Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil

Abstract

The aim of the present study was to assess Public Health Service clinicians' treatment decisions about deep carious lesions in the city of Porto Alegre, Brazil. Treatment decisions were assessed with a structured questionnaire (open/discursive and containing information about gender, university and year of college graduation, and college major) and three simulated clinical cases composed of teeth with primary deep carious lesion. All professionals working for the Public Health Service in the city were addressed. Out of 122 professionals, 54 participated in the study (response rate of 44 percent). There was no difference between respondents and non-respondents regarding gender, year of college graduation, or college major. The most commonly indicated procedure was direct complete excavation (71.1 percent), followed by stepwise excavation (17.6 percent), partial caries removal (8.8 percent), and pulp therapies (direct pulp capping, partial or complete pulpotomy, and endodontics) (2.5 percent). Year of college graduation was the only variable influencing treatment decision. Logistic regression analysis showed that professionals who had graduated after the year 2000 were significantly more likely to indicate a conservative treatment than were dentists who graduated through 1979 (odds ratio = 5.5). The most commonly proposed treatment is the one with the highest risk of pulp exposure, and consequently the poorest prognosis. Younger dentists tended to indicate more conservative approaches, compared with those indicated by older dentists.