30 July 2019

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Deep caries in the occlusal areas: what clinical attitude to have?

Massimo Gagliani

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The study published on the Journal of Dentistry in May 2019  quantified and compared practice patterns of treatment for deep occlusal carious lesions among Japanese dentists, and tested the hypothesis that dentist characteristics are significantly associated with the decision to choose an indirect pulp capping (IPC), a form of selective carious tissue removal that involves leaving a thin layer of demineralized tissue over the pulp, that is then covered with a protective liner.  

This cross-sectional study was conducted using a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (n = 297). Dentists were asked to indicate what percentage of time they use three treatment options when treating patients with deep occlusal caries and possible mild pulpitis on a posterior tooth. Response options were
“1. Stop before removing all caries and perform an IPC”,
 “2. Remove all caries and proceed with a direct pulp cap”, 
 “3. Remove all caries and proceed with endodontic-related procedures”.

Percentages of options 1–3 were compared by multiple comparison. Associations between dentist characteristics and a higher percentage of IPC provision (option 1) were analyzed via logistic regression.   Results Responses were obtained from 206 dentists. Median percentages (interquartile ranges) of options 1, 2 and 3 were 30% (10–59%), 10% (0–30%), and 40% (19–80%), respectively.
The differences between option 3 and options 1 and 2 were significant (p < 0.001). In logistic regression analysis, a higher frequency of obtaining evidence from English-language scientific articles was significantly associated with a higher percentage of IPC, with an odds ratio of 2.28 (95%CI: 1.14–4.54).  

CONCLUSIONS
Endodontic-related procedures remain the most frequent treatment option for deep occlusal caries. Frequent use of evidence-based information in English-language scientific articles was associated with Japanese dentists’ preference toward IPC.   Clinical Significance Japanese dentists would most frequently choose endodontic-related procedures, followed by IPC and direct pulp capping for treatment of patients with deep occlusal caries with possible mild pulpitis on posterior teeth. Significant association was identified between use of evidence-based information in the English-language scientific literature and Japanese dentists’ preference for IPC.

For additional informations: 
Dentists’ practice patterns of treatment for deep occlusal caries: Findings from a dental practice-based research network