Restorative treatment practices and dentist-related factors

Palotie U. Restorative treatment practices and dentist-related factors. Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Helsinki, Finland, 2009. 72pp. ISBN 978-952-92-6379-0. This study aimed at elucidating real-life aspects of restorative treatment practices. In addition, dentists' views and perceptions of and variation in restorative treatment practices with respect to dentist-related factors were evaluated. Reasons for placement and replacement of restoration, material selection, posterior restoration longevity, and the use of local anesthesia were assessed on two cross-sectional data sets. Data from the Helsinki Public Dental Service (PDS) included details on 3057 restorations performed by dentists (n=134) during routine clinical work in 2001. The other PDS data from Vantaa were based on 205 patient records of young adults containing information on 1969 restorations investigated retrospectively from 1994-1996 backwards; 51 dentists performed the restorations. In addition, dentists’ self-reported use of local anesthesia and estimates of restoration longevity were investigated by means of a nationwide questionnaire sent to 592 general dental practitioners selected by systematic sampling from the membership list of the Finnish Dental Association in 2004. All data sets included some background information on dentists such as gender, year of birth or graduation, and working sector. In PDS in 2001, primary caries was the reason for placement of restoration more often among patients aged under 19 years than among older patients (p<0.001). Among patients over 36 years of age, replacements represented the majority. Regarding dentist-related factors, replacements of restorations were made by younger dentists more frequently than by older dentists (p<0.001). In PDS in 1994-1996, the replacement rate of posterior restorations was greater among female dentists than among male dentists (p=0.01), especially for amalgams (p=0.008). The mean age of replaced posterior restoration among young adults was 8.9 (SD 5.2) years for amalgam and 2.4 (SD 1.4) years for tooth-colored restorations, the actual replacement rate for all existing posterior restorations being 7% in PDS in 19941996. Of all restorative materials used, a clear majority (69%) were composites in PDS in 2001. Local anesthesia was used in 48% of cases and more frequently for older patients (55%) than for patients aged under 13 years (35%) (p<0.001). Younger dentists more often used local anesthesia for primary restoration than did the older dentists (p<0.001), especially for primary teeth (p=0.005). Working sector had an impact on dentists’ selfreported use of local anesthesia and estimates of restoration longevity; public sector dentists reported using local anesthesia more frequently than private sector dentists for Class II (p=0.04) and for Class III restorations (p=0.01). Private sector dentists gave longer estimates of posterior composite longevity than public sector dentists (p=0.001). In conclusion, restorative treatment practices seem to vary according to patient age and also dentist-related factors. Replacements of restorations are common for adults. For children, clear underuse of local anesthesia prevails. Author’s address: Ulla Palotie, Department of Oral Public Health, Institute of Dentistry, University of Helsinki, P.O. Box 41, FI-00014 Helsinki, Finland. E-mail: [email protected]. LIST OF ORIGINAL PUBLICATIONS This thesis is based on the following original articles, which are referred to in the text by their Roman numerals. In addition, some unpublished data are presented. I Palotie U and Vehkalahti M. Restorative treatment and use of local anesthesia in free and subsidized public dental services in Helsinki, Finland. Acta Odontologica Scandinavica 2003; 61: 252-256. II Palotie U and Vehkalahti M. Reasons for replacement and the age of failed restorations in posterior teeth of young Finnish adults. Acta Odontologica Scandinavica 2002; 60: 325-329. III Palotie U and Vehkalahti MM. Use of local anesthesia in restorative treatment for adults in Finland. Acta Odontologica Scandinavica 2007; 65: 129-133. IV Palotie U and Vehkalahti MM. Finnish dentists’ perceptions of the longevity of direct dental restorations. Acta Odontologica Scandinavica 2009; 67: 44-49. These publications have been reprinted with the kind permission of their copyright holder. Not to be printed without the publisher’s permission.