Knowledge and Self-perception Level of Dental Students Regarding the Minimally Invasive Approach: A Cross-sectional Study

Knowledge and Self-perception Level of Dental Students Regarding the Minimally Invasive Approach: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge and Self-perception Level of Dental Students Regarding the Minimally Invasive Approach: A Cross-sectional Study Fátima Carmen Aguilar-Díaz, Leopoldo Javier Díaz-Arizmendi, Leopoldo Arturo Pérez-Miranda, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8903805/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study investigated the knowledge of final-year dental students in Mexico regarding caries management according to the principles of Minimally Invasive Dentistry (MID). Subjects and methods: Cross-sectional study. Final-year undergraduate students from various universities participated in the study during academic year 2024-25. Data on MID knowledge were obtained using a structured and validated questionnaire, administered virtually in accordance with the CHERRIES checklist. Demographic variables, including age, sex, and type of university (public/private), were recorded. For statistical analysis, the Mann-Whitney U test was used for group comparisons. The study was approved by the Ethics Committee (CEI_24_125_S43). Results The sample consisted of 494 students, with 70.4% being women and 69.3% from public universities. Although 69.5% of participants self-perceived their knowledge of Minimally Invasive Dentistry as "good" or "excellent," the overall average score on the objective assessment was 5.8 (on a scale of 0 to 10). Significant differences (p = 0.018) were observed in the scores, with students from public universities scoring higher than those from private universities. No statistically significant differences were identified by gender. Conclusions Most of the participants gave their knowledge a "good" to "excellent" self-rating. The level of knowledge about management of caries lesions according to Minimally Invasive Dentistry among final-year students is low to intermediate, suggesting the need to reinforce the teaching of this discipline during professional training. Clinical relevance: Increased curricular time and clinical training in minimally invasive dentistry are needed to move away from a curative approach and reduce overtreatment and unnecessary loss of healthy tooth structure. Dental Caries Students Dental Educational Measurement Education Dental Clinical Competence INTRODUCTION The contemporary practical approaches for caries management are based on minimally Invasive Dentistry (MID) that has established itself as the current paradigm, prioritizing the preservation of tooth structure and placing great emphasis on promoting healthier habits in patients [ 1 ]. The main components of MID include: early detection of carious lesions and assessment of caries risk and activity; remineralization of demineralized enamel and dentin; optimal measures to maintain healthy teeth; minimally invasive operative interventions to ensure tooth survival; and repairing rather than replacing defective restorations [ 2 ]. Under this paradigm, a series of interventions were agreed based on the degree of tissue removal, allowing for non-invasive, micro-invasive, or invasive/restorative intervention in existing carious lesions or in the caries process [ 3 ]. MID implementation should be a daily reality in professional practice, which is beneficial for both the individual health of the patient and for public health [ 4 , 5 ]. However, dentist practitioners showed deficiencies in their attitudes towards application of minimally invasive dentistry procedures, and many dentists still use the outdated methods of treating caries lesions [ 6 , 7 ]. Successful professional performance in this field depends on the above, so it is imperative that dental students acquire a comprehensive mastery of the MID principles during their training. This requires that future graduates not only possess a deep understanding of the etiology and biological processes of caries disease, but also the ability to apply essential clinical skills, including early diagnosis, optimization of treatment times, and obtaining predictable results [ 8 ]. Nonetheless, diverse populations have demonstrated varying competencies and use of MID. In particular, studies among Russian dentists and dental students reveal a substantial gap in the practical setting, with most of them failing to apply MID principles when treating carious lesions in permanent teeth [ 9 ]. Similarly, among interns of a university in Saudi Arabia there is a lack of understanding regarding the appropriate timing and methods for applying these strategies[ 10 ]. The objective of this project was to determine knowledge and self-perceived competence among senior dental students in the Central-Bajio region of Mexico concerning Minimal Intervention Dentistry for caries management. MATERIALS AND METHODS A cross-sectional study was conducted with undergraduate students in their final year of dentistry programs at various public and private universities during the 2024-25 academic year. Participants were those who agreed to participate and had a device with internet access to complete the questionnaire. Data on knowledge regarding the management of carious lesions using a minimally invasive approach were obtained through a structured and validated