Fatores que interferem na decisão de alunos de graduação quanto à abordagem de lesões cariosas em dentes decíduos

Abstract

Caries is one of the most frequent diseases in childhood, approximately 50% of preschool children in different countries have caries experience. In addition, the choice of intervention depends on number of factors, then making a treatment decision is a challenging task. The use of minimal intervention should be encouraged and incorporated to teaching of Cariology. This study aimed to evaluate factors that influence undergraduate students in the treatment decision in the face of carious lesions in deciduous teeth. Dentistry undergraduate students from Brazilian public and private higher education institutions participated in the study. An online questionnaire, composed of questions related to the student and clinical cases was developed and sent by email and Whatsapp. Outcome variable was the treatment decision, with the following options: follow-up, topical application of professional fluoride, silver diamine fluoride, resin or ionomeric sealant, selective carious tissue removal and restoration and/or total carious tissue removal and restoration. Independent variables were related to higher education institutions, students and patients. Descriptive and inferential analyzes were performed using the SPSS Statistics 21.0 and STATA 14.0 programs. McNemar test was used to compare the treatment decision according to child´s variables (skin color, family income and caries risk). Multinomial regression was performed to assess the association between the treatment decision outcome in three categories (non-invasive, micro-invasive and invasive) and the predictor variables of the student (gender, age, skin color and type of institution). Results with p value <0.05 were considered statistically significant. 341 students participated in the research. There was a statistically significant association between the treatment decision and the characteristics of the child, with the undergraduates being more invasive for the same clinical condition of carious lesion in white, high-income children with a higher risk of caries (p < 0.001). More than 1/3 of the students expressed an intention to perform total carious tissue removal followed by restoration when child was white. The adjusted multinomial regression models showed that students from private institutions were more stable in the treatment decision for carious lesions in relation to children with different demographic characteristics than students from public schools (OR: 0,49; IC 95% 0,28-0,86 to be less invasive in White children) OR: 0,38; IC 95% 0,24-0,61 protective to be more invasive in high-income children).The student's demographic characteristics did not influence the treatment decision, regardless of the child's characteristics. In conclusion, both patient and institution characteristics were able to influence the treatment decision of dental students for carious lesions in primary teeth