Diagnosis, Treatment and Complication of Deep Carious Lesions and Pulp Exposure

Abstract

Carious lesion refers to the white spot on the surface of the tooth that indicates an area of demineralization in the tooth. The earliest stage of the disease may not readily recognize that they have the disease since it is not easy to sense. The white deposits on the tooth surface are chalky and are the lesion or microcavity (Ricketts, 2001). The regeneration of teeth that involves the inclusion of the pulp therapy revascularisation steps is recommended for the injured tooth according to studies. This, however, does not allow the complete replication of the pulp tissue (Schwendicke et al. 2013). The effectiveness of the healing or biological regeneration depends on the swelling condition of the tissues of the pulp. This is key to be considered during the time preservation or maintenance of the tooth is to be undertaken. The clinicians still find the prevention or control of the pulp infections as an issue. As data indicate, deep caries is the reason for performing endodontic treatments (Schwendicke et al. 2016). The biological application in the pulp therapy is associated with deep caries evaluating the exposed and the unexposed pulp and the treatment taken into account. All the clinical diagnosis are the same and typical. Deep caries that has developed reversible pulpitis might be given a differing treatment that includes excavation processes that aim to avoid the cavity from being exposed or the treatment of more pulp inversion such as pulpotomy or capping which should not be the case. There is a big variation in the treatment that is notable among the clinicians on the diagnosis of same caries. There is the need for high-quality trials, and as well it is vital to obtain information regarding the depth of lesion the estimate of the lesion activity before the treatment is taken for these may indicate the regenerative potential of the dental pulp. In an attempt to solve the task of arriving at the best clinical results for the adults, modernized trials have that deal with the treatment of the deep caries are addressed embracing both noninvasive and the invasive concepts. This report is, therefore, the proposal for an assessment of the trending information about the deep carious lesion. The objective of this research proposal is to assess the Knowledge, perception and attitude of incidence, diagnosis, treatment and complication of deep carious lesions and pulp exposure and how the doctors have been able to take prescriptive measures to control the infection and to handle the already infected individuals in their regions all over the world. The study will use an online questionnaire to gather both quantitative and qualitative data in from the public worldwide and will therefore facilitate the achievement of the proposal information based on the topic. The secondary sources of data that will be utilised will include the internet books, journals and reports to ascertain the existing data on the very topic and the responses it has had. Indisputably, the secondary sources is expected to promote the identification of the current knowledge gap. The qualitative data will be collected, synthesized and analyzed and conclusions drawn from them will be aimed at generating the current gap to be narrowed and filled. This research seeks to find the reasons behind the doctor's choice and to postulates the recommendations to formulate a universal way to handle deep carious lesion effect worldwide. The proposal will as well identify the possible areas with gaps to be researched about for commonness.

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Research methodology (online questionnaire)

The online survey which one of the most vastly used method was used for this research and gave the systemically gathered data from the audience targeted and whose responses were invited to complete the questionnaire of the web. This report is based on the findings from the internet with the involvement of the people using the internet from the phones, computers and all other appliances that go online. The sampling was done online by allowing individuals to fill in the questionnaire provided on the web to gather the information. For this survey the sampling is randomized with the inclusion of the individuals from every part of the world taking part in the filling of the questionnaire with question regarding deep carious lesion and exposure. This random sampling was used to avoid the limitation of the places that could not be easily reached if other methods were used. This method achieved the results by having the internet individuals answer the questions about the Knowledge, perception and attitude of incidence, diagnosis, treatment and complication of deep carious lesions and pulp exposure at their levels and in their areas of residence. This gave the overall result worldwide since the internet is used by people all over the world at the same time. Keen look was taken to highlight the areas from which the participated individuals come from to avoid duplication of information from just a single place generalized.

