Dentists Clinical Decision-Making for Erosive Tooth Wear: An Online Study

Abstract

Objective: Erosive tooth wear (ETW) is an irreversible loss of dental hard tissue. This pilot study examined dentists’ ability to diagnose and manage ETW relative to sound and caries-affected teeth. Methods: Dentists recruited through the Indiana Dental Association (N=36) participated in an internet-based survey, containing twenty-two standardized images of buccal and occlusal surfaces of teeth (sound, ETW, or caries). For each image, they provided diagnosis (presence and differentiation) of dental condition, confidence in their judgment, management need, and likelihood to recommend specific management strategies. Dentists made these judgments for teeth with no, initial, moderate, or severe ETW/caries. Results: Dentists demonstrated poor detection of ETW compared to sound teeth and caries at each level of severity. The dentists were less confident, less able to correctly diagnose and manage ETW, and less likely to recommend most management strategies for ETW than caries at each level of severity. Conclusions: Dentists had difficulty correctly diagnosing (both detection and differentiation) and managing ETW, across all severity levels and particularly in early stages. These difficulties were particularly apparent when compared to caries. The current results are clinically relevant given the importance of early diagnosis for ETW management.