Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland.

OBJECTIVES: To find out which management methods are preferred by dentists in Finland for a deep carious lesion or a pulp exposed during carious tissue removal in adult patients. MATERIALS AND METHODS: An electronic questionnaire consisting of 25 questions was sent to 1000 randomly sampled dentists in Finland. The response rate was 32%. RESULTS: Less invasive excavation strategies (stepwise or selective removal) were preferred by 64% for an asymptomatic deep lesion, while 34% chose nonselective removal to hard dentine. In the presence of an asymptomatic pulpal exposure, vital pulp therapy was preferred, as 71% of the respondents chose direct pulp capping (DPC) or partial pulpotomy, compared to root canal treatment (26%). Mineral trioxide aggregate (MTA) and calcium hydroxide-based materials were both chosen by 40% for vital pulp therapy. In the management of a deep carious lesion, less invasive excavation strategies were significantly associated with having clinical guidelines vs. no guidelines at the practice [odds ratio (OR) 3.5, confidence interval (CI) 1.4-9.0]. MTA was favored over other DPC materials significantly more often by those who had attended continuing education courses during the last 3 years (OR 2.8, CI 1.2-6.5). CONCLUSIONS: Less invasive management strategies have been adopted into clinical practice by the majority of dentists in Finland. There is a need to encourage the use of MTA in the case of a pulpal exposure. CLINICAL RELEVANCE: The results of this study can be utilized in continuing education, to raise awareness of management strategies supported by present scientific evidence.

Dentists' attitudes and behaviour regarding deep carious lesion management: a multi-national survey.

OBJECTIVES: The present study aimed, using a questionnaire, to assess and compare behaviour, attitudes and beliefs of French, German and Norwegian dentists regarding deep carious lesion management. MATERIALS AND METHODS: A mail survey was applied to simple random national samples of dentists. Descriptive analysis and logistic regression analysis were performed. RESULTS: Sample size was 661 (response rate, 33 %) in France, 622 (25 %) in Germany and 199 (33 %) in Norway. Hardness was the criterion used most often for assessing carious tissue removal in all three countries (>95 %), with most dentists aiming for only hard dentine remaining at the pulpal wall (>66 %); dentine colour was not found relevant by most respondents. The majority of French and German practitioners (>66 %) would perform complete excavation even for deep lesions, while most Norwegian dentists (84 %) opted for stepwise excavation. Most dentists thought complete removal was required to avoid lesion progression and were uncertain if remaining sealed bacteria would harm the pulp. Treatment decisions were guided by prior experience and familiarity. For example, stepwise removal was performed less often by dentists who were male, French, German or those in the private sector. CONCLUSIONS: Less invasive strategies for managing deep lesions have not widely entered clinical practice in France and Germany. Underlying beliefs shape decision-making. CLINICAL RELEVANCE: The present study is the first of its nature to analyse and compare deep carious lesion management between three European countries. It shows that there is an urgent need to practically educate dentists in less invasive strategies.

Management of pulps exposed during carious tissue removal in adults: a multi-national questionnaire-based survey.

OBJECTIVES: The aim of the present study was to investigate and compare the management of pulps exposed during carious tissue removal by French, German, and Norwegian general dental practitioners (GDPs). We further aimed to assess possible dentist- and patient-related factors associated with these management decisions. MATERIALS AND METHODS: A structured questionnaire was send via mail to a simple random sample of dentists. RESULTS: The analyzed sample consisted of 661 (33%) French GDPs, 622 (25%) German GDPs, and 199 (34%) Norwegian GDPs. No single management method gained uniform consensus in any of the three countries. However, the most preferred management option in all three countries was direct pulp capping (DPC) (68-93%) mainly performed with calcium hydroxide paste/slurry (CH). Alternatively, root canal treatment was performed (7-22%). The reasons that guided GDPs were the same in all three countries; "good results" and "ease of use, familiar with the technique." Having read scientific articles about cariology/operative dentistry in the last 5 years increased the odds for the preference of DPC instead of root canal treatment (OR = 2.1, 95% CI 1.3-3.2). CONCLUSIONS: Among GDPs in France, Germany, and Norway, there was no uniform management option for pulp exposures during carious tissue removal. DPC with CH was the most preferred management, even though the current evidence suggests DPC with mineral trioxide aggregate (MTA) to be more successful. The outcome expectations and the assumed ease of use were reasons for GDPs' choice. Moreover, knowledge on current evidence towards such management options influenced treatment decisions. CLINICAL RELEVANCE: GDPs are encouraged to adopt management options based on current scientific evidence.

Light-curing units used in dentistry: factors associated with heat development-potential risk for patients.

OBJECTIVES: To investigate how heat development in the pulp chamber and coronal surface of natural teeth with and without cusps subjected to irradiance using light-emitting diode (LED)-light-curing units (LCUs) is associated with (i) irradiance, (ii) time, (iii) distance, and (iv) radiant exposure. MATERIALS AND METHODS: Three different LED-LCUs were used. Their irradiance was measured with a calibrated spectrometer (BlueLight Analytics Inc., Halifax, Canada). An experimental rig was constructed to control the thermal environment of the teeth. The LED-LCU tip position was accurately controlled by a gantry system. Tooth surface temperature was measured by thermography (ThermaCAM S65 HS, FLIR Systems, Wilsonville, USA) and pulp chamber temperature with a thermocouple. LED-LCU tip distance and irradiation times tested were 0, 2, and 4 mm and 10, 20, and 30 s, respectively. Ethical permission was not required for the use of extracted teeth. RESULTS: Maximum surface and pulp chamber temperatures were recorded in tooth without cusps (58.1 °C  ± 0.9 °C and 43.1 °C ± 0.9 °C, respectively). Radiant exposure explained the largest amount of variance in temperature, being more affected by time than irradiance. CONCLUSIONS: At all combinations of variables tested, repeated measurements produced consistent results indicating the reliability of the method used. Increased exposure time seems to be the factor most likely to cause tissue damage. CLINICAL RELEVANCE: Risk of superficial tissue damage at irradiances >1200 mW/cm2 is evident. There is a risk of pulp damage when only thin dentin is left at higher irradiances (>1200 mW/cm2). Clinicians should be aware of LED-LCU settings and possible high temperature generated.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study.

OBJECTIVES: To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC. MATERIALS AND METHODS: The final study sample (n=1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records. RESULTS: About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC. CONCLUSIONS: Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway.

OBJECTIVE: To investigate preferred treatment methods of deep carious lesions in mature permanent teeth among dentists in Northern Norway. MATERIALS AND METHODS: The survey included all 437 general dental practitioners in Northern Norway working in the private or the public dental health service. The participants received an invitation with a radiograph and a clinical picture of a deep carious lesion in a mature permanent tooth and a questionnaire asking about demographic characteristics and their preferred treatment methods related to different clinical deep caries diagnoses. RESULTS: The response rate was 56%. There was an over-representation of publicly employed dentists among the respondents; otherwise no systematic bias related to non-responders was detected. In the absence of carious exposure and no symptoms, total caries excavation was the preferred treatment method (49%) followed by stepwise excavation (45%). In cases of deep caries and no exposure with symptoms, the preferences were equally distributed between root canal treatment (39%) and stepwise excavation (38%). In the presence of carious exposure but no symptoms, the preferred treatment method was direct pulp capping (51%) and in carious exposure with symptoms root canal treatment was the preferred treatment method (91%). CONCLUSIONS: There is no uniform treatment method of deep carious lesions among dentists in Northern Norway.