questionnaire. This questionnaire consisted of 10 questions, which were evaluated by eight experts in the field of minimally invasive dentistry. Each question was assessed according to the criteria of the modified Lawshe test, resulting in scores greater than 0.66 for each question, with a content validity index of 0.87. The questionnaire presented ten distinct clinical scenarios, requiring students to specify the type of intervention or treatment they would select: non-invasive, micro-invasive, invasive, mixed intervention, or no treatment. The questionnaire also collected demographic information, including age, sex, and university type (public or private). Additionally, it included a general question assessing self-perceived competence in managing caries lesions in accordance with the principles of minimal intervention dentistry, with response options of “excellent,” “good,” “fair,” and “poor.” The questionnaire was administered via Google Forms, adhering to the guidelines for communicating results of online questionnaires and surveys (CHERRIES) [ 11 ]. It was available to all participants who accepted the privacy statement and provided their consent to participate in the study. The questions were not randomly arranged; the order was the same for all participants. Participants were contacted via the internet, and the survey was distributed via email and/or social media (Wa®) without advertising. The estimated time to complete the survey was less than 10 minutes. All questions were answered to ensure the questionnaire could be finalized using the options integrated into the Google Forms® application. An informed consent section explaining the study´s objective, its anonymity and requested voluntary participation was also included at the beginning of the questionnaire. Demographic variables, including age, sex, and university (public/private), were recorded. The data were analyzed using IBM's Statistical Package for the Social Sciences (SPSS), version 27. Measures of central tendency and normality tests were calculated, and the Mann-Whitney U test was used for group comparisons, establishing a significance level of p < 0.05. This project was approved by the Research Ethics Committee of the National School of Higher Studies, León Unit, UNAM CEI_24_125_S43. RESULTS A total of 494 students were invited to participate; 483 completed the questionnaire which represents a participation rate of 98%. 70.5% were women, and the mean age of all participants was 22.39 (+ 1.9). 69.3% study at public universities (Table 1 ). Table 1 Sex distribution according to the type of school of participants: Public Private Total n % n % n % Female 237 70,7 103 70,1 340 70,5 Male 99 29,3 44 29,9 143 29,5 Total 336 100 147 100 483 100 Chi-square = 0.00, p=.894 In the self-assessment of knowledge about MID, sixty-nine-point five percent of respondents rated their knowledge as "good" or "excellent", while the remaining percentage was distributed between the categories of "fair" and "poor" (Table 2 ). It was observed that students from private schools, in a higher percentage, consider their knowledge to be good or excellent (p < 0.05). Table 2 Self-assessment of knowledge about minimally invasive dentistry according to the type of school of participants. Public Private Total n % n % n % Poor-Fair 110 32,8% 37 25,2% 147 30.4,0% Good-Excellent 226 67,2% 110 74,8% 336 69.6% Total 336 100% 147 100% 483 100% Chi-square = 3,36, p = 0.04 In evaluating each item of the questionnaire, the percentage of correct answers was found to be very similar in both groups. As shown in Table 3 statistically significant differences were only observed in item two, which inquires about the treatment to follow in the presence of active, non-cavitated lesions. A higher percentage of those from public schools identified the correct answer. The average score for the entire population was 5.9 (on a scale of 0 to 10). Public school students performed better than private school students (p = 0.018), with average scores of 5.7 and 6.1 for private and public schools, respectively. No statistically significant differences were identified by gender. When comparing total scores according to self-perception, no statistically significant differences were observed between them. DISCUSSION Current evidence strongly supports the benefits of minimally invasive restorative techniques for managing dental caries and preserving healthy tooth structure. This philosophy of Minimally Invasive Dentistry has established itself as a paradigm that prioritizes tissue preservation and a preventive approach. Evidence suggests that minimally invasive restorative techniques are beneficial in managing dental caries and preserving healthy tissue, and they should be used whenever possible [ 12 ]. Despite this scientific consensus, the dissemination and implementation of this knowledge in the dental sector has historically been limited. Our study addresses an area with limited research: comparing and evaluating the level of knowledge about MID among final-year students from public and private universities, who represent the next generation of oral health professionals. One of the most notable findings is the marked disparity between self-perceived knowledge and performance on the objective assessment. Slightly more than two-thirds of respondents rated their MID knowledge as "good" or "excellent." However, the overall average