removal of third molars only if a patient presents with symptoms or pathology associated with third molars."

Overall, the practitioners' had a mean rate of 62% agreement with published evidence.

Female dentists' responses were consistent with the evidence a mean of 70% of the time, vs 67% for men, a difference that was statistically significant (P = .06).

Dentists in the large practices (Health Partners Dental Group and Permanente Dental Associates) were in agreement with the evidence 77% of the time vs 60% of those in smaller practices, a difference that was statistically significant (P < .001).

The authors speculate that dentists in the large practices might be more aware of current evidence because the practices make an organized effort to disseminate evidence-based guidelines.

Dentists who graduated from dental school before 1990 were in agreement 65% of the time, whereas those who graduated in 1990 or later were in agreement 62% of the time (P = .02).

The finding is consistent with research in medicine, the authors write.

The research was supported by the National Institute of Dental and Craniofacial Research, National Institutes of Health. The authors have disclosed no relevant financial relationships.

JADA. 2014;145:22-31. Abstract

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