Preferences for Vital Pulp Treatments in Primary Molars: A Survey of Spanish Dentists

Abstract

AIM: To assess the preferences of dentists working in Spain regarding the management of deep caries removal and carious pulp exposures in primary molars. METHODOLOGY: An anonymous web-based survey was developed with Microsoft Forms (Microsoft Office 365) and distributed through social media among dentists in Spain. The questionnaire was divided into five sections regarding demographic data, caries removal management, pulp exposure decision-making, direct pulp capping and pulpotomy procedures. Likelihood ratio and logistic regression analyses were performed (p < 0.05). RESULTS: A total of 228 valid responses were collected. Selective excavation to firm dentine was the preferred strategy for deep carious lesions (66.1%). Carious pulp exposure in vital asymptomatic primary molars was mainly managed with pulpotomy (48.3%) or direct pulp capping (48.7%). Pulpotomy was preferred for reversible pulpitis (66.7%), while pulpectomy was favoured for irreversible pulpitis (58.3%). Direct pulp capping was routinely performed by 42.2% and pulpotomy by 88.4% of respondents. These practices were significantly associated with the self-reported area of expertise and continuous education in vital pulp treatment. Haemostasis was most often achieved with a dry cotton pellet (direct pulp capping: 50.5%; pulpotomy: 47.7%). Biodentine was the pulp capping agent of choice (43.2% for direct pulp capping and 39.2% for pulpotomy), followed by mineral trioxide aggregate (MTA) (26.3%, 29.2%). CONCLUSIONS: Although pulpotomy remains the more predictable and generally recommended treatment for cariously exposed pulps in primary molars, many dentists reported performing direct pulp capping in asymptomatic teeth or those with reversible pulpitis symptoms. For irreversible pulpitis symptoms, about half opted for pulpectomy.