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

Jennifer Kettle; Zoe Marshman; Alice Hamilton; Sarab El-Yousfi; Sarah R. Baker; Avijit Banerjee; Chris Deery; Craig R. Ramsay; David Ricketts; Janet E. Clarkson

doi:10.1186/s12903-025-05699-8

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

Jennifer Kettle (Lead / Corresponding author), Zoe Marshman, Alice Hamilton, Sarab El-Yousfi, Sarah R. Baker, Avijit Banerjee, Chris Deery, Craig R. Ramsay, David Ricketts, Janet E. Clarkson (Lead / Corresponding author)

Dentistry

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Abstract

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.

Original language	English
Article number	362
Number of pages	12
Journal	BMC Oral Health
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12903-025-05699-8
Publication status	Published - 9 Mar 2025

Keywords

Caries
Complete caries removal
Dental
Minimally invasive dentistry
Primary care
Qualitative
Randomised controlled trial
Selective caries removal
Theoretical domains framework

ASJC Scopus subject areas

General Dentistry

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Cite this

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title = "Dentists{\textquoteright} perspectives on selective caries removal for the management of deep carious lesions in permanent teeth",

abstract = "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 {\textquoteleft}comfort using selective caries removal{\textquoteright}, {\textquoteleft}potential value of SCRiPT{\textquoteright} and {\textquoteleft}challenges of subjectivity{\textquoteright}. Sub-themes included six enablers and five barriers to the use of selective caries removal, as well as five contextual factors potentially impacting dentists{\textquoteright} decision-making. The SCRiPT trial was found to have potential value in terms of {\textquoteleft}overcoming uncertainty{\textquoteright}, 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{\textquoteright} 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.",

keywords = "Caries, Complete caries removal, Dental, Minimally invasive dentistry, Primary care, Qualitative, Randomised controlled trial, Selective caries removal, Theoretical domains framework",

author = "Jennifer Kettle and Zoe Marshman and Alice Hamilton and Sarab El-Yousfi and Baker, {Sarah R.} and Avijit Banerjee and Chris Deery and Ramsay, {Craig R.} and David Ricketts and Clarkson, {Janet E.}",

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AU - Kettle, Jennifer

AU - Marshman, Zoe

AU - Hamilton, Alice

AU - El-Yousfi, Sarab

AU - Baker, Sarah R.

AU - Banerjee, Avijit

AU - Deery, Chris

AU - Ramsay, Craig R.

AU - Ricketts, David

AU - Clarkson, Janet E.

N1 - Publisher Copyright: © The Author(s) 2025.

PY - 2025/3/9

Y1 - 2025/3/9

N2 - 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.

AB - 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.

KW - Caries

KW - Complete caries removal

KW - Dental

KW - Minimally invasive dentistry

KW - Primary care

KW - Qualitative

KW - Randomised controlled trial

KW - Selective caries removal

KW - Theoretical domains framework

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DO - 10.1186/s12903-025-05699-8

M3 - Article

C2 - 40059145

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SN - 1472-6831

VL - 25

JO - BMC Oral Health

JF - BMC Oral Health

IS - 1

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ER -

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

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Keywords

ASJC Scopus subject areas

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