Therapy and material choices in pulp exposure among public dentists in Norway

Authors

  • Bo Wold Nilsen Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  • Nema Rashdan Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  • Mudar Rashdan Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  • Anca Virtej Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

DOI:

https://doi.org/10.2340/aos.v85.45574

Keywords:

Survey, vital pulp therapy, biomaterial, public dental service

Abstract

Objective: This study aimed to investigate the following: (1) the preferences of public dentists for procedures and materials in carious or non-carious pulp exposure of permanent teeth; (2) how factors such as clinical experience, scientific literature reading, and material availability affect their choices; (3) the self-assessed risk of root canal treatment after pulp capping.

Materials and methods: An online questionnaire consisting of 20 multiple choice and open-ended questions was e-mailed to Norwegian public dental clinics. It assessed dentists’ material preferences for direct pulp capping for carious or non-carious exposures, alongside factors such as years since graduation, scientific literature engagement, availability of materials, and clinical scenario choices. Respondents were also asked to estimate and reason long-term outcomes of their chosen materials. Standardized case descriptions ensured shared clinical understanding. Data were statistically analyzed and p-values ≤ 0.05 were considered statistically significant.

Results: A total of 218 (23.9%) dentists responded. Direct pulp capping was preferred by 65% of respondents, with chemically curing materials – primarily calcium hydroxide – being most used. Chi-square analyses showed that dentists with fewer years of experience and those who had read scientific literature were more likely to prefer calcium silicate materials; however, these variables were not statistically significant predictors in the logistic regression models. Material availability was the strongest predictor of preference, with significantly increased odds of selecting calcium silicates or light-curing materials when available. ‘Satisfied with clinical results for the chosen material’ was the most frequently reported reason for material selection.

Conclusion: Most respondents in this study preferred calcium hydroxide for direct pulp capping in permanent teeth with closed apices, despite the superior clinical outcomes of hydraulic calcium silicates. Material availability in the clinic was the primary factor influencing dentists’ choices, surpassing clinical experience and scientific literature engagement.

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References

Yu C, Abbott P V. An overview of the dental pulp: its functions and responses to injury. Aust Dent J. 2007;52(1 SUPPL.):S4–6.

https://doi.org/10.1111/j.1834-7819.2007.tb00525.x DOI: https://doi.org/10.1111/j.1834-7819.2007.tb00525.x

Veerayutthwilai O, Byers MR, Pham TTT, Darveau RP, Dale BA. Differential regulation of immune responses by odontoblasts. Oral Microbiol Immunol. 2007;22(1):5–13.

https://doi.org/10.1111/j.1399-302X.2007.00310.x DOI: https://doi.org/10.1111/j.1399-302X.2007.00310.x

Stangvaltaite L, Kundzina R, Bolstad NL, Eriksen HM, Kerosuo E. Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: a cross-sectional age cohort study. Acta Odontol Scand. 2014;73(6):401–7.

https://doi.org/10.3109/00016357.2014.971866 DOI: https://doi.org/10.3109/00016357.2014.971866

Croft K, Kervanto-Seppälä S, Kerosuo E. Deep carious lesions and their management among Finnish adolescents: a retrospective radiographic study. Clin Oral Investig. 2022;26(11):6503–10.

https://doi.org/10.1007/s00784-022-04599-3 DOI: https://doi.org/10.1007/s00784-022-04599-3

Taha NA, Ahmad MB, Ghanim A. Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. Int Endod J. 2017;50(2):117–25.

https://doi.org/10.1111/iej.12605 DOI: https://doi.org/10.1111/iej.12605

Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J. 2018;51(8):819–28.

https://doi.org/10.1111/iej.12903 DOI: https://doi.org/10.1111/iej.12903

Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P, et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. J Dent. 2019;88(May):103158.

https://doi.org/10.1016/j.jdent.2019.06.005 DOI: https://doi.org/10.1016/j.jdent.2019.06.005

Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, et al. European Society of Endodontology position statement: management of deep caries and the exposed pulp. Int Endod J. 2019;52(7):923–34.

https://doi.org/10.1111/iej.13080 DOI: https://doi.org/10.1111/iej.13080

Duncan HF. Present status and future directions – vital pulp treatment and pulp preservation strategies. Int Endod J. 2022;55(S3):497–511.

https://doi.org/10.1111/iej.13688 DOI: https://doi.org/10.1111/iej.13688

Eleazer PD, Glickman GN, Scott JD, Mcclanahan B, Terry MS, Webb D, et al. Glossary of endodontic terms. Vol. 10. American Association of Endodontists; 2020. p. 1–48. https://www.aae.org/specialty/download/glossary-of-endodontic-terms/