score on the questionnaire was low, at 5.9 (on a scale of 0 to 10). It is worth noting that no statistically significant differences were observed in total scores across self-perception, suggesting a generalized overestimation of competence among future professionals. Besides, when analyzing answers for each clinical situation, it becomes clear that actual knowledge does not consistently align with those self-perceptions. Students are more accurate at identifying when an invasive intervention should be performed than when a non-invasive, micro-invasive, or mixed intervention should be performed. This is a noticeable lack of knowledge about when caries lesions can be treated with minimally invasive procedures. Similarly, Russian dentists and dental undergraduate students showed that most do not follow the MID concept when treating dental caries in permanent teeth [ 9 ]. These findings reflect the persistence of a traditional, restorative-oriented educational paradigm, despite strong scientific consensus supporting tissue-preserving approaches [ 13 ], indicating that science is not yet incorporated into dental schools' practice. Insufficient management of inactive or non-cavitated lesions increases the likelihood of overtreatment. Such overtreatment results in unnecessary loss of healthy tooth structure and imposes additional economic burdens on both patients and healthcare systems. Furthermore, overtreatment can accelerate tooth loss with a significant impact on an individual´s quality of life [ 14 , 15 ]. Limited information exists regarding the professions responsible for training dental students. Determining whether these professionals possess comprehensive knowledge of the MID paradigm is essential. Although theoretical components are generally addressed, additional practical training is necessary to facilitate accurate identification of initial caries lesions. Furthermore, effective MID management requires understanding dental caries as a behavioral, multifactorial, and non-transmissible disease. Mandatory teacher evaluation and training within the MID paradigm should be implemented to ensure educators possess the necessary skills to deliver current knowledge to students. On the other hand, the findings of this study suggest that students from public universities have a higher level of knowledge about minimally invasive dentistry than their counterparts from private institutions. Future research should examine educational programs, student demographics, faculty evaluations, and additional factors to elucidate the causes of this disparity, so it would be up to each educational institution to identify its own areas of opportunity in the academic field and update the teaching programs in dentistry, such as giving more academic hours to the teaching of minimal intervention in an equal way to the time dedicated to learning invasive techniques or operative dentistry. Also, a deep understanding is needed to understand what professors recommend for managing caries lesions. For instance, in Chilean universities, when evaluating which clinical visual/tactile severity stage of the lesion does your Faculty/School indicate operative treatment?” 38.9% report that operative treatment is indicated when an underlying shadow is present, 33.3% when enamel microcavitation is observed, and 27.8% when a dentin-exposed cavity is detected. In that report, no universities recommend operative treatment for non-cavitated lesions [ 16 ]. In recent years, there has been a significant global shift in cariology education, moving from a predominantly restorative approach to one that emphasizes prevention and oral health promotion [17]. Establishing a fundamental cariology curriculum for dentistry schools in Latin America is the main goal of the Latin American Oral Health Association (LAOHA). To move away from the curative approach found in international surveys of cariology instruction, the second of the suggested activities focuses on creating and reaching an agreement on a core cariology curriculum for dental schools in Spanish-speaking Latin American nations. A limitation of this assessment is that knowledge was evaluated solely on the basis of visual characteristics (images and clinical features), without consideration of additional factors essential to decision-making, such as the patient's risk level. These factors are essential components of the decision-making process for determining appropriate treatment or managing caries as a disease. CONCLUSIONS Most of the participants rated their knowledge as "Good" to "Excellent." The level of knowledge regarding Minimally Invasive Dentistry among final-year students in the region was found to be low to intermediate. Only one-third of participants correctly identified the appropriate management for inactive lesions, indicating a potential risk of overtreatment. These findings underscore the need to enhance MID instruction during professional training. Declarations The current study received ethical approval from the Research Ethics Committee of the National School of Higher Studies, León Unit, UNAM (CEI_24_125_S43). All participants provided informed consent prior to participation. CREDIT AUTHORSHIP CONTRIBUTION STATEMENT FÁTIMA DEL CARMEN AGUILAR-DÍAZ: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review and editing. LEOPOLDO JAVIER DÍAZ-ARIZMENDI: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review and