Understanding dentists’ management of deep carious lesions in permanent teeth: a systematic review and meta-analysis

Abstract

BackgroundIncreasing evidence supports selective/incomplete (SE) or stepwise (SW) instead of non-selective/complete tissue removal for deep carious lesions in vital teeth, mainly as pulpal risks are significantly reduced. Our aims were to analyze the proportion of dentists who utilize SE/SW for deep lesions in permanent teeth and to identify barriers and facilitators of utilizing SE/SW.MethodsWe included studies that were original, and reported on the proportion of dentists utilizing SE/SW (quantitative studies), or reported on barriers or facilitators of such utilization (qualitative studies). Electronic databases (PubMed, CENTRAL, Embase, PsycINFO) were searched and screening and data extraction performed by two reviewers. Random-effects meta-analysis and meta-regression were used for quantitative synthesis of the proportion of dentists utilizing SE/SW. Thematic analysis was performed to assess barriers and facilitators on SE/SW utilization. Identified themes were translated into the constructs of the theoretical domains framework.ResultsFrom 1728 articles, nine studies were included, all using quantitative methods. Four thousand one hundred ninety-nine dentists had been surveyed. The mean (95% CI) proportion of dentists using SE/SW for deep lesions was 53 % (44/62 %). More recent studies reported significantly higher proportions (p < 0.05). Reported estimates and thematic analysis found dentists’ age and an understanding of the disease caries and the scientific rationale behind different removal strategies to affect dentists’ behavior. Guidelines, peers, and the social and professional identity were further associated with the motivation of utilizing SE/SW. Environmental incentives, sanctions, or restrictions, mainly of financial but also regulatory character, impacted on decision-making, as did the specific indication (the patient, the tooth) and the beliefs on how well different treatments perform.ConclusionsAround half of all dentists rejected evidence-based carious tissue removal strategies. A range of factors can be addressed for improving implementation. Future studies should use mixed qualitative-quantitative methods to yield a deeper understanding of dentists’ decision-making.Trial registrationPROSPERO CRD42016038047 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0505-4) contains supplementary material, which is available to authorized users.

To fill or not to fill: a qualitative cross-country study on dentists’ decisions in managing non-cavitated proximal caries lesions

“…The social aspects also shape behaviour, which may impact within the practice or the wider healthcare setting. For example, mandating guarantee times on restorations incentivised restorative overtreatment, shifting priorities towards restoration longevity, not patients’ health or tooth retention [ 21 , 30 , 31 ]. Another important barrier was NI/MI being remunerated only for children or adolescents [ 15 , 32 ].…”

“…Here, we used the Theoretical Domains Framework (TDF), which has been used previously to understand the motivations, cognitions and behaviours of health professionals when implementing evidence-based practice [ 17 – 19 ]. Few dental studies have used it [ 17 , 20 , 21 ]. Since interventions for implementing behaviour change must be setting-specific, we aimed to identify barriers and enablers to dentists non- or micro-invasively managing proximal caries lesions in New Zealand (NZ), the USA, and Germany.…”

Treatment preferences for deep caries lesions among Australian dentists

“…6 Despite recent studies showing that choosing the less-invasive restorative options is cost effective (reducing the cost up to 50%) even in high-risk individuals, 7-9 practitioners tend to have very strong conventional opinions on the required extent of caries removal. [10][11][12] Furthermore, although traditional teaching advocates placement of a liner in deep caries lesions, particularly under metallic restorations such as amalgam, their role has recently been questioned. 13 The placement of a liner neither improves the longevity of the restoration 13 nor does it reduce the pulpal complications.…”

“…Non‐selective removal (NSR), formerly known as complete caries removal, is no longer advocated . Despite recent studies showing that choosing the less‐invasive restorative options is cost effective (reducing the cost up to 50%) even in high‐risk individuals, practitioners tend to have very strong conventional opinions on the required extent of caries removal …”

The Effectiveness of the Partial Caries Removal as a Treatment Option in Deep Carious Lesion Management- Review

“…Dental caries is a widely prevalent disease, burdening billions of individuals and causing significant healthcare costs [1][2][3]. The carious process begins in the enamel, with demineralization caused by bacterial acids that come from dental biofilm.…”