stomaeduj 2 SEJ_1-2017_screen | Page 33

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 33