Exploring Occlusal Caries Management over 2 Decades in France among General Dental Practitioners

Abstract

Objectives:

Despite being a central concept in dentistry, minimum intervention dentistry (MID) still faces a gap between evidence and practice. The aim of this study was to investigate the management decisions of French general dental practitioners (FrGDPs) for occlusal carious lesions (OCL) in 2023 and to compare the results to those obtained in 2002 and 2012 using the same questionnaire.

Methods:

An online, cross-sectional survey was conducted using a precoded questionnaire among the French dental practice–based research network (ReCOL). The structured questionnaire assessed the restorative threshold and management strategies for OCL. Three simulated clinical scenarios are presented: 1 illustrating a discrete progression of an OCL (assessing the intervention threshold) and 2 clinical cases (focusing on diagnosis and caries management). Descriptive and statistical analyses were performed to study the evolution over 2 decades.

Results:

The response rate was 45.4%. The 2023 sample included 56% female dentists and was younger and less experienced than the 2002 and 2012 population studies. In 2023, 68.5% of the respondents stated a restorative threshold when the OCL reached the outer third of dentine. Over the last 2 decades, this threshold has been significantly delayed to later stages of carious progression and so is shifting the cavity preparation to a more conservative approach. Over the 2 decades, for clinical cases 1 and 2, diagnosis, management strategies, and material selection have significantly evolved toward earlier grades of carious extension, a more micro- and non-invasive approach, and composite (P < 0.0001). Substantial variability persists among respondents.

Conclusions:

The results reveal a significant shift over the last 2 decades among FrGDPs toward MID. Initial and continuing education are key factors in the improved implementation of MID into practice. Resistance and variability act as barriers, and uncertainty proves to be a challenge, all of which require further investigation.

Knowledge Transfer Statement:

This 2-decade study on the diagnosis and management of dental caries provides valuable insights for dental practitioners, academic institutions, policy-makers, and health system stakeholders. The findings underscore the importance of education, consideration of barriers, and tolerance for uncertainty. These findings are important for raising awareness of, and helping to reduce, the gap between evidence and clinical practice.