Factors Influencing Treatment Decisions in Permanent Mature Teeth with Irreversible Pulpitis: a Questionnaire-based Study

Overview

Journal Aust Dent J

Specialty Dentistry

Date 2024 Jun 8

PMID 38850075

Authors

Y Alfaisal

G Idris

O A Peters

C I Peters

S Zafar

Affiliations

Soon will be listed here.

Abstract

Background: Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis.

Methods: An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario.

Results: Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%).

Conclusions: Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.

References

Bjorndal L . Is pulpotomy preferable to root treatment where there is pulp exposure?. Evid Based Dent. 2019; 20(4):117-118. DOI: 10.1038/s41432-019-0057-y. View

Bidar M, Gharechahi M, Soleimani T, Eslami N . A Survey over the Dentists' and Endodntists' Approaches towards the Management of Endodontic Emergencies in Mashhad, Iran. Iran Endod J. 2015; 10(4):256-62. PMC: 4609665. DOI: 10.7508/iej.2015.04.010. View

Aguilar P, Linsuwanont P . Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod. 2011; 37(5):581-7. DOI: 10.1016/j.joen.2010.12.004. View

Ghoneim A, Yu B, Lawrence H, Glogauer M, Shankardass K, Quinonez C . What influences the clinical decision-making of dentists? A cross-sectional study. PLoS One. 2020; 15(6):e0233652. PMC: 7274387. DOI: 10.1371/journal.pone.0233652. View

Grembowski D, Milgrom P, Fiset L . Variation in dentist service rates in a homogeneous patient population. J Public Health Dent. 1990; 50(4):235-43. DOI: 10.1111/j.1752-7325.1990.tb02129.x. View

Croft K, Kervanto-Seppala S, Stangvaltaite L, Kerosuo E . Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland. Clin Oral Investig. 2018; 23(3):1271-1280. DOI: 10.1007/s00784-018-2556-1. View

Ricucci D, Loghin S, Siqueira Jr J . Correlation between clinical and histologic pulp diagnoses. J Endod. 2014; 40(12):1932-9. DOI: 10.1016/j.joen.2014.08.010. View

Mota de Almeida F, Knutsson K, Flygare L . The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics. Dentomaxillofac Radiol. 2014; 43(4):20130137. PMC: 4082257. DOI: 10.1259/dmfr.20130137. View

Adeyemo W, Taiwo O, Oderinu O, Adeyemi M, Ladeinde A, Ogunlewe M . Oral health-related quality of life following non-surgical (routine) tooth extraction: A pilot study. Contemp Clin Dent. 2013; 3(4):427-32. PMC: 3636819. DOI: 10.4103/0976-237X.107433. View

10.

Simon S, Perard M, Zanini M, Smith A, Charpentier E, Djole S . Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Int Endod J. 2012; 46(1):79-87. DOI: 10.1111/j.1365-2591.2012.02113.x. View

11.

Bogen G, Kim J, Bakland L . Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008; 139(3):305-15. DOI: 10.14219/jada.archive.2008.0160. View

12.

Wigsten E, Kvist T, Jonasson P, Davidson T . Comparing Quality of Life of Patients Undergoing Root Canal Treatment or Tooth Extraction. J Endod. 2019; 46(1):19-28.e1. DOI: 10.1016/j.joen.2019.10.012. View

13.

Al-Asmar A, Al-Hiyasat A, Abu-Awwad M, Mousa H, Salim N, Almadani W . Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making. Int J Dent. 2022; 2021:4871385. PMC: 8741395. DOI: 10.1155/2021/4871385. View

14.

Ford T, Torabinejad M, Abedi H, Bakland L, Kariyawasam S . Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996; 127(10):1491-4. DOI: 10.14219/jada.archive.1996.0058. View

15.

Koopaeei M, Inglehart M, McDonald N, Fontana M . General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis. J Am Dent Assoc. 2016; 148(2):64-74. DOI: 10.1016/j.adaj.2016.11.001. View

16.

Duncan H, Kirkevang L, Peters O, El-Karim I, Krastl G, Fabbro M . Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J. 2023; 56 Suppl 3:238-295. DOI: 10.1111/iej.13974. View

17.

Gemmell A, Stone S, Edwards D . Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. Br Dent J. 2020; 228(7):521-526. DOI: 10.1038/s41415-020-1419-8. View

18.

Wolters W, Duncan H, Tomson P, Karim I, McKenna G, Dorri M . Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017; 50(9):825-829. DOI: 10.1111/iej.12793. View

19.

Chin J, Thomas M, Locke M, Dummer P . A survey of dental practitioners in Wales to evaluate the management of deep carious lesions with vital pulp therapy in permanent teeth. Br Dent J. 2016; 221(6):331-8. DOI: 10.1038/sj.bdj.2016.684. View

20.

Atav Ates A, AlOmari T, Bhardwaj A, Tabnjh A, Gambarini G . Differences in endodontic emergency management by endodontists and general dental practitioners in COVID-19 times. Braz Oral Res. 2020; 34:e122. DOI: 10.1590/1807-3107bor-2020.vol34.0122. View