Implementation of repairs in dental practice: Randomized behavior simulation trial
Affiliation:
Professor, Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Professor, Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Professor, Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Dentist, Vitadent, Rotterdam, the Netherlands;Associate Professor, Department of Preventive Dentistry and, Department of Cariology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Assistant Professor, Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Associate Professor, Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA;Professor, Biomedical Sciences, UNLV School of Dental Medicine, University of Nevada, Las Vegas, Las Vegas, NV;Biostatistician, PPD, Thermo Fisher Scientific, Wilmington, NC;Director of Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA;Adjunct Professor, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA;Junior Physician, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China;Head Nurse, Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
Abstract:
BackgroundDespite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists’ behavior.MethodsProblem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of 2 interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists’ stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05).ResultsTwo interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists’ behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving 1 of the 2 behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19).ConclusionsSystematically developed interventions targeting dentists’ repair behaviors are likely efficacious to promote repairs.Practical ImplicationsMost partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists’ behavior.This trial was registered at https://www.clinicaltrials.gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.
