Dentists’ perspectives on selective caries removal for the management of deep carious lesions in permanent teeth

Background

To explore the views of dentists participating in the Selective Caries Removal in Permanent Teeth (SCRiPT) randomised controlled clinical trial on selective caries removal versus complete or near complete caries removal for the management of deep carious lesions.

Methods

Nineteen semi-structured one-to-one telephone or online video interviews were conducted with dentists involved in SCRiPT, using an interview guide informed by the Theoretical Domains Framework (TDF). Data were initially analysed deductively using a framework informed by the TDF, and subsequently using reflexive thematic analysis.

Results

Three themes and 25 sub-themes were generated. Themes were ‘comfort using selective caries removal’, ‘potential value of SCRiPT’ and ‘challenges of subjectivity’. Sub-themes included six enablers and five barriers to the use of selective caries removal, as well as five contextual factors potentially impacting dentists’ decision-making. The SCRiPT trial was found to have potential value in terms of ‘overcoming uncertainty’, although perceived limitations were noted. The potential value of SCRiPT may depend on other factors, including the willingness of dentists to follow evidence from the trial (reflecting personal attributes and comfort with selective caries removal). The interviews also highlighted how caries removal is perceived as subjective and involves the application of clinical judgement to individual cases. General dental practitioners who are less comfortable with selective caries removal may not start to use this approach as defined within SCRiPT, particularly if there is a lack of strong evidence from the trial.

Conclusions

Dentists’ level of comfort with selective caries removal is multi-faceted and informed by contextual factors. SCRiPT has the potential to increase acceptance of selective caries removal, but the findings may not be interpreted in this way. Future work should further explore the concept of comfort with selective caries removal, using the thematic framework outlined here to inform the design of interview topic guides.

Trial registration

Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019.