Prasertsuksom N, Osiri S, Jaruchotiratanasakul N, Ongchavalit L. Treatment outcomes and prognostic factors of direct pulp capping in permanent teeth: a systematic review and meta-analysis. Eur Endod J. 2024;9(4):295–307.

https://doi.org/10.14744/eej.2024.93723 DOI: https://doi.org/10.14744/eej.2024.93723

De Souza Costa CA, Hebling J, Hanks CT. Current status of pulp capping with dentin adhesive systems: a review. Dent Mater. 2000;16(3):188–97.

https://doi.org/10.1016/s0109-5641(00)00008-7 DOI: https://doi.org/10.1016/S0109-5641(00)00008-7

Kundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E. Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J. 2017;50(10):924–32. DOI: https://doi.org/10.1111/iej.12719

https://doi.org/10.1111/iej.12714 DOI: https://doi.org/10.1111/iej.12714

Kunert M, Lukomska-Szymanska M. Bio-inductive materials in direct and indirect pulp capping – a review article. Materials. 2020;13(5):1–20.

https://doi.org/10.3390/ma13051204 DOI: https://doi.org/10.3390/ma13051204

Paula AB, Laranjo M, Marto CM, Paulo S, Abrantes AM, Casalta-Lopes J, et al. Direct pulp capping: what is the most effective therapy? Systematic review and meta-analysis. J Evid Based Dent Pract. 2018;18(4):298–314.

https://doi.org/10.1016/j.jebdp.2018.02.002 DOI: https://doi.org/10.1016/j.jebdp.2018.02.002

Slaboseviciute M, Vasiliauskaite N, Drukteinis S, Martens L, Rajasekharan S. Discoloration potential of biodentine: a systematic review. Materials. 2021;14(22):6861.

https://doi.org/10.3390/ma14226861 DOI: https://doi.org/10.3390/ma14226861

Nilsen BW, Jensen E, Örtengren U, Michelsen VB. Analysis of organic components in resin-modified pulp capping materials: critical considerations. Eur J Oral Sci. 2017;125(3):183–94.

https://doi.org/10.1111/eos.12347 DOI: https://doi.org/10.1111/eos.12347

Camilleri J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. Dent Mater. 2014;30(7):709–15.

https://doi.org/10.1016/j.dental.2014.03.012 DOI: https://doi.org/10.1016/j.dental.2014.03.012

Peskersoy C, Lukarcanin J, Turkun M. Efficacy of different calcium silicate materials as pulp-capping agents: randomized clinical trial. J Dent Sci. 2021;16(2):723–31.

https://doi.org/10.1016/j.jds.2020.08.016 DOI: https://doi.org/10.1016/j.jds.2020.08.016

Kayad M, Koura A, El-Nozahy A. A comparative histological study of the effect of TheraCal LC and biodentine on direct pulp capping in rabbits: an experimental study. Clin Oral Investig. 2023;27(3):1013–22.

https://doi.org/10.1007/s00784-022-04658-9 DOI: https://doi.org/10.1007/s00784-022-04658-9

Argueta-Figueroa L, Jurado CA, Torres-Rosas R, Bautista-Hernández MA, Alhotan A, Nurrohman H. Clinical efficacy of biomimetic bioactive biomaterials for dental pulp capping: a systematic review and meta-analysis. Biomimetics. 2022;7(4):1–15.

https://doi.org/10.3390/biomimetics7040211 DOI: https://doi.org/10.3390/biomimetics7040211

García-Mota LF, Hardan L, Bourgi R, Zamarripa-Calderón JE, RiveraGonzaga JA, Hernández-Cabanillas JC, et al. Light-cured calcium silicate based-cements as pulp therapeutic agents: a meta-analysis of clinical studies. J Evid Based Dent Pract. 2022;101776. Fel! Ogiltig hyperlänkreferens. DOI: https://doi.org/10.1016/j.jebdp.2022.101776

Stangvaltaite L, Schwendicke F, Holmgren C, Finet M, Maltz M, Elhennawy K, et al. Management of pulps exposed during carious tissue removal in adults: a multi-national questionnaire-based survey. Clin Oral Investig. 2017;21(7):2303–9.

https://doi.org/10.1007/s00784-016-2023-9 DOI: https://doi.org/10.1007/s00784-016-2023-9

Croft K, Kervanto-Seppälä S, Stangvaltaite L, Kerosuo E. Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland. Clin Oral Investig. 2019;23(3):1271–80.

https://doi.org/10.1007/s00784-018-2556-1 DOI: https://doi.org/10.1007/s00784-018-2556-1

Stangvaltaite-Mouhat L, Stankeviciene I, Brukiene V, Puriene A, Drachev SN. Changes in management preference of deep carious lesions and exposed pulps: questionnaire studies with a 10-year interval among dentists in Lithuania. Caries Res. 2023;56(5–6):512–23.

