Den terapeutiske beslutningsproces ved carieslasioner uden abenlys kavitetsdannelse i primare tander. (Danish)

BACKGROUND - Dental caries diagnosis and management have changed over time. AIM - To identify the treatment decision-making process performed by paediatric dentists, after caries detection using CAST instrument (Caries Assessment Spectrum and Treatment), for enamel (CAST 3) and non- cavitated dentin caries lesions (CAST 4) before and after analysing radiographic images. DESIGN - Seventy-four paediatric dentists were invited to participate. Twelve clinical cases were presented online, and treatment decisions before and after the analysis of bitewing radiographs were evaluated. RESULTS - Sixty-one specialists answered the questionnaire. The necessity for radio-graphs was significantly associated with the presence and depth of the caries lesion (P < 0.0001). CAST 3 lesions were preferentially monitored before and after the radiographic assessment. For CAST 4 lesions limited to the outer half of dentin, treatments indicated before and after radiographic analysis were sealant (33%) and restoration (40%). For the lesions in the inner half of dentin, restoration was the most cited before (45%) and after (84%) radiographs. The radiographic depth was the only significant independent variable when “change in the treatment option” was analysed by the regression model (P < 0.001). CONCLUSIONS - Enamel lesions were treated through less invasive treatments. Radiographs influenced the decision, especially for the lesions that involved the inner half of dentin. [ABSTRACT FROM AUTHOR]

BAGGRUND - Diagnostik og behandling af caries har ændret sig i løbet af de senere år. FORMÅL - At kortlægge den terapeutiske beslutningsproces blandt børnetandlæger, som anvender værktøjet CAST (Caries Assessment Spectrum and Treatment) til registrering af emaljecaries (CAST 3) og dentincaries uden kavitetsdannelse (CAST 4), før og efter analyse af røntgenoptagelser. DESIGN - 74 børnetandlæger blev opfordret til at deltage i undersøgelsen. 12 kliniske tilfælde blev præsenteret via internettet, og behandlingsbeslutninger blev bedømt før og efter analyse af røntgenoptagelser. RESULTATER - 61 tandlæger besvarede spørgeskemaet. Behovet for røntgenoptagelser hang signifikant sammen med carieslæsionens dybde (P < 0,0001). For CAST 3-læsioner var observation den foretrukne behandling både før og efter radiologisk vurdering. For CAST 4-læsioner i den yderste halvdel af dentinen var forsegling (33 %) den foretrukne behandling inden radiologisk vurdering, og fyldning (40 %) var den foretrukne behandling efter radiologisk vurdering. For læsioner i den inderste halvdel af dentinen var fyldning den foretrukne behandling både før (45 %) og efter (84 %) radiologisk vurdering. Læsionernes radiologisk bedømte dybde var den eneste signifikante uafhængige variable, når “ændring af behandlingsplan” blev underkastet regressionsanalyse (P < 0,001). KONKLUSION - Emaljelæsioner blev behandlet med mindre invasive indgreb. Røntgenoptagelser påvirkede de terapeutiske beslutninger, især ved læsioner, der inddrog den inderste halvdel af dentinen. [ABSTRACT FROM AUTHOR]

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