editing. LEOPOLDO ARTURO PÉREZ-MIRANDA: Conceptualization, Investigation, Writing – review and editing. BRENDA MARIANA-MARTINEZ: Investigation, Writing – review and editing. MARÍA DE LOS ÁNGELES RAMÍREZ-TRUJILLO: Investigation, Writing – review and editing. MARÍA DEL CARMEN VILLANUEVA-VILCHIS: Investigation, Writing – review and editing. FUNDING This study received no external funding. References Barrett B, Mclindent B, O’sullivan M (2021) Management of the deep carious lesion: a literature review. J Ir Dent Assoc 67:36–42 FDI (2017) FDI policy statement on Minimal Intervention Dentistry (MID) for managing dental caries. Int Dent J 67:6–7. https://doi.org/10.1111/idj.12308 Schwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S et al (2019) When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig 23:3691–3703. https://doi.org/10.1007/S00784-019-03058-W Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E (2012) Minimal intervention dentistry for managing dental caries - A review: Report of a FDI task group. Int Dent J 62:223–243. https://doi.org/10.1111/IDJ.12007 Dalli M, Çolak H, Mustafa Hamidi M (2012) Minimal intervention concept: a new paradigm for operative dentistry. J Investig Clin Dent 3:167–175. https://doi.org/10.1111/j.2041-1626.2012.00117.x Dixit A, Sindi AS, Paul S, Badiyani BK, Kumar A, Arya R et al (2023) A Study to Assess Knowledge, Attitude, and Perception of Dental Practitioners on Minimally Invasive Dentistry Concepts. J Pharm Bioallied Sci 15(Suppl 2):S993–S996. https://doi.org/10.4103/JPBS.JPBS_255_23 Shah AH, Sheddi FM, Alharqan MS, Khawja SG, Vohra FM, Akram Z et al (2016) Knowledge and Attitude among General Dental Practitioners towards Minimally Invasive Dentistry in Riyadh and AlKharj. J Clin Diagn Res 10:90–94. https://doi.org/10.7860/JCDR/2016/20543.8207 Ismail AI, Tellez M, Pitts NB, Ekstrand KR, Ricketts D, Longbottom C et al (2013) Caries management pathways preserve dental tissues and promote oral health. Community Dent Oral Epidemiol 41. https://doi.org/10.1111/CDOE.12024 Drachev SN, Galieva AS, Yushmanova TN, Polivanaya EA, Stangvaltaite-Mouhat L, Al-Mahdi R et al (2021) Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry? BMC Oral Health 21. https://doi.org/10.1186/S12903-021-01978-2 Hafiz Z, Alhomaidhi M, Almutairi R, Alharbi A, Alshahrani L, Alzahrani S (2025) Knowledge and attitudes of dental students and interns on minimally invasive dentistry for pediatric dentistry at King Saud University. BMC Oral Health 25. https://doi.org/10.1186/S12903-025-06087-Y Eysenbach G (2004) Improving the quality of web surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. https://doi.org/10.2196/jmir.6.3.e34 . 6 Warreth A (2023) Dental Caries and Its Management. Int J Dent. https://doi.org/10.1155/2023/9365845 Kakudate N, Yokoyama Y, Pereira Da E, Tagliaferro S, Sumida F, Matsumoto Y et al (2024) The Evidence-Practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil. Oper Dent 49:127–135. https://doi.org/10.2341/23-074-C Della TM, Garrido B, Pereira PSS, Foloni K, Pegoraro HD, Souza IR, Bastos JRM et al (2025) Tooth Loss, Nutrition, and Oral Health-Related Quality of Life in Older Adults: Evidence from a Structural Equation Model. Int J Environ Res Public Health 22:1793. https://doi.org/10.3390/ijerph22121793 Sukumar MBA, Peter RM, Joseph A (2025) Tooth morbidity and its impact on oral related quality of life in elderly tribal population-The Irula experience. BMC Oral Health 25. https://doi.org/10.1186/S12903-025-05628-9 Díaz-Yokens M, González S, Giacaman RA, Araya-Bustos F, Moncada G, Martignon S et al (2018) Cariology Curriculum in Chilean Universities. Revista clínica de periodoncia, implantología y rehabilitación oral. 11:98–101. https://doi.org/10.4067/S0719-01072018000200098 Table 3 Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8903805","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593657667,"identity":"97714801-6586-4961-9df8-2c23265805c0","order_by":0,"name":"Fátima Carmen Aguilar-Díaz","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"Fátima","middleName":"Carmen","lastName":"Aguilar-Díaz","suffix":""},{"id":593657668,"identity":"f399056f-86dd-4348-9fc2-c2c4a1ee225a","order_by":1,"name":"Leopoldo Javier Díaz-Arizmendi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYFAC5gYGHgaGBD5mmAB7AyEtjBAtbHAtPAeI1QIXkEjAr0G+/WCbxNsdh/PY2JkffmCouCMnP/ON2YOfOQzRBjhsMziT2CY598zhYjZmNmMJhjPPjA1u55gb9m5jyJ2Jw08GDIlt0rxthxPbmHkYJBiBjA3SOWYSvEAt/bgc1v8QroX5B+O/w/XzZ54xk/wL1NKGyzM3ELawSTA2HE5guMFjJo3PFoMbD5st555JB/nFzCLh2GHDDWfSyqRlt0ng9It8f/LBG293WOfx8x9+fONDzWF5+fbD2yTfbrPJ3YAjxMCAEWZeAkJMAo96ZC2jYBSMglEwCrABAIYTWZSSSS1NAAAAAElFTkSuQmCC","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":true,"prefix":"","firstName":"Leopoldo","middleName":"Javier","lastName":"Díaz-Arizmendi","suffix":""},{"id":593657669,"identity":"c07ad841-d5d3-4547-a884-39bdb91f4afe","order_by":2,"name":"Leopoldo Arturo Pérez-Miranda","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"Leopoldo","middleName":"Arturo","lastName":"Pérez-Miranda","suffix":""},{"id":593657670,"identity":"6e5c95e8-a7b9-4e25-9f9f-add32ed6b96b","order_by":3,"name":"Brenda Mariana-Martínez","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"Brenda","middleName":"","lastName":"Mariana-Martínez","suffix":""},{"id":593657671,"identity":"ecc736f0-11e7-492f-b1f6-a336395d0e5b","order_by":4,"name":"María de los Ángeles