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CONTEMPORARY DENTAL CARIES MANAGEMENT CONCEPTS IN PAEDIATRIC DENTISTRY : A SURVEY OF AWARENESS AND PRACTICE OF A GROUP OF GULF COOPERATION COUNCIL DENTISTS

Original Articles of caries and restoring the defective tooth structure is only one of the treatment modalities used . 31 SDC in permanent teeth where the carious lesion is partially removed or completely left has been employed as an accepted therapeutic technique by some with ten year results 32 and current available evidence supports the SDC approach . 31 , 33 , 34 There are several techniques of SDC that are currently employed , ranging from indirect pulp capping 17 either by incomplete removal of caries and sealing over the carious lesion closest to the pulp or by stepwise caries removal where only partial removal of caries is employed , followed by temporary restoration of the tooth for few months . Finally the tooth is re-entered the rest of the carious lesion , if any present , is removed and the final restoration is placed . 31 Another technique 35 is the no caries removal technique where the entire carious lesion is sealed in permanent teeth as well as primary teeth as highlighted above in the HT section . In permanent teeth , the amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions . 36 A systematic review and meta-analysis of incomplete caries removal studies 37 concluded that in complete caries removal appeared superior compared to complete caries excavation , especially in lesions very close to the pulp . However , evidence levels are currently insufficient for definitive conclusions because of high risk of bias within the studies . A qualitative examination of private dentists ’ treatment decisions towards non-cavitated carious lesions concluded that the practitioners based their their decisions on their practical clinical experience and dentists ’ knowledge of the evidence-based recommendations did not lead to higher compliance with these recommendations . 38 In our survey , we had attempted to assess the opinion of the surveyed dentists regarding sealing decay in primary and permanent teeth . It was clear that the majority did not believe that SDC was a viable option for both the primary and permanent teeth ( 56.6 % and 53.3 %) although we specified “ enamel non-cavitated lesion ” in the latter question . This indicated that there was reluctance in the GCC region to accept this new concept , and concurred with the pro “ drill and fill ” results from the first question in this survey . Whether the participant was a PD or GDP had no significant bearing on this result ( p = 0.517 and p = 0.182 ), although there was a slight tendency for PDs to be tolerant to SDC in both dentitions . This correlated in part with the result seen above with regards to the HT , in essence a method for SDC in primary teeth . Therefore , the hypothesis , that the surveyed GCC dentists ; agreed on treatment options for RCM when faced with a non-pulpally involved carious primary molar in a cooperative child , agreed on the PM used in a primary molar pulpotomy , had practiced the HT , and agreed to the concept of SDC in primary and permanent teeth was rejected . However they were aware of the HT . Therefore , there is a great need to organise continuing dental education courses for GDPs and PDs in the GCC region to update them with contemporary guidelines and recommendations related to RCM , PM , HT and SDC . On a final note , ideally we would have liked the sample of PDs to be the same size of GDPs in this study , however , it is known that there are fewer specialist PDs per paediatric dental population ( average 7 per 100000 in the USA ) compared to GDPs ( 60 per 100000 persons in the USA ). 39 In the UK , there are 242 registered PDs , compared to 41,000 GDPs ( personal communication , General Dental Council , UK , 2016 ). Therefore , our study sample effectively reflected the relative proportions of the said groups in society . 40

5 . Conclusion Upon surveying the opinion of a group of dentists in the GCC region , we can conclude that there were disagreements amongst them in relation to the concepts of RCM , PM , HT and SDC . They did not agree on treatment choices for RCM , although the majority would surgically remove rather than seal asymptomatic non- pupal caries in a primary molar . There was no agreement of the PM choices for a primary tooth pulpotomy . The majority were aware of the HT but only a minority used it . A majority did not believe in SDC in both dentitions . Therefore there was a reluctance to accept new concepts , such as the HT and SDC . PDs choice of RCM significantly differed from GDPs , and their awareness of HT and practice of HT were more favourable .
Disclosure of potential conflicts of interest Ethical approval : “ All the procedures ( questionnaires ) performed in this study were in accordance with the ethical standards of Mohammed Bin Rashid University of Medicine and Health Science ( MBRU ) and the Hamdan Bin Mohammed College of Dental Medicine ( HBMCDM ), Dubai , United Arab Emirates and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards .” Informed consent : “ Verbal informed consent was obtained from all individual participants included in the study .” Conflict of Interest : The authors declare that they have no conflict of interest . Funding : This research did not receive any specific grant from funding agencies in the public , commercial , or not-for-profit sectors .
Authors Contributions : IH ( principle author ): Concept and design of study , bulk of write up of article , editing , data gathering , analysis and graphs . MH : Design of study , data gathering and sealing caries section in article . MK : Design of study , data gathering and pulpotomy section in article . AKH : Protocol and statistical analysis and tables .

36 Stoma Edu J . 2017 ; 4 ( 1 ): 27-38 . http :// www . stomaeduj . com