Clinical Decision Making in Managing Deep Carious Lesions in Primary Teeth Based on Clinical Experience Among Pediatric Dentists- A Cross Sectional Study
Main Article Content
Keywords
Deep carious lesions, primary teeth, Clinical experience, Saudi Arabia, Pediatric dentists
Abstract
Objective: To explore the different treatment methods employed in managing DCL of vital primary teeth among pediatric dentists practicing in Saudi Arabia. We also want to find out whether the experience of pediatric dentists has any influence on clinical decision-making in managing DCL in primary teeth.
Methods: This online questionnaire-based cross-sectional study was carried out among pediatric dentists practicing in Saudi Arabia. We used a self-administered questionnaire consisting of five sections demographic data, clinical decisions in managing DCL, clinical protocols, and dentist’s knowledge about allowing carious dentine to remain under a restoration. The questionnaire was administrated electronically via SurveyMonkey.
Results: Totally 216 pediatric dentists participated, and nearly 60% of them were male. Most dentists reported they preferred partial caries removal (63%), and the hall technique (68%) was the most often practiced in managing DCL. Nearly 93.5% of dentists reported performing indirect pulp capping before placing a permanent restoration, and the most preferred liner was dycal (60%). About 47.2% of senior dentists reported that they practice complete caries removal. Multivariate logistic regression analysis revealed that younger dentists (5 to 10 years) preferred the practiced partial caries excavation two times more often than the senior dentist (>10 years).
Conclusions: Pediatric dentists should focus on minimally invasive approaches such as partial caries excavation for DCL treatment. Pediatric dentists, especially senior practitioners, should be educated and trained to adopt minimally invasive strategies in managing DCL that could reduce unnecessary risks such as iatrogenic pulpal damage.
References
2. Colombo S, Gallus S, Beretta M, Lugo A, Scaglioni S, Colombo P, Paglia M, Gatto R, Marzo G, Caruso S, Paglia L. Prevalence and determinants of early childhood caries in Italy. Eur J Paediatr Dent. 2019 Dec;20(4):267-273
3. Gimenez T, Bispo BA, Souza DP, Viganó ME, Wanderley MT, Mendes FM, Bönecker M, Braga MM. Does the Decline in Caries Prevalence of Latin American and Caribbean Children Continue in the New Century? Evidence from Systematic Review with Meta-Analysis. PLoS One. 2016 Oct 21;11(10):e0164903.
4. Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. Int J Paediatr Dent. 2019 May;29(3):238-248..
5. Bawaskar HS, Bawaskar PH. Oral diseases: a global public health challenge. Lancet. 2020 Jan 18;395(10219):185-186.
6. Nuvvula S, Bhumireddy JR, Kamatham R, Mallineni SK. Diagnostic accuracy of direct digital radiography and conventional radiography for proximal caries detection in primary teeth: A systematic review. J Indian Soc Pedod Prev Dent. 2016 Oct-Dec;34(4):300-5.
7. Croft K, Kervanto-Seppälä S, Stangvaltaite L, Kerosuo E. Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland. Clin Oral Investig. 2019 Mar;23(3):1271-1280.
8. Schwendicke F, Göstemeyer G. Understanding dentists' management of deep carious lesions in permanent teeth: a systematic review and meta-analysis. Implement Sci. 2016 Oct 19;11(1):142.
9. Rapport F, Clay-Williams R, Churruca K, Shih P, Hogden A, Braithwaite J. The struggle of translating science into action: Foundational concepts of implementation science. J Eval Clin Pract. 2018 Feb;24(1):117-126.
10. Muller-Bolla M, Garcia A, Aïem E, Doméjean S. Dentists' decisions for deep carious lesions management in primary teeth. Int J Paediatr Dent. 2020 Sep;30(5):578-586.
11. Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc. 2008 Jun;139(6):705-12.
12. AlBlehed AK, AlThumairy AF, AlTurayri WS , Alassaf A , Almulhim B, Alghamdi S, Almalki A, Mallineni SK. Assessment of Knowledge, Attitude and Practices Regarding Oral Hygiene Followed by Parents of PreSchool Children in Riyadh, Saudi Arabia: A Cross-Sectional Study. Ann Med Health Sci Res. 2021;11:S2: 82-86.
13. Crespo-Gallardo I, Hay-Levytska O, Martín-González J, Jiménez-Sánchez MC, Sánchez-Domínguez B, Segura-Egea JJ. Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment? J Clin Exp Dent. 2018 Aug 1;10(8):e751-e760.
14. Nair M. Clinical and radiographic outcomes of calcium hydroxide vs other agents in indirect pulp capping of primary teeth: A systematic review. Int. J. Clin. Pediatr. Dent. 2019;12:437–444.
15. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NP. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res. 2016 May;28(2):58-67.
16. Koopaeei MM, Inglehart MR, McDonald N, Fontana M. General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis. J Am Dent Assoc. 2017 Feb;148(2):64-74.
17. Alnahwi TH, Alhamad M, Majeed A, Nazir MA. Management preferences of deep caries in permanent teeth among dentists in Saudi Arabia. Eur J Dent. 2018 Apr-Jun;12(2):300-304.
18. Shah AH, Sheddi FM, Alharqan MS, Khawja SG, Vohra F, Akram Z, Faden AA, Khalil HS. Knowledge and Attitude among General Dental Practitioners towards Minimally Invasive Dentistry in Riyadh and AlKharj. J Clin Diagn Res. 2016 Jul;10(7):ZC90-4.
19. Alyousef AM, Almehrej BA , Alshahrani MA , Almutairi KM , Muhannad Abdulrahman Alqasir MA, Alassaf A , Almulhim B, Alghamdi S. Mallineni SK. Arabian Parents’ Knowledge, Attitude, and Practice towards their Children’s Oral Health and Early Childhood Caries Resided in Riyadh Province: An Online-Based CrossSectional Survey. Ann Med Health Sci Res. 2021;11:S2: 73-81.
20. Innes NPT, Schwendicke F. Restorative Thresholds for Carious Lesions: Systematic Review and Meta-analysis. J Dent Res. 2017 May;96(5):501-508.
21. Muller-Bolla M, Aïem E, Coulot C, Doméjean S. Restorative thresholds for carious lesions in primary molars: French dentist's decisions. Eur Arch Paediatr Dent. 2021 Jun;22(3):441-448.
22. Chevalier V, Le Fur Bonnabesse A, Duncan HF. Frightened of the pulp? A qualitative analysis of undergraduate student confidence and stress during the management of deep caries and the exposed pulp. Int Endod J. 2021 Jan;54(1):130-146.
23. Tedesco TK, Reis TM, Mello-Moura ACV, Silva GSD, Scarpini S, Floriano I, Gimenez T, Mendes FM, Raggio DP. Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis. Braz Oral Res. 2020 Nov 13;35:e004.
24. Ricucci D, Siqueira JF Jr, Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent. 2019 Jul;86:41-52.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.