Ramírez-Trujillo","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"de los Ángeles","lastName":"Ramírez-Trujillo","suffix":""},{"id":593657672,"identity":"3ad9e1e9-605a-47fc-85d2-f59b0464b830","order_by":5,"name":"María del Carmen Villanueva-Vilchis","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"del Carmen","lastName":"Villanueva-Vilchis","suffix":""}],"badges":[],"createdAt":"2026-02-17 19:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8903805/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8903805/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104189218,"identity":"0920eddd-80f2-497b-a542-3dbfc7b5dc08","added_by":"auto","created_at":"2026-03-08 23:08:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":468477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8903805/v1/2f70cf5b-bf44-499c-bacf-8a54a8dbe164.pdf"},{"id":103392851,"identity":"309871a4-2bb6-4de3-a569-8ec1c0d2ac14","added_by":"auto","created_at":"2026-02-25 08:12:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":209730,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8903805/v1/0576a178948ef8cbcf549f83.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eKnowledge and Self-perception Level of Dental Students Regarding the Minimally Invasive Approach: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe contemporary practical approaches for caries management are based on minimally Invasive Dentistry (MID) that has established itself as the current paradigm, prioritizing the preservation of tooth structure and placing great emphasis on promoting healthier habits in patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The main components of MID include: early detection of carious lesions and assessment of caries risk and activity; remineralization of demineralized enamel and dentin; optimal measures to maintain healthy teeth; minimally invasive operative interventions to ensure tooth survival; and repairing rather than replacing defective restorations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnder this paradigm, a series of interventions were agreed based on the degree of tissue removal, allowing for non-invasive, micro-invasive, or invasive/restorative intervention in existing carious lesions or in the caries process [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMID implementation should be a daily reality in professional practice, which is beneficial for both the individual health of the patient and for public health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, dentist practitioners showed deficiencies in their attitudes towards application of minimally invasive dentistry procedures, and many dentists still use the outdated methods of treating caries lesions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Successful professional performance in this field depends on the above, so it is imperative that dental students acquire a comprehensive mastery of the MID principles during their training. This requires that future graduates not only possess a deep understanding of the etiology and biological processes of caries disease, but also the ability to apply essential clinical skills, including early diagnosis, optimization of treatment times, and obtaining predictable results [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNonetheless, diverse populations have demonstrated varying competencies and use of MID. In particular, studies among Russian dentists and dental students reveal a substantial gap in the practical setting, with most of them failing to apply MID principles when treating carious lesions in permanent teeth [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilarly, among interns of a university in Saudi Arabia there is a lack of understanding regarding the appropriate timing and methods for applying these strategies[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this project was to determine knowledge and self-perceived competence among senior dental students in the Central-Bajio region of Mexico concerning Minimal Intervention Dentistry for caries management.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eA cross-sectional study was conducted with undergraduate students in their final year of dentistry programs at various public and private universities during the 2024-25 academic year. Participants were those who agreed to participate and had a device with internet access to complete the questionnaire.\u003c/p\u003e \u003cp\u003eData on knowledge regarding the management of carious lesions using a minimally invasive approach were obtained through a structured and validated questionnaire. This questionnaire consisted of 10 questions, which were evaluated by eight experts in the field of minimally invasive dentistry. Each question was assessed according to the criteria of the modified Lawshe test, resulting in scores greater than 0.66 for each question, with a content validity index of 0.87. The questionnaire presented ten distinct clinical scenarios, requiring students to specify the type of intervention or treatment they would select: non-invasive, micro-invasive, invasive, mixed intervention, or no treatment.\u003c/p\u003e \u003cp\u003eThe questionnaire also collected demographic information, including age, sex, and university type (public or private). Additionally, it included a general question assessing self-perceived competence in managing caries lesions in accordance with the principles of minimal intervention dentistry, with response options of \u0026ldquo;excellent,\u0026rdquo; \u0026ldquo;good,\u0026rdquo; \u0026ldquo;fair,\u0026rdquo; and \u0026ldquo;poor.