Variations in dentists’ thresholds for restorative treatment of active non-cavitated carious lesions: a multinational cross-sectional study
Hatipoğlu Ö. Taha N. Karobari M.I. Aldhelai T.A. Ayyad D.M. Madfa A.A. Martin-Cruces J. Fernández-Grisales R. Kopbayeva M. Lim W.Y. Alfirjani S. Nijakowski K. Deepak shah T. Pappa E. Jukić Krmek S. Wahjudianto N. Iqbal A. Abidin I.Z. Intriago M.G. Elhamouly Y. Carlos Ramos J. Pertek Hatipoğlu F.
November 2025Elsevier Ltd
Journal of Dentistry
2025#162
Objectives: To assess patterns across 21 countries in dentists’ thresholds for initiating operative treatment of active non-cavitated carious lesions and to evaluate the influence of caries risk, clinician characteristics, and geographic variation on decision-making in accordance with current guidelines. Methods: A cross-sectional, vignette-style web-based survey was conducted between June and October 2023 across 21 countries. A standardized questionnaire, comprising theoretical radiographic scenarios of occlusal and approximal active non-cavitated carious lesions at four progressive stages (E1,E2,EDJ,D1), was distributed to general dentists and specialists. Respondents selected the radiographic threshold at which they would initiate invasive treatment for patients with low and high caries risk. Guideline-concordant benchmarks were predefined as D1 for low-risk and EDJ/D1 for high-risk; any earlier choice was coded as overtreatment. Cumulative-link mixed models estimated determinants of thresholds; guideline concordance was summarized descriptively. Results: A total of 3680 dentists provided 7360 valid responses. High caries risk significantly predicted earlier intervention (occlusal OR= 0.34; approximal OR= 0.38, p < 0.001). Female dentists and restorative specialists were more conservative, while age showed no significant effect. Overall guideline adherence was low (22.7 % in low-risk and 32.7 % in high-risk scenarios). Substantial inter-country variation was observed; Bangladesh and Portugal showed highest adherence, while Kazakhstan and Colombia demonstrated overtreatment tendencies. Conclusions: Despite global promotion of minimally invasive dentistry, overtreatment of enamel lesions remains widespread. Addressing systemic, educational, and policy-level barriers is essential to improve adherence to evidence-based, risk-informed caries management. Clinical significance: This multinational study highlights substantial variability and premature intervention in caries management across countries. Identifying patterns of overtreatment and guideline discordance informs dental education and policy, emphasizing the urgent need to reinforce minimally invasive, risk-based strategies in clinical practice across participating countries.
Caries management , Conservative strategies , Dental caries , Non-invasive treatment , Preventive dentistry
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Department of Restorative Dentistry, Recep Tayyip Erdogan University, Turkey
Department of Conservative Dentistry Jordan University of Science and Technology, Irbid, Jordan
Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Tamil Nadu, Chennai, 600077, India
Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, 52571, Saudi Arabia
Department of Endodontics, Faculty of dentistry, AL-QUDS University, Palestine
Department of Restorative Dental Science, College of Dentistry, University of Hail, Hail, Saudi Arabia
Restorative Dentistry and Endodontics, School of Medicine and Dentistry, Universidade Santiago de Compostela, Rúa Entrerríos s/n, 15705, Spain
Department of Endodontics, CES University, Medellin, Colombia
S. D. Asfendiyarov Kazakh National Medical University, Dentistry School, Almaty, Kazakhstan
Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
Department of Conservative Dentistry and Endodontics, University of Benghazi, Libya
Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poland
Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Greece
University of Zagreb School of Dental Medicine, Zagreb, Croatia
Faculty of Dental Medicine, Universitas Airlangga, Indonesia
Department of Restorative Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
Department of Operative Dentistry & Endodontics, Frontier Medical & Dental College, Abbottabad, Pakistan
Department of Restorative Dentistry International Islamic University Malaysia, Malaysia
Endodontic department of Dentistry Universidad Central del Ecuador Quito, Ecuador
Department of Pediatric and Community Dentistry Faculty of Dentistry, Pharos University in Alexandria, Egypt
Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, Coimbra, 3000-075, Portugal
Department of Endodontics, Recep Tayyip Erdogan University, Turkey
Department of Restorative Dentistry
Department of Conservative Dentistry Jordan University of Science and Technology
Department of Conservative Dentistry and Endodontics
Department of Orthodontic and Pediatric Dentistry
Department of Endodontics
Department of Restorative Dental Science
Restorative Dentistry and Endodontics
Department of Endodontics
S. D. Asfendiyarov Kazakh National Medical University
Department of Restorative Dentistry
Department of Conservative Dentistry and Endodontics
Department of Conservative Dentistry and Endodontics
Department of Conservative Dentistry and Endodontics
Department of Operative Dentistry
University of Zagreb School of Dental Medicine
Faculty of Dental Medicine
Department of Restorative Dental Sciences
Department of Operative Dentistry & Endodontics
Department of Restorative Dentistry International Islamic University Malaysia
Endodontic department of Dentistry Universidad Central del Ecuador Quito
Department of Pediatric and Community Dentistry Faculty of Dentistry
Center for Innovation and Research in Oral Sciences (CIROS)
Department of Endodontics
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