National Comparison of Pediatric Dental Treatment Decisions by Practice Environment

Objectives: Determine the impact of practice environment on treatment decision in the primary dentition.
Methods: A survey was sent to 7934 (dental school faculty, AAPD members, and private practice dentists). Participants were presented a series of 10 clinical cases with varying degrees of severity (ICDAS 2-6), each presented as two scenarios, with and without radiographs via Qualtrics survey and provided a bank of non-invasive and/or invasive treatment options. Non-invasive treatment options ranged from no-treatment, fluoride and dental sealants, and invasive treatment options ranged from filling to crown and extraction. Clinically, 1 lesion was ICDAS 2, 1 ICDAS 3, 4 ICDAS 4, 3 ICDAS 5, and 1 ICDAS 6. Radiographically, 6 of 10 lesions penetrated the outer dentinal 1/3, 1 the middle 1/3, 3 the inner 1/3. Comparisons of treatment decision between groups (dental school faculty, private practice and corporate dentists) were performed per scenario.
Results: Out of the 7934, response rate was 12.9% (N=1026) with 834 qualified responses. Participant’s age ranged from 25 to 82 (6.9% were 25-29; 34.7% 30-39; 20.9% 40-49 years; 15.9% 50-59; and 21.6% 60+). Participants were analyzed with respect to their clinical environment: private practice, academic, corporate practice, or a combination thereof. In 98% of group comparisons, there was no significant difference in treatment decisions. Clinicians that worked in a combination of private practice, academic, and corporate practice environments treated patients differently than those that worked in private practice (P < 0.05) in 35% of scenario presentations.
Conclusions: In almost all comparisons of treatment decisions in the tested clinical environments, there were no statistically significant differences between practitioners. The few statistical significant results found can be explained by the chance occurrence of significance in multiple comparisons and no practical significance can be attached.