Two decades of approximal carious lesion management in France: A repeated cross-sectional survey (2002-2023)

Despite the dissemination of Minimum Intervention Dentistry (MID) principles, substantial discrepancies persist between recommendations and clinical decision-making, with heterogeneous and asynchronous adoption across countries. The aims of the present study were (1) to describe the two-decade evolution since 2002 of thresholds and strategies (cavity preparation and dental material) for restorative approximal carious lesions (ACLs) management in France, and (2) to explore, through additional questions, the 2023 French general dental practitioners' (Fr-GDPs) knowledge and perceptions of the caries process.

A repeated cross-sectional, questionnaire-based study was conducted among Fr-GDPs in 2002 (n = 766), 2012 (n = 765), and 2023 (n = 244). The questionnaire included demographic characteristics, restorative threshold, and management strategies for ACLs.

Across the three successive surveys, restorative threshold was significantly delayed to more advanced stages of caries progression (p < 0.0001). The proportion of respondents restoring enamel ACLs decreased from 55.7% in 2002 to 22.5% in 2023. Greater accuracy of cariology-related knowledge and beliefs was associated with clinical decisions more consistent with MID principles. Differences in sampling strategy across surveys are acknowledged as a study limitation.

Over two decades, the successive surveys indicate a shift toward delayed restorative thresholds for ACLs. It may be hypothesised that, if implementation is approaching a plateau, further progress may require addressing cognitive dimensions, including decision-making under complexity, tolerance of uncertainty, and adaptation strategies.

This two-decade survey demonstrates a marked shift toward MID in ACLs management among Fr-GDPs, despite a remaining evidence-to-practice gap.