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Restorative Treatment Decisions for Deep Proximal Carious Lesions in Primary Molars

  • M. A. QudeimatEmail author
  • F. A. Al-Saiegh
  • Q. Al-Omari
  • R. Omar
Article

Abstract

Aim: To assess clinicians’ individual variables that might influence decision-making for the restoration of deep proximal carious lesions in primary molars. Methods: A precoded questionnaire that sought participants’ treatment choices for a deeply carious second mandibular primary molar as depicted in a simulated periapical radiograph, along with a specific clinical scenario, was distributed among a random sample of 157 dentists and 15 paediatric dentists. Participants were asked to answer all questions. After combining the pulpotomy and pulpectomy treatment choices under a “pulp therapy” category, a binary dependant variable was constructed. Logistic regression of the ratio of the participants who would restore the questioned tooth by the methods in question, was run. Results: A total of 155 dentists (116 males and 39 females) completed the survey, giving a response rate of 90 %. Of these 53 % of dentists recommended pulpotomy followed by definitive restoration and 39% recommended removal of caries and restoration without pulp therapy. In the logistic regression model, males and graduates from English language undergraduate dental programs had higher probabilities of restoring without prior pulp therapy (P<0.03 and P<0.02, respectively). Compared with graduates of Asian dental programs, dentists who graduated from Eastern Europe and the Middle East showed lower likelihoods of restoring the tooth without prior pulp therapy (P<0.01 and P<0.004, respectively). Dentists who treated an average of 6–16 child patients during a week had a lower probability of restoring the tooth without prior pulp therapy than those who were not currently involved in treating children (P<0.01). No other measured variables were associated with the participant’s treatment choices. Conclusions: The lack of agreement among dentists regarding their optimal treatment recommendations for deep proximal carious lesions appears to be due mainly to inter-individual, educational training and practice characteristics factors.

Key words

Restoration Primary Molars Proximal Caries Pulp Therapy Decision-making 

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References

  1. Al-Ali K, Marghalani H, Al-Yahya A, Omar R. An assessment of endodontic retreatment decision-making in an educational setting. Int Endod J 2005;38:470–476.PubMedCrossRefGoogle Scholar
  2. American Academy of Pediatric Dentistry. Guidelines on pulp therapy for primary and young permanent teeth. Pediatr Dent 2005–2006:27:130–134.Google Scholar
  3. Aryanpur S, van Niewenhuysen J-P, D’Hoore W. Endodontic retreatment decisions. Int Endod J 2000:33:208–218.CrossRefGoogle Scholar
  4. Bader JD, Kaplan AL. Treatment distributions in dental practice. J Dent Educ 1983:47:142–148.PubMedGoogle Scholar
  5. Bader JD, Shugars DA. What do we know about how dentists make cariesrelated treatment decisions? Community Dent Oral Epidemiol 1997:25:97–103.PubMedCrossRefGoogle Scholar
  6. Carrotte P. Endodontic treatment for children. Br Dent J 2005:198:9–15.PubMedCrossRefGoogle Scholar
  7. Duggal MS, Nooh A, High A. Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. Eur J Paediatr Dent 2002:3:111–114.PubMedGoogle Scholar
  8. Duggal MS, Day PF. Operative treatment of dental caries in the primary dentition. In: Welbury RR, Duggal MS, Hosey MT (eds). Paediatric Dentistry. 3rd ed. Oxrofd: Oxford University Press: 2005. pp 149–174.Google Scholar
  9. Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent 2000:22:278–286.PubMedGoogle Scholar
  10. Field M, Lohr K. Clinical Practice Guidelines: Directions for a New Program. Washington: National Academy Press: 1990.Google Scholar
  11. Forrest JL, Miller SA. Evidence-based decision making in action: Part 1-Finding the best clinical evidence. J Contemp Dent Pract 2002:3:10–26.PubMedGoogle Scholar
  12. Forrest JL, Miller SA. Evidence-based decision making in action: Part 2. Evaluating and applying the clinical evidence. J Contemp Dent Pract 2003:4:42–52.PubMedGoogle Scholar
  13. Guelmann M, Mjor IA, Jerrell GR. The teaching of Class I and II restorations in primary molars: a survey of North American dental schools. Pediatr Dent 2001:23:410–414.PubMedGoogle Scholar
  14. Helminen SE, Vehkalati M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. Int Den J 2002:52:71–74.CrossRefGoogle Scholar
  15. Hobson P. Pulp treatment of deciduous teeth. 2. Clinical investigation. Br Dent J 1970:128:275–282.PubMedCrossRefGoogle Scholar
  16. Kay EJ, Locker D. Variations in restorative treatment decisions: an international comparison. Community Dent Oral Epidemiol 1996:24:376–379.PubMedCrossRefGoogle Scholar
  17. Llewelyn DR. UK National Clinical Guidelines in Paediatric Dentistry. The pulp treatment of the primary dentition. Int J Paediatr Dent 2000:10:248–252.PubMedGoogle Scholar
  18. Marinho V, Richards D, Niederman R. Variation, certainty, evidence, and change in dental education: Employing evidence-based dentistry in dental education. J Dent Educ 2001:65:449–455PubMedGoogle Scholar
  19. McKnight-Hanes C, Myers DR, Dushku JC, Barenie JT. A comparison of general dentists’ and pediatric dentists’ treatment recommendations for primary teeth. Pediatr Dent 1991:13:344–348.PubMedGoogle Scholar
  20. Mejare I, Sundberg H, Espelid I, Tveit B. Caries assessment and restorative treatment thresholds reported by Swedish dentists. Acta Odontol Scand 1999:57:149–154.PubMedCrossRefGoogle Scholar
  21. Nadin G, Goel BR, Yeung CA, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev 2003:(1):CD003220.Google Scholar
  22. Omar R, Al-Kokani M, Abu Nassif L, Khan N. Influence of dentist-related factors on the time spent on providing prosthodontic services among general dentists. Saudi Dent J 2003:15:2–10.Google Scholar
  23. Tickle M, Milsom KM, Humphris GM, Blinkhorn AS. Parental attitudes to the care of the carious primary dentition. Br Dent J 2003:195:451–455.PubMedCrossRefGoogle Scholar
  24. Tillinghast SJ. Can Western quality improvement methods transform the Russian health care system? Jt Comm J Qual Improv 1998:24:280–298.PubMedGoogle Scholar
  25. Tveit AB, Espelid I, Skodje F. Restorative treatment decisions on approximal caries in Norway. Int Dent J 1999:49:165–172.PubMedCrossRefGoogle Scholar
  26. Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent 2004:26:214–220.PubMedGoogle Scholar

Copyright information

© European Archives of Paediatric Dentistry 2007

Authors and Affiliations

  • M. A. Qudeimat
    • 1
    Email author
  • F. A. Al-Saiegh
    • 2
  • Q. Al-Omari
    • 2
  • R. Omar
    • 2
  1. 1.Department of Developmental and Preventive Sciences, Faculty of DentistryKuwait UniversitySafatKuwait
  2. 2.Dept Restorative SciencesKuwait UniversityKuwait

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