https://doi.org/10.1159/000527960 DOI: https://doi.org/10.1159/000527960

Stangvaltaite L, Kundzina R, Eriksen HM, Kerosuo E. Treatment preferences of deep carious lesions in mature teeth: questionnaire study among dentists in Northern Norway. Acta Odontol Scand. 2013;71(6):1532–7.

https://doi.org/10.3109/00016357.2013.775338 DOI: https://doi.org/10.3109/00016357.2013.775338

Asgary S, Eghbal MJ. Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial. Acta Odontol Scand. 2013;71(1):130–6.

https://doi.org/10.3109/00016357.2011.654251 DOI: https://doi.org/10.3109/00016357.2011.654251

Taha NA, Al-Rawash MH, Imran ZA. Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: a parallel, double blind, randomized controlled trial. Int Endod J. 2022;55(5):416–29.

https://doi.org/10.1111/iej.13707 DOI: https://doi.org/10.1111/iej.13707

Tzanetakis GN, Koletsi D, Georgopoulou M. Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: a randomized clinical trial. Int Endod J. 2023;56(10):1178–96.

https://doi.org/10.1111/iej.13955 DOI: https://doi.org/10.1111/iej.13955

Bletsa A, Iden O, Sulo G, Berggreen E. Work experience influences treatment approaches in endodontics: a questionnaire survey among dentists in Western Norway. Acta Odontol Scand. 2019;77(8):617–23.

https://doi.org/10.1080/00016357.2019.1631470 DOI: https://doi.org/10.1080/00016357.2019.1631470

Malmberg L, Hägg E, Björkner AE. Endodontic infection control routines among general dental practitioners in Sweden and Norway: a questionnaire survey. Acta Odontol Scand. 2019;77(6):434–8.

https://doi.org/10.1080/00016357.2019.1584330 DOI: https://doi.org/10.1080/00016357.2019.1584330

Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978;4(8):232-7

https://doi.org/10.1016/s0099-2399(78)80153-8. DOI: https://doi.org/10.1016/S0099-2399(78)80153-8

Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol. 2010;26(6):466–75.

https://doi.org/10.1111/j.1600-9657.2010.00924.x DOI: https://doi.org/10.1111/j.1600-9657.2010.00924.x

Wang G, Wang C, Qin M. Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures – a retrospective study. Dent Traumatol. 2017;33(4):255–60.

https://doi.org/10.1111/edt.12332 DOI: https://doi.org/10.1111/edt.12332

Kostopoulou MN, Duggal MS. A study into dentists’ knowledge of the treatment of traumatic injuries to young permanent incisors. Int J Paediatr Dent. 2005;15(1):10–9.

https://doi.org/10.1111/j.1365-263x.2005.00588.x DOI: https://doi.org/10.1111/j.1365-263X.2005.00588.x

Cvijic A, Åstrøm A, Kvernenes M, Tsilingaridis G, Bletsa A. Traumatic dental injuries: knowledge assessment of dentists in the Norwegian Public Dental Service of Vestland. Dent Traumatol. 2024;40(4):398–409.

https://doi.org/10.1111/edt.12945 DOI: https://doi.org/10.1111/edt.12945

Bailleul L, Ceballos L, Doméjean S, Fuentes V. Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists. Int Endod J. 2025 Feb;58(2):239-256. https://doi: 10.1111/iej.14159. Epub 2024 Oct 30. PMID: 39474713; PMCID: PMC11715150. DOI: https://doi.org/10.1111/iej.14159

Bakhtiar H, Nekoofar MH, Aminishakib P, Abedi F, Naghi Moosavi F, Esnaashari E, et al. Human pulp responses to partial pulpotomy treatment with TheraCal as compared with Biodentine and ProRoot MTA: a clinical trial. J Endod. 2017;43(11):1786–91.

https://doi.org/10.1016/j.joen.2017.06.025 DOI: https://doi.org/10.1016/j.joen.2017.06.025

Vinall C V., Garcia-Silva TC, Lou JSB, Wells MH, Tantbirojn D, Versluis A. Intrapulpal temperature rise during light activation of restorative composites in a primary molar. Pediatr Dent. 2017;39(3):E125–30.

Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig. 2016;20(6):1121–32.

https://doi.org/10.1007/s00784-016-1802-7 DOI: https://doi.org/10.1007/s00784-016-1802-7

Silva GAB, Gava E, Lanza LD, Estrela C, Alves JB. Subclinical failures of direct pulp capping of human teeth by using a dentin bonding system. J Endod. 2013;39(2):182–9.

https://doi.org/10.1016/j.joen.2012.09.022 DOI: https://doi.org/10.1016/j.joen.2012.09.022

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Published

2026-03-18