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

Abstract

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.

Dentist´s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions

“…In fact, a recent study investigating the preferred management methods of Finish dentists for DCLs in adult patients (24), has found that less invasive treatments are being selected into clinical practice by the majority of dentists in Finland. Similar results have been reported in a survey carried out to a sample of Spanish dentists (25).…”

YouTube as a source of information about pulpotomy and pulp capping: a cross sectional reliability analysis

“…The number of views was found to be significantly higher in pulpotomy contents, probably because of the applicability of this procedure to deciduous teeth in pediatric dentistry and the specialized nature of the pulp capping treatment for young permanent teeth with open apices that are usually referred to experts. In general, it has been documented that vital pulp treatment procedures for the fully developed permanent teeth are less popular and root canal treatment is preferable among dentists, a fact that may be reflected by the lower number of views regarding direct pulp cap videos [ 23 24 ]. Regarding patients, low popularity of dental pulp capping videos may be attributed to the specialized nature of these procedures.…”

To Fill or do a Root Canal??? That’s the Question

“…The results of this review advocate step wise partial caries removal [26] or selective caries removal [17] as the more favorable technique. Although, generally, for the authors'-complete caries Discussion removal has worked well in the past where the soft carious tissue is removed till hard dentinal tissue is encountered [35] and then covered with Calcium hydroxide liner and Glass Ionomer at a single visit followed by Composite layer on the same visit or subsequent visit.…”

“…But the authors' current practice may not be factual and deemed as "over-treatment" [18,35] as new research on cariology [18,35] has refuted our myth and we like the 80% dentists as compared to 8.8 [35] believed in total excavation and the study [35] reflects on encouraging more dentists to take up cariology CPD courses as literature supports selective/ partial caries removal being definitely better than complete caries removal to prevent a pulp exposure [38,43] and unnecessary endodontic treatment [39]. The need to incorporate evidenced based dentistry via CPD courses and reading peer reviewed journals is important to educate ourselves in using less invasive strategies to treat deep carious lesions and not allow just our beliefs of the past gained through didactic methods, influence better decision making in our dental practices.…”