Figure 6. Overall results for Hall Technique awareness and practice.
composite’ (33.3%). Although SSCs, both HT SSCs
and conventional SSCs when considered together,
would represent a larger majority (17.4%+24.2%=
41.8%), they were considered separately in this
study, as they represented two different modalities
of treatment (biological Vs conventional).
The choice of material differed significantly
between GDPs and PDs: GDPs tended to choose
composite and GIC more than PDs, while PDs
tended to choose conventional SSCs more than
GDPs (p<0.05) while, interestingly, no PD chose
GIC at all. The choice of GIC for Class II lesions,
chosen by GDPs in the case, had been previously
reported to have a high failure rate. 6 Moreover,
the choice of SSCs by most of the PDs in our study
was in agreement with the latest guidelines and
systematic reviews that favour SSCs multi-surface
carious primary molars. 15
None of the GDPs and only one PD chose Zirconia
possibly because it is a newer material on the
market with a lot of promise, requires extensive
crown preparation and is expensive.
Finally, a few PDs and GDPs chose amalgam,
indicating that this material is falling out of favour
in the GCC region.
4.2. Discussion of the choice of pulpotomy
medicament (PM)
The American Academy of Pediatric Dentistry
(AAPD) suggested two treatment options for vital
primary teeth with deep caries approaching the
pulp. These treatment options were indirect pulp
therapy (IPT) and cervical pulpotomy. 17 GDPs
were more likely to attempt IPT on primary teeth
than paediatric dentists to treat deep caries in
asymptomatic primary teeth. 18 A primary molar
pulpotomy is defined as the clinical procedure
involving the removal of the inflamed and infected
Stomatology Edu Journal
coronal pulp tissue while maintaining vital healthy
radicular pulp. Following amputation of the coronal
pulp, the remaining pulp is treated with one of the
following medicaments 19 : Formocresol (FC), Ferric
sulphate (FS), Mineral trioxide aggregate(MTA)
and Calcium hydroxide (CH). The debate about
which medicament to use has engaged the dental
literature for a long time, subsequently affecting
the clinical decisions of PDs and GDPs alike. This
was indeed reflected in our study. As there was no
uniform agreement on what constitutes the ideal
PM in a given scenario (Fig. 4) and not one PM
had an outright majority. Historically, FC has been
the medicament of choice for the primary tooth
pulpotomy. Buckley in 1904 first used equal parts
of tricresol and formalin, although the procedures
and formulation have changed since Buckley’s
first publication, 20 FC has remained popular as
a medicament for vital pulp therapy. Dunston
and Coll 21 reported that 81% of surveyed USA
paediatric dentist diplomates used either diluted
or full-strength FC, 18% used FS, and only 1% used
some other medicament or technique for primary
tooth pulpotomies. FC popularity as a pulp therapy
medicament has decreased in some countries and
banned in others such as the United Kingdom
(UK) because of its alleged cytotoxicity, potential
mutagenicity and immune sensitization. 22,23
However, in the USA, a recent survey showed that
FC is still the most popular pulpotomy medicament,
despite published concerns regarding its potential
toxicity among both GDPs and PDs. 18 Despite
the fact that the British Society of Paediatric
Dentistry (BSPD) guidelines had discouraged the
use of FC 19 the AAPD most recent pulp therapy
guidelines 17 recommended Buckley’s Solution
of FC as a pulpotomy medicament in primary
CONTEMPORARY DENTAL CARIES MANAGEMENT CONCEPTS IN PAEDIATRIC DENTISTRY:
A SURVEY OF AWARENESS AND PRACTICE OF A GROUP OF GULF COOPERATION COUNCIL DENTISTS
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