Management of deep carious lesions among Syrian dentists: a cross-sectional study

Deep carious lesions present significant challenges in dental practice, requiring effective management strategies to preserve tooth sensibility and function. This study aimed to assess Syrian dentists 'practices related to deep carious lesions and managing exposed pulps in teeth with reversible pulpitis in permanent teeth. It also examined the impact of dentists' experience and specialization on their choice of techniques and diagnostic tools.

A cross-sectional study was conducted using a self-administered paper-based questionnaire distributed to dentists in Damascus. The questionnaire collected 1- demographic data, 2- clinical decisions before the start of the treatment, and 3- clinical decisions to treat deep carious lesions in different clinical cases and the management of exposed pulps. Data were analyzed to identify trends and differences in practices based on experience and specialization. Data were coded into excel and analyzed using SPSS V.25.

The study included responses from 252 dentists. The majority of dentists chose to take radiographs before treatment (69.4%), or do a sensibility test (70.6%). A strong preference for minimally invasive techniques was observed, such as partial caries removal to avoid pulp exposure (71.7%) and the use of hand excavators (53.2%). Dentists with more than 10 years of experience were more likely to work without rubber dam (< 0.001), while endodontists tended to apply rubber dam more than other clinicians (< 0.001). Experienced and specialist dentists were more likely to use rubber dam (p = 0.001) and perform sensibility tests (p = 0.000). The unique context of practicing in Syria, marked by conflict and political sanctions, significantly influenced decision-making of the biomaterials used, with the majority using calcium hydroxide (60.7%) and avoiding other materials, such as MTA and Biodentine, due to cost (31.5%) and availability (9.2%).

This study documented the clinical decision among Syrian dentist before and during the treatment of deep carious lesions. Clinical decisions and practices are significantly affected by years of experience and whether the dentist is specialized or not. General dentists and other specialists were less likely to perform vital pulp therapies when pulp exposed in teeth with reversible pulpitis than endodontists. Complementary education of Syrian dentists in the domain of pulps exposed management appears necessary regarding current recommendations.