Clinical decision-making in pulp therapy of primary teeth among Tunisian dental practitioners: a cross-sectional...

To assess clinical decision-making patterns in pulp therapy of primary teeth among Tunisian dental practitioners and explore the influence of diagnostic uncertainty on treatment selection.

A cross-sectional, scenario-based survey was conducted among 263 dental practitioners in Tunisia (March-August 2025), including general dentists and specialists involved in paediatric care. A structured questionnaire based on the American Academy of Pediatric Dentistry (AAPD) guidelines presented three standardised clinical scenarios with increasing diagnostic complexity: asymptomatic deep caries, mechanical pulp exposure, and progressive pulpal disease. Participants selected treatment options which were compared to guideline-recommended management.

Most participants were early-career practitioners (85% ≤5 years of experience). A consistent tendency towards more invasive treatment was observed. In asymptomatic deep caries, pulpotomy was the most frequently selected option (51.1%) followed by indirect pulp treatment (26.2%). For mechanical pulp exposure, 78.7% of participants selected pulpotomy instead of direct pulp capping. In progressive pulpal disease, pulpectomy was the most frequently selected option (44.1%). Rubber dam isolation was inconsistently applied (6.8% systematic use), and calcium silicate-based materials were used in only 22.1% of pulpotomy procedures. Speciality status significantly influenced treatment selection across all scenarios (p≤0.004).

Clinical decision-making in pulp therapy was strongly influenced by diagnostic uncertainty, leading to a general tendency towards overtreatment and limited adherence to minimally invasive principles. These findings highlight a persistent evidence-practice discordance, and underscore the need to integrate uncertainty-based reasoning into paediatric dental education.