Abstract
Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.
Highlights
Regular, frequent intake of fermentable dietary carbohydrates results in the oral environment becoming more favourable for aciduric and acidogenic bacteria to thrive within the stagnating biofilm.[1]
168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts
There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported
Summary
Frequent intake of fermentable dietary carbohydrates results in the oral environment becoming more favourable for aciduric (acidwithstanding) and acidogenic (acid-producing) bacteria to thrive within the stagnating biofilm.[1] The shift in activity within the biofilm leads to an increased production of organic acids and a net mineral loss from the dental hard tissue (demineralisation), resulting in a carious lesion.[2] Remineralisation occurs through. This process, known as the ‘ecologic plaque hypothesis’,3 challenges the traditional measures of managing a carious lesion, both those that are confined to enamel and those that extend into dentine, with more contemporary techniques. Managing deep carious lesions in vital teeth is a significant challenge for general dental practitioners (GDPs).[4] Removal of caries in close proximity to the pulp carries risks of pulpal inflammation and pain in a previously asymptomatic tooth.[5]
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