Non-invasive caries management: dentist and practice staff perceptions

The Monitor Dental Practice Program is the first study being undertaken in Australasia to establish the cost-effectiveness of a structured non-invasive approach, the Caries Management System (CMS), to treat tooth decay compared with ‘usual care' as provided by a range of city, suburban, and rural dental practices in fluoridated and non-fluoridated communities. A qualitative study of patient and professional experiences is being undertaken in conjunction with the cost-effectiveness analysis. Objectives: To (1) understand dentist and practice staff perceptions and expectations in adopting a non-invasive approach to caries management and (2) develop recommendations for best practice concerning the reorientation of healthcare delivery towards this non-invasive approach. Methods: This qualitative study drew primarily on an established systematic methodology, grounded theory procedures. The final sample will include staff and patients from four practices which have implemented this program. This study describes analysis of data from the first practice sampled. Participants provided a detailed narrative and explanation of their experience in adopting and implementing the CMS. Results: In this practice, the CMS successful implementation was a process of refocusing the evolving, taken-for-granted norms of dentistry towards dental caries prevention and its non-invasive management, a process we refer to as preventive enculturation. This process entangled the adoption of practical knowledge, the regaining and maintaining of profit, the shifting of dental practice logistics, and the solving of scheduling issues. As a consequence, dentists and practice staff matured as a unit that provided a distinct treatment option for their patients. Conclusion: Enculturation occurred through (1) selling prevention and coming to believe in its intrinsic worth, and in oneself as a professional; (2) embracing the danger of novelty; (3) learning by doing (including teaching); and (4) allowing team members and patients to find their own way of practicing prevention.

Acknowledgement: Oral Health Foundation, University of Sydney