Self-Reported Preferences for Selective Caries Removal: A Survey Study among Swedish Dentists

Introduction: Selective caries removal (SE) involves intentionally leaving some decayed dentine in deep lesions to maintain pulp vitality and avoid overtreatment. In Sweden, clinical practice has traditionally emphasized stepwise caries removal (SW). However, recently published national guidelines accord equal importance to SE. The present study aimed to investigate the therapeutic approaches reported by general Swedish dentists in the management of deep carious lesions in permanent teeth, the patient- and practitioner-related factors influencing the preference for SE, and the materials employed during the procedure.

An electronic questionnaire was distributed to 200 randomly selected public dental clinics and 150 private dental clinics across Sweden. Additionally, it was shared via professional newsletters and social media platforms.

A total of 447 practitioners from all 21 counties in Sweden completed the questionnaire, whose data were included in the analysis. Their collective responses showed that, for an asymptomatic deep caries lesion, less invasive excavation strategies, such as SE and SW, were preferred by 91.3% of dentists, whereas 6.7% favored nonselective removal and 2% chose other approaches. Of note, 85% of the surveyed individuals had previously performed SE on permanent teeth. Dentists aged 36 years or older were significantly less likely to perform SE compared to the control group aged 25 years or younger (p < 0.01). Additionally, dentists working in public dental clinics (odds ratio [OR] = 0.59, p = 0.015) were significantly less likely to perform SE compared to practitioners working in private dental clinics. When performing SE, 58.4% of surveyed dentists preferred composite restorations without any cavity liner closest to the pulp.

The majority of surveyed dentists opt for less invasive treatment methods for caries management. SE emerged as the most widely used technique, particularly among younger age-groups and in private practice.