Table 1 Included studies
Study | Method | Country, year | Sample | Scenario | Treatment decisions | Reasons, barriers, facilitators |
|---|---|---|---|---|---|---|
Oen [9] | Quest | USA, 2006 | PEARL research network, response 92 %, final 85 | Deep dentin lesion in permanent molar with vital (sensible) pulp (pain lasts <3 s) and different risk of exposure | No risk of exposure: 58/85 CR, 19/85 SE, 8/85 endodontic treatment Risk of exposure: 51/85 CR, 15/85 SE, 17/85 endodontic treatment | Age and general caries risk/experience of patient influenced decisions (more invasive in older and high-risk patients); dentists knew risk of failure of direct capping. Authors discuss peer pressure and educational background. |
Seale and Glickman [29] | Real-time poll | USA, 2007 | Conference, 376 dentists (102 endodontists, 252 pedodontists, 22 others), unclear response | Young permanent teeth with open apex | Pedodontists: 179/252 SW, endodontists: 222/376 SW | Reasons against SW: second visit needed—compliance problems, MTA pulpotomy better evidence, SE better evidence, reimbursement. Reasons for SW: option to recall symptoms/vitality, root maturation, low costs, re-assess dentin, payment for second appointment. |
Weber [8] | Quest | Brazil, 2009 | Dentists from one southern city 44 % response, final 54 | Deep carious lesion in permanent molar with vital pulp and no spontaneous pain, but pain when chewing or cold | 42/53 CR, 7/53 SW, 4/53 SE. We excluded the third case as the pulp and peri-apical status were unclear. | SE/SW: female OR 0.6 (0.2–1.2), younger (graduation >2000): OR 5.5 (1.5–19.7), possible reasons: SW requires second appointment, patients, do not return, younger dentists use evidence-base better. |
Chisini [34] | Quest | Brazil, 2009 | Single city, all dentists, 68 % response, final 187 | Deep lesion in proximity of pulp, unclear pulp status and dentition (assumed permanent) | 65/171 CR, 106/171 SE | Dentists with more recent graduation or postgraduate training chose SE more often. Authors evaluated experience and setting (public versus private practice versus university). |
McBride [35] | Quest | USA, 2009/2010 | National, practice based research networks, 66–82 % response, final 950 | Lower molar with visible cavitated lesion, deeper than anticipated, may involve pulp (pulpal status not stated) | 372/812 CR 285/812 SE 155/812 ET | Age was found a factor, with dentists practicing 5–15 years performing ET more often, while those <5 years performed SE more often; full network participant also more likely to perform SE. |
Stangvaltaite [7] | Quest | Norway, 2011 | Northern Norway, all dentists, 56 % response, final 222 | Deep carious lesion in permanent mature teeth without symptoms and exposure (further scenarios: with symptoms and exposure) | Without symptoms and exposure: 104/212 CR, 95/212 SW, 13/212 SE | CR versus SE: male OR 1.5 (0.8–2.8), from Norway: 0.5 (0.2–0.9), public practice: 0.6 (0.3–1.3), experienced (5+ years): 1.3 (0.7–2.6), urban: 2.2 (1.2–4.1), main reasons for choosing a strategy were good results, easy, restoration longevity, patients’ health; SW recommended in guidelines. |
Katz [27] | Quest | Brazil, 2012 | Northeastern Brazil, participants of a regional dentistry congress, final 123 | Unclear scenario | 59/108 CR, 49/108 SE | Majority of dentists considers caries to be treated only restoratively. Attitudes towards minimally invasive dentistry procedures significantly associated with SE (professionals considering minimal invasive as permanent recommended SE); Lack of belief in SE rather than knowledge or specialist status drove decision-making. |
Schwendicke [28] | Quest | Germany, 2012 | Northern Germany, all practitioners, 35 % response, final 821 | Young female patient with deep lesion in vital asymptomatic tooth, risk of pulp exposure | 400/799 CR, 160/799 SE, 239/799 both | Dentists aware of risks and success rates; dentists who accepted bacteria to remain and possible restorative risks were more likely to SE, those who strived for restorative longevity and feared bacteria to remain performed CR and accepted ET. Demographics not a factor; generally more or less invasive dentist types. |
Schwendicke [6] | Quest | Germany, France, Norway 2015 | National, all practitioners, 28–50 % response, final 1481 | Deep lesion in permanent tooth with a vital painless pulp with risk of exposure in young patient | France: 340/661 CR, 62/661 SE, 259/661 SW, Germany: 201/622 CR, 122/622 SE, 299/622 SW, Norway: 3/199 CR, 29/199 SE, 167/199 SW | Male dentists chose SE more often (OR: 1.73 [1.26/2.45]), dentists in private setting performed fewer SW (0.60 [0.39/0.93]), those who believed bacteria needed removal to avoid progression chose SE less often (0.48 [0.33/0.71]), as did those who feared bacteria to harm the pulp (0.42 [0.28/0.62]) and vice versa for those who thought sealed lesions to arrest (2.84 [1.86/4.36]) or who strived to avoid exposure (2.18 [1.40/3.29]). Satisfaction with a treatment, familiarity and its evidence-base were main reasons, only few stated financial issues or peers as problems, knowledge also minor factor. Authors discuss education, caries philosophy as further reasons. |