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe questionnaire was administered via Google Forms, adhering to the guidelines for communicating results of online questionnaires and surveys (CHERRIES) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It was available to all participants who accepted the privacy statement and provided their consent to participate in the study. The questions were not randomly arranged; the order was the same for all participants. Participants were contacted via the internet, and the survey was distributed via email and/or social media (Wa\u0026reg;) without advertising. The estimated time to complete the survey was less than 10 minutes. All questions were answered to ensure the questionnaire could be finalized using the options integrated into the Google Forms\u0026reg; application. An informed consent section explaining the study\u0026acute;s objective, its anonymity and requested voluntary participation was also included at the beginning of the questionnaire. Demographic variables, including age, sex, and university (public/private), were recorded. The data were analyzed using IBM's Statistical Package for the Social Sciences (SPSS), version 27. Measures of central tendency and normality tests were calculated, and the Mann-Whitney U test was used for group comparisons, establishing a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. This project was approved by the Research Ethics Committee of the National School of Higher Studies, Le\u0026oacute;n Unit, UNAM CEI_24_125_S43.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 494 students were invited to participate; 483 completed the questionnaire which represents a participation rate of 98%. 70.5% were women, and the mean age of all participants was 22.39 (+\u0026thinsp;1.9). 69.3% study at public universities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSex distribution according to the type of school of participants:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e70,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e29,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eChi-square\u0026thinsp;=\u0026thinsp;0.00, p=.894\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the self-assessment of knowledge about MID, sixty-nine-point five percent of respondents rated their knowledge as \"good\" or \"excellent\", while the remaining percentage was distributed between the categories of \"fair\" and \"poor\" (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It was observed that students from private schools, in a higher percentage, consider their knowledge to be good or excellent (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSelf-assessment of knowledge about minimally invasive dentistry according to the type of school of participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor-Fair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32,8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25,2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.4,0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood-Excellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67,2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74,8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eChi-square\u0026thinsp;=\u0026thinsp;3,36, p\u0026thinsp;=\u0026thinsp;0.04\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn evaluating each item of the questionnaire, the percentage of correct answers was found to be very similar in both groups. As shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e statistically significant differences were only observed in item two, which inquires about the treatment to follow in the presence of active, non-cavitated lesions. A higher percentage of those from public schools identified the correct answer.\u003c/p\u003e\u003cp\u003eThe average score for the entire population was 5.9 (on a scale of 0 to 10). Public school students performed better than private school students (p\u0026thinsp;=\u0026thinsp;0.018), with average scores of 5.7 and 6.1 for private and public schools, respectively. No statistically significant differences were identified by gender. When comparing total scores according to self-perception, no statistically significant differences were observed between them.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCurrent evidence strongly supports the benefits of minimally invasive restorative techniques for managing dental caries and preserving healthy tooth structure. This philosophy of Minimally Invasive Dentistry has established itself as a paradigm that prioritizes tissue preservation and a preventive approach. Evidence suggests that minimally invasive restorative techniques are beneficial in managing dental caries and preserving healthy tissue, and they should be used whenever possible [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this scientific consensus, the dissemination and implementation of this knowledge in the dental sector has historically been limited. Our study addresses an area with limited research: comparing and evaluating the level of knowledge about MID among final-year students from public and private universities, who represent the next generation of oral health professionals.