Dentists' choice of treatment for root caries - a qualitative study

Despite existing recommendations for root caries treatment, their implementation in clinical practice remains inconsistent. This qualitative study explores the factors influencing dentists' decision-making in selecting appropriate therapies for root caries.

A structured interview guide was designed based on the Theoretical Domains Framework (TDF), and 15 semi-structured individual interviews were conducted with dentists (mean (min/max) professional experience: 14.8 (3/48) years). The interview transcripts were analysed using the TDF and the Capability-Opportunity-Motivation-Behaviour (COM-B) model to identify key motivations behind treatment choices for root caries.

Data saturation was reached, and a total of 34 barriers, facilitators or conflicting themes were identified that aligned to all COM-B domains. Main barriers included limited awareness of current diagnostic and treatment guidelines, a lack of sufficient incentives for root caries therapy and the perception of root caries management as a frustrating task. Facilitators included viewing root caries management as a high-priority task and a strong interest in offering evidence-based management options.

Root caries management is complex and often under-prioritized, despite clinicians' motivation to provide quality care. Knowledge gaps, emotional strain, and systemic disincentives hinder effective treatment and need to be addressed to improve outcomes.

This study identifies behavioural, emotional, and systemic barriers that contribute to continued invasive management of root caries despite evidence-based recommendations for non-invasive care of early lesions, particularly in older and care-dependent patients. Identifying these barriers may support more consistent adoption of evidence-based approaches in routine dental practice.