Evidence-based caries management in Latin American dental schools: a COM-B implementation-science baseline study

Abstract

Background: Adopting core cariology curricula into dental schools remains a dental education and clinical practice international challenge. For the first time implementation science is supporting this adoption process. Therefore, as part of the Exploration phase of the Latin-American-Cariology-Curriculum-Framework implementation, this baseline COM-B study assessed how best-practice caries risk/lesions diagnosis and management behaviours are being performed across regional dental schools. Methods: We administered an adapted, previously validated COM-B model (Capability, Opportunity, Motivation-Behaviour) caries-care best-practice questionnaire to 1,317 participants (806 final-year students and 511 clinical educators) across eight Latin American dental schools. The 56-item instrument evaluated self-reported behaviours regarding caries diagnosis and management (5-point Likert-response scale). Descriptive statistics, Welch's ANOVA, and multiple linear regression models applied to ordinal Likert-frequency ratings treated as approximately continuous, with heteroskedasticity-consistent robust standard errors (HC3) were performed. Results: The overall response rate was 71.1% (students: 74.8%, educators: 65.4%). Respondents reported performing these behaviours ‘most of the time’, with averages (mean±SD) ranging from 4.0±1.0 to 4.3±0.9. The most frequently reported behaviours were related to caries management, particularly ‘Advising on reducing free-sugar intake’ and ‘Implementing oral hygiene behaviour change strategies’ (both 4.5±0.7). The least frequent behaviour was ‘Monitoring/watching initial inactive caries lesions’ (3.7±1.2). Only one dental school showed overall behaviour-frequency values below ‘most of the time’. Within the COM-B model, capability showed the strongest association with diagnostic behaviours, whereas opportunity-resources showed the strongest association with management behaviours. Conclusion: Clinical educators and final-year students from Latin American dental schools reported high baseline engagement in evidence-based caries diagnosis and management. Capability and opportunity were COM-B components most strongly associated with these behaviours. As part of a regional implementation-science study, these findings serve as a case study of a global implementation challenge: translating evidence-based cariology principles into dental education and clinical practice.