Community Dent Oral Epidemiol 2015; 43; 68–74 All rights reserved

Ó 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Dentist-specific effects on the longevity of dental restorations

Andreas Dobloug and Jostein Grytten Department of Community Dentistry, University of Oslo, Oslo, Norway

Dobloug A, Grytten J. Dentist-specific effects on the longevity of dental restorations. Community Dent Oral Epidemiol 2015; 43: 68–74 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Abstract – Background: Numerous studies have been carried out on the longevity of restorations. The focus in these studies has been to explain differences in longevity according to characteristics of the patient and type of restoration. No attempts have been made to estimate dentist-specific effects, that is, how much of the variation in longevity can be explained by dentist variation compared with patient variation. If dentist-specific variation is large, this may indicate a need to reassess the way dentists are taught restorative dentistry, or it may indicate a need for further education of qualified dentists. Objectives: To estimate dentist-specific variation in the longevity of restorations in the first permanent molars for children aged 6–18 years in Norway. Methods: The data set encompassed all children born in 1993 who received one or more restorations in their first permanent molars. This encompassed 72 573 restorations for 64 728 children who were treated by 2473 public dental officers. The data were analysed using two multilevel models – mixed-effects logistic regression and mixed-effects linear regression. Results: The dentist-specific variation was low. The intraclass correlation coefficient varied from 0.03 to 0.09 in different specifications. Conclusions: Public dental officers in Norway show a high degree of homogeneity with regard to longevity of restorations. Further improvements in the longevity of restorations can most likely be achieved by preventing secondary caries and by improving the physical properties of materials.

Numerous studies have been carried out on the longevity of restorations [for a review see (1)]. The focus in most of these studies has been to explain differences in longevity according to characteristics of the patient (dental health behaviour, socioeconomic background, dental health status, age) and by type of restoration (amalgam versus composite). One limitation of the studies is that no attempts have been made to estimate dentist-specific effects, that is, how much of the variation in longevity can be explained by dentist variation compared with patient variation. Ideally, we want the dentists’ contribution to be small. In that case, longevity is primarily determined by characteristics of the patient, and not by dentists’ clinical practice. An important part of clinical practice style reflects differences between dentists in cavity design, moisture control, use of anaesthesia, choice of

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Key words: cariology; clinical research; health services research; quality of care; restorative dentistry Jostein Grytten, Department of Community Dentistry, University of Oslo, Post Box 1052, Blindern, 0316 Oslo, Norway Tel.: +47 22 84 03 87 e-mail: [email protected] Submitted 1 October 2013 accepted 10 May 2014

material, technique for application of material and procedure for polishing the restoration (1). If dentist-specific variation is large, this indicates a need to reassess the present way dentists are taught restorative dentistry. Alternatively, this may indicate a need for further education of qualified dentists. An important part of a further education programme would be to improve the skills of dentists who have a high failure rate for their restorations. Conversely, if patient-specific variation is large compared with the dentist-specific variation, the focus should be on measures directed towards the patient, primarily towards strategies to improve patients’ dental health behaviour so that secondary caries can be prevented. In this study, we estimated dentist-specific variation in the longevity of restorations in first permanent molars for children aged 6–18 years in

doi: 10.1111/cdoe.12114

Dentist-specific effects and dental restorations

Norway. The maximum observation period was 12 years, which is considerably longer than for most studies in which longevity of fillings has been examined. In most studies, the observation period has been

Dentist-specific effects on the longevity of dental restorations.

Numerous studies have been carried out on the longevity of restorations. The focus in these studies has been to explain differences in longevity accor...
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