German dentists' management of non-cavitated proximal caries lesions: A qualitative interview study

For managing non-cavitated proximal caries lesions, non- or micro-invasive strategies (NI/MI) are currently recommended over invasive (restorative) approaches. However, survey data indicate that dentists may not have adopted these strategies. This qualitative study aimed to identify barriers and facilitators for using NI/MI in Germany. Methods: A diverse sample of 12 dentists was recruited. Semi-structured interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework. Results: Limited financial reimbursement and an organizational framework centering around placing restorations, patients' lacking adherence to advice and oral hygiene (and associated high caries risk) as well as the fear of lesion progression (anticipated regret) were identified as relevant barriers for NI/MI. Facilitators were found to be working in a team where NI/MI is promoted, having knowledge of the disadvantages of restorations and the evidence supporting NI/MI, regularly attending ongoing professional development courses and professional satisfaction when doing "the right thing" for the patient. Conclusions: A number of aspects at individual, practice and healthcare level could be targeted to enhance dentists' uptake of NI/MI for managing non-cavitated proximal caries lesions. Keywords: attitudes, decision-making, dental, enamel caries, evidence-based practice, qualitative studies, theoretical domains framework