\u003c/p\u003e \u003cp\u003eOne of the most notable findings is the marked disparity between self-perceived knowledge and performance on the objective assessment. Slightly more than two-thirds of respondents rated their MID knowledge as \"good\" or \"excellent.\" However, the overall average score on the questionnaire was low, at 5.9 (on a scale of 0 to 10). It is worth noting that no statistically significant differences were observed in total scores across self-perception, suggesting a generalized overestimation of competence among future professionals.\u003c/p\u003e \u003cp\u003eBesides, when analyzing answers for each clinical situation, it becomes clear that actual knowledge does not consistently align with those self-perceptions. Students are more accurate at identifying when an invasive intervention should be performed than when a non-invasive, micro-invasive, or mixed intervention should be performed. This is a noticeable lack of knowledge about when caries lesions can be treated with minimally invasive procedures. Similarly, Russian dentists and dental undergraduate students showed that most do not follow the MID concept when treating dental caries in permanent teeth [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These findings reflect the persistence of a traditional, restorative-oriented educational paradigm, despite strong scientific consensus supporting tissue-preserving approaches [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], indicating that science is not yet incorporated into dental schools' practice. Insufficient management of inactive or non-cavitated lesions increases the likelihood of overtreatment. Such overtreatment results in unnecessary loss of healthy tooth structure and imposes additional economic burdens on both patients and healthcare systems. Furthermore, overtreatment can accelerate tooth loss with a significant impact on an individual\u0026acute;s quality of life [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimited information exists regarding the professions responsible for training dental students. Determining whether these professionals possess comprehensive knowledge of the MID paradigm is essential. Although theoretical components are generally addressed, additional practical training is necessary to facilitate accurate identification of initial caries lesions. Furthermore, effective MID management requires understanding dental caries as a behavioral, multifactorial, and non-transmissible disease. Mandatory teacher evaluation and training within the MID paradigm should be implemented to ensure educators possess the necessary skills to deliver current knowledge to students.\u003c/p\u003e \u003cp\u003eOn the other hand, the findings of this study suggest that students from public universities have a higher level of knowledge about minimally invasive dentistry than their counterparts from private institutions. Future research should examine educational programs, student demographics, faculty evaluations, and additional factors to elucidate the causes of this disparity, so it would be up to each educational institution to identify its own areas of opportunity in the academic field and update the teaching programs in dentistry, such as giving more academic hours to the teaching of minimal intervention in an equal way to the time dedicated to learning invasive techniques or operative dentistry. Also, a deep understanding is needed to understand what professors recommend for managing caries lesions. For instance, in Chilean universities, when evaluating which clinical visual/tactile severity stage of the lesion does your Faculty/School indicate operative treatment?\u0026rdquo; 38.9% report that operative treatment is indicated when an underlying shadow is present, 33.3% when enamel microcavitation is observed, and 27.8% when a dentin-exposed cavity is detected. In that report, no universities recommend operative treatment for non-cavitated lesions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In recent years, there has been a significant global shift in cariology education, moving from a predominantly restorative approach to one that emphasizes prevention and oral health promotion [17].\u003c/p\u003e \u003cp\u003e Establishing a fundamental cariology curriculum for dentistry schools in Latin America is the main goal of the Latin American Oral Health Association (LAOHA). To move away from the curative approach found in international surveys of cariology instruction, the second of the suggested activities focuses on creating and reaching an agreement on a core cariology curriculum for dental schools in Spanish-speaking Latin American nations.\u003c/p\u003e \u003cp\u003eA limitation of this assessment is that knowledge was evaluated solely on the basis of visual characteristics (images and clinical features), without consideration of additional factors essential to decision-making, such as the patient's risk level. These factors are essential components of the decision-making process for determining appropriate treatment or managing caries as a disease.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eMost of the participants rated their knowledge as \"Good\" to \"Excellent.