Assessment of primary caries lesion depths in Dental PBRN practices

Objective: To investigate the ability of Dental Practice-Based Research Network (DPBRN; www.DPBRN.org) dentists to assess the depth of primary caries lesions being treated in their practices. We also investigated the lesion depths at which DPBRN dentists intervene with a restoration. DPBRN comprises practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; HP/MN: dentists employed by HealthPartners and in private practice from the Minneapolis, Minnesota area; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente Center for Health Research; and SK: Denmark, Norway, and Sweden. Methods: To date, 129 practitioner-investigators (out of 212 anticipated) collected data on 4966 consecutive primary caries lesions to be restored in 3325 patients. Using whatever diagnostic methods they typically use in their clinical practices (e.g., dental explorers, radiographs, transillumination, optical techniques), practitioner-investigators estimated caries lesion depth pre-operatively and post-operatively. Depths were recorded as being in the outer ½ (E1) or inner ½ (E2) of enamel, or in the outer 1/3 (D1), middle 1/3 (D2) or inner 1/3 (D3) of dentin. Results: Most restorations were placed to treat lesions that had extended to a D1 (42%) depth, followed by D2 (33%), D3 (14%), E2 (8%), and E1 (3%) depths. Pre-operative assessment of lesion depth was more concordant with its post-operative assessment when the lesion was at an advanced stage: 87% concordance with post-operative assessment when the pre-operative assessment was at D3 depth; compared to 69% concordance when the pre-operative depth was at D2; 64% for D1; 55% for E1, and 51% when the pre-operative depth was judged to be at the E2 level. Conclusion: Practitioner-investigators can identify and discriminate lesion depths, and their pre-operative and post-operative assessments are more concordant when pre-operative assessments are into the dentin. Some DPBRN practitioner-investigators do intervene surgically when pre-operative lesion depths are in the enamel. Support: U01-DE 16746, U01-DE 16747.