Carious Lesion Management Strategies – A Comparison Between France and California

Objectives: Questionnaire surveys are becoming more and more popular to explain dental practices. The present study aimed to compare the management strategies for occlusal carious lesions among French and Californian dentists.
Methods: A questionnaire developed by Espelid et al. was sent by mail to a random sample of 2,000 French dentists (from a national register) in September 2012 and by email to 16,960 dentists in California in May 2013, respectively. A χ² test was performed.
Results: Responses were received from 838 (41.9%) French and 1,922 (11.2%) Californian dentists. When asked about their occlusal restorative threshold, 39.3% of the French respondents would place a restoration for a lesion confined to enamel, 54.7% for a lesion at the enamel-dentin junction and 6% for a lesion in the outer third of dentin or deeper. For the same three stages of caries progression the threshold distribution was 40.7%, 49.9% and 9.4% among Californian dentists (p=0.006). Questions related to diagnosis also revealed wide disparities within the responses. When shown a particular clinical case, 41.3% diagnosed an enamel lesion, 10.4% a dentin lesion, 33.2% thought that the tooth was sound and 15.2% were uncertain. For the same case the diagnosis distribution among California dentists was 50.6%, 15%, 19.1% and 15.4% (p<0.0001). Furthermore, disparities related to management strategies were shown among those respondents who for this situation had diagnosed an enamel lesion. 11.4% French respondents choose to abstain from therapy, 46.3% choose a non-invasive and 42.3% an invasive treatment. The treatment decisions distribution for California respondents was 6.2%, 26.8% and 67% (p<0.0001), respectively
Conclusions: The data may not be considered fully representative of the attitude of dentists in the regions studied due to the low participation rates. Carious lesion management strategies seem to differ markedly between France and California. Further investigations are needed to explain the influencing factors.