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  • Title: Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland.
    Author: Croft K, Kervanto-Seppälä S, Stangvaltaite L, Kerosuo E.
    Journal: Clin Oral Investig; 2019 Mar; 23(3):1271-1280. PubMed ID: 29987635.
    Abstract:
    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.
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