Patterns of restorative practice related to clinical experience of Michigan dentists

• Main Author: Al-Badr, Abid Hamoud
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2007
• Subjects: Dental care; Dentistry; Public health; Studies
• ISBN: 0549424946; 9780549424949

Introduction. The study was conducted to investigate the survival of restorations (amalgam, tooth-colored, and crown restorations) among Michigan dentists, and the association of these patterns with time since licensure (a proxy for clinical experience), provider gender, and change of dentist. A number of studies have investigated patterns of restorative treatments and possible associations with patient, provider, and procedure factors. However, those that focused on provider characteristics were compromised either by their study designs (e.g., cross sectional surveys), or by conflicting findings. Methods. The data used in this study come from the Delta Dental Plan of Michigan insurance database with data accumulated over 14 years. This database includes claims from over 6,000 dentists. A subset of data was used for the study. This subset included those enrolled throughout the study period, and who also had at least one restorative procedure within that time period, with a maximum of one tooth per person. Analysis of data included the construction of a multivariable survival model that used the Cox proportional hazard approach, and the survival time of restorations as the outcome of interest. The model also included covariables for the dentist's characteristics (gender, experience, and indicator for change of dentist), patient's factors (age and gender), and procedure's characteristics (material and size) as the independent variables. Results. A total of 189,308 cases were analyzed, with adjustment for patient, procedure and provider covariables. No clinically meaningful associations were found between survival of dental restorations and provider's clinical experience for any type of restorations. Similarly, provider's gender did not show any association with the survival of restorations. As for change of dentist, in which the variable was measured by focusing on the patient history of dental visits, rather than the dentist who actually did the replacement, analysis showed a greater association between patients who change their dentists and failure of dental restorations when compared with patients who didn't change their dentists. On the other hand, analysis in which change of dentist is measured by focusing on the dentist who did the replacement procedure, rather than the patient's visit history, revealed no significant association between failure of dental restorations and change of dentists. Conclusion. The results suggest that the clinical experience and gender of the dentist are not associated with the survival of restorations. The results also suggest that the association between change of dentist and failure of dental restorations is related to the patients who change dentists, but that different dentists are not more likely to replace restorations than the dentists who originally placed them.