Clinical Decision Making in Managing Deep Carious Lesions in Primary Teeth Based on Clinical Experience Among Pediatric Dentists- A Cross Sectional Study

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.