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

Abstract

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.

Keywords: Deep carious lesion; Dental pulp exposure; Direct pulp capping; Partial pulpotomy; Pulpectomy.