General dentists’, pediatric dentists’, and endodontists’ diagnostic assessment and treatment strategies for deep carious lesions

Koopaeei, Mahshid Majlessi; Inglehart, Marita R.; McDonald, Neville J.; Fontana, Margherita

doi:10.1016/j.adaj.2016.11.001

Cited by 28 publications

(61 citation statements)

References 15 publications

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“…Namely, response rate, whether the sample is representative of the population studied and the self‐reported nature of the disclosed information. The overall response rate in this current study was low (12.6%), although previous surveys on this topic reported response rates ranging from 4 to 92%. Comparison of demographic factors between the sample population and the national distribution revealed our sample has an over‐representation of dentists whose initial qualification was obtained in Australia .…”

Section: Discussioncontrasting

confidence: 65%

Treatment preferences for deep caries lesions among Australian dentists

Chai

Tay

Chow

et al. 2020

Australian Dental Journal

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Background There is a global disparity in managing deep caries lesions and evidence‐based strategies are not always followed. The aim of this study was to gain insight into current practices of Australian dentists for deep caries management and to determine their procedural and materials choices. Methods An online questionnaire was sent to 1988 randomly selected practitioners across Australia asking their choice of treatment in a tooth showing symptoms of reversible pulpitis and deep caries. A total of 255 (12.6%) practitioners responded. Results About 85% of respondents chose selective caries removal to selective removal (SR) while 15% chose non‐selective removal to hard dentine. Respondents whose preferred approach was SR had greater odds in believing that incomplete caries removal alone would not have any effect on pulp vitality (OR = 5.20) and had greater odds of thinking that peripheral seal was more important than other factors (OR = 3.50). They also had lesser odds of believing that placing a liner would reduce postoperative sensitivity (OR = 0.269) and lesser odds of thinking that removal of all bacteria or carious dentine was important when placing a restoration (OR = 0.196). Conclusion Most Australian dentists reported practising evidence‐based carious tissue removal strategies and accepted the concept of selectively leaving carious dentine under a sealed restoration.

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Section: Discussioncontrasting

confidence: 65%

Treatment preferences for deep caries lesions among Australian dentists

Chai

Tay

Chow

et al. 2020

Australian Dental Journal

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“…Diagnosing pulp status is the key to the treatment decision. However, both the diagnostic criteria to assess pulp status and the treatment decisions applied by each dentist in the management of deep caries lesions (DCLs) are highly variable ( 5 , 6 ). The variability of criteria is especially evident in relation to the depth of the excavation of the carious tissue, ranging from the complete and non-selective removal of carious tissue to hard dentin, with the risk of pulp exposure and endodontic treatment, to the selective excavation that leaves soft and affected dentine in the central area of the lesion near the pulp ( 5 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…The International Caries Consensus Collaboration Group (ICCC), linked to the International Association for Dental Research - Cariology Group, has established well-defined criteria for the treatment of DCLs ( 8 , 9 ). The complete excavation or removal of carious dentine is currently considered over-treatment ( 6 , 8 , 9 , 10 ) but several surveys carried out in different countries indicate that many dentists continue this practice ( 5 , 11 - 14 ). Moreover, some dental schools still recommended the elimination of the bacteria present in soft dentine, forgetting other ways to fight the infection ( 5 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Especially worrying are the results obtained in surveys conducted in USA ( 5 ), Brazil ( 11 ) and central and northern Europe ( 12 - 14 ), showing disturbing results regarding the therapeutic decision making in cases of DCLs in which the pulpal diagnosis was reversible pulpitis. However, no study has investigated this topic in southern Europe.…”

Section: Introductionmentioning

confidence: 99%

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Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

Crespo-Gallardo¹,

Hay-Levytska²,

Martín-González³

et al. 2018

J Clin Exp Dent

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BackgroundThe aim of this study was to investigate the diagnostic criteria and treatment decisions in the management of deep caries lesions (DCLs). The null hypothesis tested was that DCLs are managed according to the current scientific evidence.Material and MethodsA total of 288 dentists were contacted directly or by mail, and 125 (43%) were included in the study. Dentists were requested to answer a questionnaire about the routine approach to the diagnosis and treatment of DCLs. Logistic regression analyses were carried out to calculate odds ratios (OR).ResultsPulp sensitivity tests were used by 65% of dentists when assessing pulpal health in cases of DCLs, particularly those who had followed courses in cariology (OR = 3.8; p = 0.005). Dentine hardness was the most frequent criterion used during DCLs excavation (98%). Two thirds of the respondents (65%) removed carious tissue until they felt hard dentine, and feeling hard dentine correlated with caries removal even at the risk of pulpal exposure (OR = 15.8; p = 0.0000). Acute transient pain or sensitivity to cold or heat (reversible pulpitis) were considered by 58% of respondents as a reason to provide endodontic therapy.ConclusionsThe null hypothesis tested is rejected. The evidence-based more conservative approach on the management of DCLs is not being translated to clinical dentistry. Root canal treatment is being indicated in cases of DCLs in which the diagnosis is reversible pulpitis. Likewise, it can be concluded that non-conservative management of DCLs, with endodontic overtreatment, could be occurring. Key words:Deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, pulpal diagnosis, reversible pulpitis, treatment decisions.

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“…Indeed, selective removal of carious tissue is encouraged with composite restorations . Such cavity preparations are routinely infected with residual S. mutans . If, like amalgam, the material has bacteriostatic effects or if there is an impervious seal between the material and the tooth, these residual bacteria might not be major concern.…”

Section: Minimally Invasive Restorationsmentioning

confidence: 99%

Threats to adhesive/dentin interfacial integrity and next generation bio‐enabled multifunctional adhesives

Spencer

Song

et al. 2019

J Biomed Mater Res

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Nearly 100 million of the 170 million composite and amalgam restorations placed annually in the United States are replacements for failed restorations. The primary reason both composite and amalgam restorations fail is recurrent decay, for which composite restorations experience a 2.0–3.5‐fold increase compared to amalgam. Recurrent decay is a pernicious problem—the standard treatment is replacement of defective composites with larger restorations that will also fail, initiating a cycle of ever‐larger restorations that can lead to root canals, and eventually, to tooth loss. Unlike amalgam, composite lacks the inherent capability to seal discrepancies at the restorative material/tooth interface. The low‐viscosity adhesive that bonds the composite to the tooth is intended to seal the interface, but the adhesive degrades, which can breach the composite/tooth margin. Bacteria and bacterial by‐products such as acids and enzymes infiltrate the marginal gaps and the composite's inability to increase the interfacial pH facilitates cariogenic and aciduric bacterial outgrowth. Together, these characteristics encourage recurrent decay, pulpal damage, and composite failure. This review article examines key biological and physicochemical interactions involved in the failure of composite restorations and discusses innovative strategies to mitigate the negative effects of pathogens at the adhesive/dentin interface. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2466–2475, 2019.

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General dentists’, pediatric dentists’, and endodontists’ diagnostic assessment and treatment strategies for deep carious lesions

Cited by 28 publications

References 15 publications

Treatment preferences for deep caries lesions among Australian dentists

Treatment preferences for deep caries lesions among Australian dentists

Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

Threats to adhesive/dentin interfacial integrity and next generation bio‐enabled multifunctional adhesives

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