Treatment of Deep Carious Lesions: Study of Acceptability of Alternative: Caries Removal Techniques among Dentists Practicing in Iowa

Objectives: Most U.S. dentists believe that non-selective caries removal is necessary to avoid caries progression and pulpal complications; however, this approach is associated with a higher likelihood of pulp exposure in deep carious lesions (DCLs). This study identified factors that influence dentists’ decisions regarding selective caries removal techniques such as stepwise removal (SWP) and selective removal (SR) using a marketing research technique, conjoint analysis
Methods: A survey was sent to 1,434 dentists practicing in State of Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SWP or SR in hypothetical clinical scenarios. The scenarios were created by conjoint design including three attributes (depth of lesion, hardness of carious dentin and patient age).
Results: Response rate was 36%. The study revealed that when choosing a SWP to treat a DCL, depth of lesion was the most important factor in dentists’ decisions (48.39 importance value) followed by hardness of carious dentin (30.89) and patient age (20.71). For the SR-group, depth of the lesion was also the predominant factor when selecting a treatment (46.99 importance value). The study also identified three distinct clusters of dentists with different preferences regarding treatment of DCLs, including 24.9% of dentists who would not use SWP or SR under any circumstances
Conclusions: The study showed that depth of lesion was the most important reason to select an alternative caries removal method. The high proportion of dentists indicating they would never consider SWP or SR suggests that selective caries removal techniques are underutilized. Evidence of the effectiveness of those techniques should be communicated to dentists to increase its use in the treatment of DCLs.