Manejo de lesões de cárie profunda em pacientes adultos por cirurgiões-dentistas brasileiros

Abstract

Dental caries is a chronic, non-communicable disease, socially determined, dynamic in nature, sugar-dependent, and mediated by the presence of dental biofilm, resulting in the mineral loss of hard dental tissues. Diagnosing and defining an appropriate therapeutic plan for carious lesions still represents a major challenge for dentists. The International Caries Consensus Collaboration (ICCC) has published recommendations on the removal of carious tissue to treat cavitated carious lesions in a way that preserves the hard tissue as much as possible and, consequently, maintains the teeth for a longer period. This cross- sectional study, conducted through a questionnaire, evaluated the reported use of selective caries removal when treating deep caries in asymptomatic and symptomatic teeth in response to different clinical scenarios (CEP opinion no. 6.266.463). In addition to socioeconomic characteristics, the questionnaire assessed different treatment options for deep carious cavities, including: (1) removal of carious tissue from the surrounding walls up to hard dentin and selective removal from the pulpal/axial wall (without pulpal exposure); (2) removal of all carious tissue (with potential pulpal exposure) and direct pulp capping; and (3) removal of all carious tissue (with potential pulpal exposure) and endodontic treatment. The questionnaire developed by Jurasic et al. (2022) was used as the data collection instrument for this research. This questionnaire was translated from English to Portuguese, adapted to the Brazilian context, and previously tested by three Cariology faculty members to evaluate its comprehension and suitability. The images and radiographs used were kindly provided by the author of the original questionnaire. A total of 59 dentists responded to the survey, with the sample calculation estimating that 422 responses are required to ensure a 95% confidence interval and a 5% margin of error. A preliminary descriptive analysis was conducted with the responses of the 59 participants. 71% of the participants are female, 49% are from the state of Minas Gerais, 70% self- identified as white, and 55,9% declared they graduated from private institutions. When asked about having completed postgraduate studies, 60% reported having a specialization, while 24% were general practitioners. Approximately 68% of the respondents work in private practice (shared clinic or own office). When specifically asked about selective carious tissue removal in the scenario of deep asymptomatic caries, 43% of respondents stated they would never use treatment (3), 38% would never use treatment (2), but only 27% would always recommend selective removal of carious tissue (1), a response aligned with ICCC recommendations. When presented with a case of symptomatic pulpitis (mild reversible pulpitis), 35% of respondents stated they would never recommend treatment (3), while 25% would never recommend treatment (2), and only 18% would always recommend selective carious tissue removal, a response aligned with ICCC recommendations. Therefore, based on the preliminary results of this study, it is possible to observe that selective carious tissue removal still faces resistance among dentists.