Approximal and occlusal caries lesions: Restorative treatment decisions by California dentists.

J Am Dent Assoc. 2016 Feb 9. pii: S0002-8177(15)01037-5. doi: 10.1016/j.adaj.2015.10.006. [Epub ahead of print]



Investigators use questionnaire surveys to evaluate treatment philosophies in dental practices. The aim of this study was to evaluate the management strategies California dentists use for approximal and occlusal caries lesions.


In May 2013, the authors e-mailed a questionnaire that addressed approximal and occlusal caries lesion management (detection and restorative threshold, preferred preparation type, and restorative materials) to 16,960 dentists in California. The authors performed a χ2 statistical analysis to investigate the relationship between management strategies and respondent demographic characteristics.


The authors received responses from 1,922 (11.3%) dentists; 42.6% of the respondents would restore approximal lesions at the dentinoenamel junction, and 33.4% would wait until the lesion reached the outer one-third of dentin. The preferred preparation type was the traditional Class II preparation. Dentists who graduated more recently (20 years or less) were more likely to delay approximal restorations (P < .0001); 49.9% of the more recent graduates would wait to restore an occlusal lesion until the outer one-third of dentin was involved, and 42.6% would restore a lesion confined to enamel.


There is wide variety among California dentists regarding their restorative treatment decisions, with most dentists restoring a tooth earlier than the literature would advise. More recent dental graduates were more likely to place their restorative threshold at deeper lesions for approximal caries lesions.


Clinical evidence shows that noncavitated caries lesions can be remineralized; therefore, early restorative treatment may no longer be necessary or appropriate. Noninvasive and minimally invasive measures should be taken into consideration.


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