A new sample was released in the field daily for Five days to ensure a complete process was conducted for the whole sampling activity. At least 20 questionnaire samples were attempted to complete from every region of the internet users. The samples were analyzed daily to maximize the chances of reaching the whole population as targeted. Much concentration was put on investigating how knowledgeable people were about the effect and the areas that were highly affected by the carious lesion of the tooth (Weber, Alves, & Maltz, 2011). The diagnosis given to the infected people in different areas and to compile the best diagnosis that would be universal out of the information received. The accumulation of the information in the internet was reduced by critical analysis of the items and the grouping of the information and selection of the information required. Technical accuracy was introduced to take care of the sensitivity and specificity and the clinical accuracy was used to predict values so as to distinguish the measure of the performance and the clinical utility. The results were quantified and classifications were made for to find clarified information on the project topics covered. This was possible with the development of the interactive tools that allowed the internet users to quantitatively ad critically explore the effects the dental issues in their regions on the clinical and technical accuracy of the wrong or right results as well as the prevalence of the same condition. The following study records were used:

• The selection process-in this a spreadsheet was used to extract data and to manage data as well. The findings from the different participants were viewed independently and a comparison of the findings made and this proved not disagreement on the conclusion of the data.
• Data collection process-the data was extracted by the panel reviewers independently and the process recorded no disagreements during the extraction exercise.
• Data items-the collection included study type, author year, sampling and survey/ interview method , the characteristics of the investigated dentist, lesion scenarios, the belief underlying the dentist decision as brought out by the study itself or as explained by the author and the proportion of the dentists that use otherwise removal strategies.
• Data synthesis- this was done by using the comprehensive meta-analysis which use the Cochrane to assess the heterogeneity.

Literature review

The carious lesion is a very prevalent disease that burdens millions of people and as well it causes major costs of health. The treatment of this disease is a challenge to the dentists more or so the cavitated lesions that and some that require dentin removal prior to the restoration to be sure of the longevity of the very restoration (Craig, Curro, Green, & Ship, 2008). The evidence therefore supports the stepwise selective methods instead of the complete non-selective dentin removal in the deep lesion of the permanent teeth since they both prevent the exposure of the pulp as well as the postoperative complications. When the complete removal uses a similar way of assessment criterion all-round the cavity which in itself may lead to the possibility of removing dentin in proximity to the pulp harmful, the selective removal targets to leave the dentin in the surface and the soft leathery dentin found in the pulp-proximal cavity areas.

The stepwise removal exists between the two with the first step being equal to the selective removal, the second being the being the sealing of the cavity and third the reopening some months later and the non-selective removal (Bjorndal et al. 2010; Stangvaltaite, 2015; Sundararaj et al. 2015). l. Both the selective and stepwise removal are accepted in treating the lesion permanent teeth though using the selective removal has some pros over the stepwise removal (Bjorndal & Thylstrup, 1998). Studies reveal that the dentists have not embraced these less invasive strategies that are based on the evidences to manage the deep lesion. The reason for the dentists to accept or refuse and reject the selective or stepwise carious tissue and the factors that drive their interest and decision making towards deep lesion are however not known yet. The aim of this review that is systematic is to analyze the proportion of the dentists that are already surveyed serving in different countries and employ the selective stepwise methods of excavation in handling the deep lesion in permanent teeth as well as investigating the changes that are possible in the proportions over a time.

An elaborated aim is to find out the barriers, challenges and the facilitators of the adoption of either selective or stepwise as an alternative to non-selective excavation which would aid the facilitation of the implementation of the interventions (Bjorndal & Thylstrup, 1998). The risk of biasness is possible in this study and therefore the included studies were mostly found to have a yielding of samples of the dentists that represented. However this sample is not drawn universally according to the studies taken (Mejare et al. 2012). The sample calculation was not reported by only one study but several of the studies reiterated the same with some of them having non-response rates which were not sufficiently accounted for by all the studies undertaken. The validity of this survey for this case therefore was not proved by most of the studies with some studies not publishing the survey instruments. Of these the only way to make reach information is by self-reporting and this has a lot of effects on the credibility of the findings. In order to reduce the risk of bias that would possibly occur during the review process and ensuring that amore exhaustive, reliable and valid results are recorded, the investigation that is systemic and theory based of the drawbacks should be used.

Analytic Plan and Limitation

For some reasons, there has been different views have come from individual social scientists concerning how survey should be designed with antagonistic suggestions about the methods. The statistics like margin error are really appreciated in online survey though they are used widely still. In planning the survey therefore will involve majorly all the processes for compiling the market research, performance monitoring and ways of soliciting feedback. The specific knowledge that would be gained to be written down together with simple questions that seeks to answer the hypotheses of the survey which will include the possible answers. After the answers, the percentage answers expected in comparison wi...