Toggle Main Menu Toggle Search

Open Access padlockePrints

The management of deep caries in UK primary care: a nationwide questionnaire-based study

Lookup NU author(s): David Edwards, Dr Simon StoneORCiD, Oliver BaileyORCiD, Dr Holly Duncan



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley-Blackwell Publishing Ltd, 2021.

For re-use rights please refer to the publisher's terms and conditions.


Aim To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). Methodology Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly-funded National Health Service [NHS], privately-funded, military and community dental services. Demographic variables investigated included: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length, and clinician type. Management variables focused on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p≤0.2 were selected for binary logistic regression modelling. Results A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65,1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24,1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS-practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), while non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12,1.17-3.87). Conclusions This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.

Publication metadata

Author(s): Edwards D, Stone S, Bailey O, Duncan H

Publication type: Article

Publication status: Published

Journal: International Endodontic Journal

Year: 2021

Volume: 54

Issue: 10

Pages: 1804-1818

Print publication date: 01/10/2021

Online publication date: 05/06/2021

Acceptance date: 02/06/2021

Date deposited: 07/06/2021

ISSN (print): 0143-2885

ISSN (electronic): 1365-2591

Publisher: Wiley-Blackwell Publishing Ltd


DOI: 10.1111/iej.13585


Altmetrics provided by Altmetric