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Abstract

Objective: The aim of this cross-sectional study is to investigate Turkish dentists’ opinions and preferences regarding the management of deep carious lesions and compare them with modern dental education concepts as provided by dental schools. Methods: Questionnaire 1 and Questionnaire 2 were sent separately to dental practitioners via the Turkish Dental Association and to university department heads of restorative dentistry. The data obtained were analyzed using chi-square tests and one-way ANOVA tests (p < 0.05). Results: Regarding Questionnaire 1, most of the dentists (89.3%) responded that caries lesions should be removed completely up to the hard cut-off condition of the cavity floor. There was a statistically significant difference between female and male dentists’ preferences on less invasive treatment (p < 0.05). Female dentists prefer less invasive treatment compared with male dentists (p = 0.002). Relatively older dentists (mean age = 41.8) are more inclined towards complete caries removal even if pulp exposure is likely (p = 0.040). The results of Questionnaire 2 reveal that there is no association between the time spans of education at dental schools and their caries removal approach curriculum (p > 0.05). Most department heads of restorative dentistry prefer to apply complete caries removal (78.5%, n = 51). Conclusion: Despite today’s curriculum encouraging less invasive caries removal techniques, most dentists prefer more invasive treatment options. Continuous education of contemporary dentistry could update these clinical treatment attitudes of dentists and improve their clinical practice.

References

1. Schwendicke F, Paris S, Stolpe M. Costeffectiveness of caries excavations in different risk groups – A micro-simulation study. BMC Oral Health. 2014; 14:153.

2. Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis - A comprehensive review. J Clin Periodontol. 2017; 44 Suppl 18:S94-105.

3. 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; 28(2):58-67.

4. European Society of Endodontology (ESE) developed by:, Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019; 52(7):923-34.

5. Innes N, Schwendicke F, Frencken J. An agreed terminology for carious tissue removal. Monogr Oral Sci. 2018; 27:155-61.

6. Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010; 118(3):290-7.

7. Bjørndal L, Fransson H, Bruun G, Markvart M, Kjældgaard M, Näsman P, Hedenbjörk-Lager A, Dige I, Thordrup M. Randomized clinical trials on deep carious lesions: 5-year follow-up. J Dent Res. 2017; 96(7):747-53.

8. Innes NP, 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 A, Schwendicke F. Managing carious lesions: Consensus recommendations on terminology. Adv Dent Res. 2016; 28(2):49-57.

9. Maltz M, Alves LS. Incomplete caries removal significantly reduces the risk of pulp exposure and post-operative pulpal symptoms. J Evid Based Dent Pract. 2013; 13(3):120-2.

10. Franzon R, Guimarães LF, Magalhães CE, Haas AN, Araujo FB. Outcomes of one-step incomplete and complete excavation in primary teeth: A 24-month randomized controlled trial. Caries Res. 2014; 48(5):376-83.

11. Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, Garcia F, Nascimento C, Oliveira A, Mestrinho HD. Randomized trial of partial vs. stepwise caries removal: 3-year followup. J Dent Res. 2012; 91(11):1026-31.

12. Carvalho JC, Dige I, Machiulskiene V, Qvist V, Bakhshandeh A, Fatturi-Parolo C, Maltz M. Occlusal caries: Biological approach for its diagnosis and management. Caries Res. 2016; 50(6):527-42.

13. Hoefler V, Nagaoka H, Miller CS. Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review. J Dent. 2016; 54:25-32.

14. Oen KT, Thompson VP, Vena D, Caufield PW, Curro F, Dasanayake A, Ship JA, Lindblad A. Attitudes and expectations of treating deep caries: A PEARL Network survey. Gen Dent. 2007; 55(3):197-203.

15. Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. J Public Health Dent. 2011; 71(4):265-70.

16. Schwendicke F, Meyer-Lueckel H, Dörfer C, Paris S. Attitudes and behaviour regarding deep dentin caries removal: A survey among German dentists. Caries Res. 2013; 47(6):566-73.

17. Stangvaltaite L, Kundzina R, Eriksen HM, Kerosuo E. Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway. Acta Odontol Scand. 2013; 71(6):1532-7.

18. Schwendicke F, Stangvaltaite L, Holmgren C, Maltz M, Finet M, Elhennawy K, Eriksen I, Kuzmiszyn TC, Kerosuo E, Doméjean S. Dentists’ attitudes and behaviour regarding deep carious lesion management: a multi-national survey. Clin Oral Investig. 2017; 21(1):191-8.

19. Crespo-Gallardo I, Martín-González J, Jiménez- Sánchez MC, Cabanillas-Balsera D, Sánchez- Domínguez B, Segura-Egea JJ. Dentist´s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. J Clin Exp Dent. 2018; 10(12):e1205-15.

20. 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; 12(2):300-4.

21. Nascimento MM, Behar-Horenstein LS, Feng X, Guzmán-Armstrong S, Fontana M. Exploring how U.S. dental schools teach removal of carious tissues during cavity preparations. J Dent Educ. 2017; 81(1):5-13.

22. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg. 2014; 12(12):1495-9.

23. Riley JL 3rd, Gordan VV, Rouisse KM, McClelland J, Gilbert GH; Dental Practice-Based Research Network Collaborative Group. Differences in male and female dentists’ practice patterns regarding diagnosis and treatment of dental caries: Findings from The Dental Practice-Based Research Network. J Am Dent Assoc. 2011; 142(4):429-40.

24. Hatipoglu Ö. Factors affecting the decisionmaking of direct pulp capping procedures amongst Turkish dental practitioners. Eur Endod J. 2018; 3(3):167-73.

25. Sebo P, Maisonneuve H, Cerutti B, Fournier JP, Senn N, Haller DM. Rates, delays, and completeness of general practitioners’ responses to a postal versus web-based survey: A randomized trial. J Med Internet Res. 2017; 19(3):e83.

26. 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; 23(3):1271-80.

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