ArticleEuropean archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry2026
Clinical decision-making in pulp therapy of primary teeth among Tunisian dental practitioners: a cross-sectional study.
Article in European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess clinical decision-making patterns in pulp therapy of primary teeth among Tunisian dental practitioners and explore the influence of diagnostic uncertainty on treatment selection.
methodsA cross-sectional, scenario-based survey was conducted among 263 dental practitioners in Tunisia (March-August 2025), including general dentists and specialists involved in paediatric care. A structured questionnaire based on the American Academy of Pediatric Dentistry (AAPD) guidelines presented three standardised clinical scenarios with increasing diagnostic complexity: asymptomatic deep caries, mechanical pulp exposure, and progressive pulpal disease. Participants selected treatment options which were compared to guideline-recommended management.
resultsMost participants were early-career practitioners (85% ≤5 years of experience). A consistent tendency towards more invasive treatment was observed. In asymptomatic deep caries, pulpotomy was the most frequently selected option (51.1%) followed by indirect pulp treatment (26.2%). For mechanical pulp exposure, 78.7% of participants selected pulpotomy instead of direct pulp capping. In progressive pulpal disease, pulpectomy was the most frequently selected option (44.1%). Rubber dam isolation was inconsistently applied (6.8% systematic use), and calcium silicate-based materials were used in only 22.1% of pulpotomy procedures. Speciality status significantly influenced treatment selection across all scenarios (p≤0.004).
conclusionClinical decision-making in pulp therapy was strongly influenced by diagnostic uncertainty, leading to a general tendency towards overtreatment and limited adherence to minimally invasive principles. These findings highlight a persistent evidence-practice discordance, and underscore the need to integrate uncertainty-based reasoning into paediatric dental education.
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