Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists

Incomplete removal of deep caries has been shown to reduce the risks of pulp exposure and postoperative pulpal complications. It is therefore of interest whether dentists perform one- or two-step incomplete excavation, and which criteria and methods they use to assess and provide removal of deep caries. This study investigated the attitudes and behaviour of dentists in northern Germany using a new, validated questionnaire. The survey included 2,346 practitioners, 821 (35%) of whom responded. Demographic and sensitivity analysis did not indicate selection bias. 50% of dentists considered only complete excavation, even if pulp exposure was likely. If caries was to be removed incompletely, 77% considered two-step excavation. Hardness was the most important criterion to assess excavation. To treat an exposed pulp, 75% of dentists considered direct capping, 70% refused incomplete excavation fearing caries progression or pulp damage, and 59% reported to prefer more invasive treatment to facilitate restoration longevity. Over 50% recognised an influence of professional regulations on their treatment decisions. There was a moderate correlation between attitudes and behaviour of dentists, with dentists who suspected residual caries to be harmful rejecting incomplete excavation and vice versa. Cluster analysis identified two groups of dentists with opposite attitudes and behaviour, independently from dentist's age or gender. In conclusion, the majority of surveyed dentists was sceptical about leaving caries during excavation and does not practice incomplete caries removal. Therefore, benefits of partial excavation should be highlighted in under- and postgraduate education and regulatory incentives modified to promote minimally invasive techniques.