Dentists' attitudes and behaviour regarding deep carious lesion management: a multi-national survey

The present study aimed, using a questionnaire, to assess and compare behaviour, attitudes and beliefs of French, German and Norwegian dentists regarding deep carious lesion management. A mail survey was applied to simple random national samples of dentists. Descriptive analysis and logistic regression analysis were performed. Sample size was 661 (response rate, 33 %) in France, 622 (25 %) in Germany and 199 (33 %) in Norway. Hardness was the criterion used most often for assessing carious tissue removal in all three countries (> 95 %), with most dentists aiming for only hard dentine remaining at the pulpal wall (> 66 %); dentine colour was not found relevant by most respondents. The majority of French and German practitioners (> 66 %) would perform complete excavation even for deep lesions, while most Norwegian dentists (84 %) opted for stepwise excavation. Most dentists thought complete removal was required to avoid lesion progression and were uncertain if remaining sealed bacteria would harm the pulp. Treatment decisions were guided by prior experience and familiarity. For example, stepwise removal was performed less often by dentists who were male, French, German or those in the private sector. Less invasive strategies for managing deep lesions have not widely entered clinical practice in France and Germany. Underlying beliefs shape decision-making. The present study is the first of its nature to analyse and compare deep carious lesion management between three European countries. It shows that there is an urgent need to practically educate dentists in less invasive strategies.