Crespo-Gallardo Isabel, Hay-Levytska Olesia, Martín-González Jenifer, Jiménez-Sánchez Mari-Carmen, Sánchez-Domínguez Benito, Segura-Egea Juan J
DDS, Department of Stomatology - Endodontic Section, School of Dentistry, University of Sevilla, C/ Avicena S/N, 41009 Sevilla, Spain.
DDS, PhD, Department of Stomatology - Endodontic Section, School of Dentistry, University of Sevilla, C/ Avicena S/N, 41009 Sevilla, Spain.
J Clin Exp Dent. 2018 Aug 1;10(8):e751-e760. doi: 10.4317/jced.55050. eCollection 2018 Aug.
The aim of this study was to investigate the diagnostic criteria and treatment decisions in the management of deep caries lesions (DCLs). The null hypothesis tested was that DCLs are managed according to the current scientific evidence.
A total of 288 dentists were contacted directly or by mail, and 125 (43%) were included in the study. Dentists were requested to answer a questionnaire about the routine approach to the diagnosis and treatment of DCLs. Logistic regression analyses were carried out to calculate odds ratios (OR).
Pulp sensitivity tests were used by 65% of dentists when assessing pulpal health in cases of DCLs, particularly those who had followed courses in cariology (OR = 3.8; = 0.005). Dentine hardness was the most frequent criterion used during DCLs excavation (98%). Two thirds of the respondents (65%) removed carious tissue until they felt hard dentine, and feeling hard dentine correlated with caries removal even at the risk of pulpal exposure (OR = 15.8; = 0.0000). Acute transient pain or sensitivity to cold or heat (reversible pulpitis) were considered by 58% of respondents as a reason to provide endodontic therapy.
The null hypothesis tested is rejected. The evidence-based more conservative approach on the management of DCLs is not being translated to clinical dentistry. Root canal treatment is being indicated in cases of DCLs in which the diagnosis is reversible pulpitis. Likewise, it can be concluded that non-conservative management of DCLs, with endodontic overtreatment, could be occurring. Deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, pulpal diagnosis, reversible pulpitis, treatment decisions.
本研究旨在探讨深龋病变（DCLs）管理中的诊断标准和治疗决策。所检验的零假设是DCLs的管理符合当前科学证据。
直接联系或通过邮件联系了总共288名牙医，其中125名（43%）纳入研究。要求牙医回答一份关于DCLs诊断和治疗常规方法的问卷。进行逻辑回归分析以计算比值比（OR）。
65%的牙医在评估DCLs病例的牙髓健康时使用了牙髓敏感性测试，尤其是那些参加过龋病学课程的牙医（OR = 3.8；P = 0.005）。牙本质硬度是DCLs洞形预备时最常用的标准（98%）。三分之二的受访者（65%）去除龋坏组织直至感觉到硬牙本质，即使有暴露牙髓的风险，感觉到硬牙本质也与龋坏组织的去除相关（OR = 15.8；P = 0.0000）。58%的受访者将急性短暂疼痛或对冷或热敏感（可复性牙髓炎）视为进行牙髓治疗的原因。
所检验的零假设被拒绝。基于证据的更保守的DCLs管理方法未转化为临床牙科实践。在诊断为可复性牙髓炎的DCLs病例中进行了根管治疗。同样，可以得出结论，可能存在对DCLs的非保守管理及牙髓治疗过度治疗的情况。深龋病变、牙髓盖髓术、牙髓健康、牙医、牙髓治疗、牙髓诊断、可复性牙髓炎、治疗决策。
