Erosive Tooth Wear Perception Among US Dentists: A Pilot Study

Objectives: To examine dentists’ ability to diagnose and manage erosive tooth wear (ETW) relative to dental caries.
Methods: As part of a larger, ongoing study, we present here focus group (n=12) interim data from a US Midwestern Dental School. Dentists viewed standardized clinical images of teeth (sound, with ETW or caries, at different severity levels) and provided their diagnostic and management decisions. Using a website we created, dentists diagnosed and determined management for teeth with no, initial, moderate, or severe signs of ETW/caries. Responses were combined and compared to a benchmark, achieved from the consensus opinion of a group of expert clinicians. We conducted paired samples t-tests comparing ETW ratings to those of caries and sound teeth.
Results: Dentists more accurately diagnosed teeth that were sound (81.3%) and affected by caries (75%) than by ETW (29.6%; t(11)=5.66, p<.01, t(11)=4.92, p<.01 respectively). At similar levels of severity, dentists more accurately diagnosed initial caries (55.6%) than initial ETW (13.9%; t(11)=3.19, p=.01), moderate caries (80.6%) than moderate ETW (22.2%; t(11)=4.71, p<.01), and severe caries (88.9%) than severe ETW (52.8%; t(11)=4.73, p<.01). Similar patterns emerged for ratings of clinical management. Dentists’ decisions corresponded to the benchmark more frequently for sound teeth (79.2%) and teeth affected by caries (94.4%) than by ETW (57.4%; t(11)=6.54, p<.01, t(11)=8.04, p<.01 respectively). At similar levels of severity, dentists’ management decisions corresponded to the benchmark more frequently for teeth affected by initial caries (88.9%) than ETW (25%; t(11)=8.37, p<.01), moderate caries (94.4%) than ETW (72%; t(11)=2.00, p=.07), and severe caries (100%) than ETW (75%; t(11)=4.18, p<.01).
Conclusions: Preliminary results suggest that dentists’ abilities differ when comparing dental caries to ETW. Specifically, dentists were less accurate when diagnosing and managing ETW compared to caries, especially at early stages. Replication of these findings at larger scale would indicate a need for greater training.