Caries Lesion Management – A Survey of California Dentists

Objectives: Questionnaire surveys are becoming more and more popular describing treatment philosophies in dental practices.
The aim of this study was to evaluate the management strategies for approximal and occlusal carious lesions among California dentists.
Methods: A questionnaire developed by Espelid et al. was emailed in May 2013 to 16,960 dentists in California. Responses were received from 1,922 (11.3%) dentists. χ² statistical analyses were performed.
Results: When asked about their approximal restorative threshold, the depth of an approximal lesion on x-ray to start drilling, 18% of the respondents suggested operative treatment for a lesion confined to enamel, 42.6% for a lesion at the enamel-dentin junction and 39.4% would start treatment when the lesion reaches the outer third of dentin or deeper. The preferred preparation type of 54.1% of respondents for those lesions was the traditional class II preparation, while 45.9% preferred more conservative cavity preparation (tunnel or saucer-shaped). The majority of the respondents (92.6%) suggested tooth coloured material, 6.4% amalgam and 1% other kind of materials (e.g. gold).
When asked about their occlusal restorative threshold, 49.9% would restore an occlusal lesion involving the outer 1/3 of dentin (ICDAS-3) while 40.7% would restore an occlusal lesion confined to enamel. 9.4% would start treatment if the lesion is in the middle 1/3 of dentine or deeper (ICDAS-4/5). A Chi-square test showed that the graduation year was significantly related to the restorative threshold for both proximal (p<0.0001) and occlusal caries lesions (p=0.05). Respondents who graduated ≤20 years ago were less likely to suggest drilling for lesions confined to enamel than those dentists who graduated >20 years ago.
Conclusions: The present study showed a wide disparity among California dentists with regards to their restorative threshold. Dentists who graduated more recently were more likely to place restorations when the lesions were into dentin rather than enamel.