\" The level of knowledge regarding Minimally Invasive Dentistry among final-year students in the region was found to be low to intermediate. Only one-third of participants correctly identified the appropriate management for inactive lesions, indicating a potential risk of overtreatment. These findings underscore the need to enhance MID instruction during professional training.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe current study received ethical approval from the Research Ethics Committee of the National School of Higher Studies, Le\u0026oacute;n Unit, UNAM (CEI_24_125_S43). All participants provided informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCREDIT AUTHORSHIP CONTRIBUTION STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF\u0026Aacute;TIMA DEL CARMEN AGUILAR-D\u0026Iacute;AZ:\u003c/strong\u003e Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing. \u003cstrong\u003eLEOPOLDO JAVIER D\u0026Iacute;AZ-ARIZMENDI:\u003c/strong\u003e Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing. \u003cstrong\u003eLEOPOLDO ARTURO P\u0026Eacute;REZ-MIRANDA:\u003c/strong\u003e Conceptualization, Investigation, Writing \u0026ndash; review and editing. \u003cstrong\u003eBRENDA MARIANA-MARTINEZ:\u0026nbsp;\u003c/strong\u003eInvestigation, Writing \u0026ndash; review and editing. \u003cstrong\u003eMAR\u0026Iacute;A DE LOS \u0026Aacute;NGELES RAM\u0026Iacute;REZ-TRUJILLO:\u003c/strong\u003e Investigation, Writing \u0026ndash; review and editing. \u003cstrong\u003eMAR\u0026Iacute;A DEL CARMEN VILLANUEVA-VILCHIS:\u0026nbsp;\u003c/strong\u003eInvestigation, Writing \u0026ndash; review and editing.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarrett B, Mclindent B, O\u0026rsquo;sullivan M (2021) Management of the deep carious lesion: a literature review. J Ir Dent Assoc 67:36\u0026ndash;42\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFDI (2017) FDI policy statement on Minimal Intervention Dentistry (MID) for managing dental caries. Int Dent J 67:6\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/idj.12308\u003c/span\u003e\u003cspan address=\"10.1111/idj.12308\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S et al (2019) When to intervene in the caries process? An expert Delphi consensus statement. 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BMC Oral Health 25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S12903-025-06087-Y\u003c/span\u003e\u003cspan address=\"10.1186/S12903-025-06087-Y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEysenbach G (2004) Improving the quality of web surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/jmir.6.3.e34\u003c/span\u003e\u003cspan address=\"10.2196/jmir.6.3.e34\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 6\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarreth A (2023) Dental Caries and Its Management. Int J Dent. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2023/9365845\u003c/span\u003e\u003cspan address=\"10.1155/2023/9365845\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakudate N, Yokoyama Y, Pereira Da E, Tagliaferro S, Sumida F, Matsumoto Y et al (2024) The Evidence-Practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil. Oper Dent 49:127\u0026ndash;135. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2341/23-074-C\u003c/span\u003e\u003cspan address=\"10.2341/23-074-C\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDella TM, Garrido B, Pereira PSS, Foloni K, Pegoraro HD, Souza IR, Bastos JRM et al (2025) Tooth Loss, Nutrition, and Oral Health-Related Quality of Life in Older Adults: Evidence from a Structural Equation Model. Int J Environ Res Public Health 22:1793. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph22121793\u003c/span\u003e\u003cspan address=\"10.3390/ijerph22121793\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSukumar MBA, Peter RM, Joseph A (2025) Tooth morbidity and its impact on oral related quality of life in elderly tribal population-The Irula experience. BMC Oral Health 25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S12903-025-05628-9\u003c/span\u003e\u003cspan address=\"10.1186/S12903-025-05628-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026iacute;az-Yokens M, Gonz\u0026aacute;lez S, Giacaman RA, Araya-Bustos F, Moncada G, Martignon S et al (2018) Cariology Curriculum in Chilean Universities. Revista cl\u0026iacute;nica de periodoncia, implantolog\u0026iacute;a y rehabilitaci\u0026oacute;n oral. 11:98\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4067/S0719-01072018000200098\u003c/span\u003e\u003cspan address=\"10.4067/S0719-01072018000200098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 3","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental Caries, Students Dental, Educational Measurement, Education Dental, Clinical Competence","lastPublishedDoi":"10.21203/rs.3.rs-8903805/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8903805/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study investigated the knowledge of final-year dental students in Mexico regarding caries management according to the principles of Minimally Invasive Dentistry (MID).\u003c/p\u003e\u003ch2\u003eSubjects and methods:\u003c/h2\u003e \u003cp\u003eCross-sectional study. Final-year undergraduate students from various universities participated in the study during academic year 2024-25. Data on MID knowledge were obtained using a structured and validated questionnaire, administered virtually in accordance with the CHERRIES checklist. Demographic variables, including age, sex, and type of university (public/private), were recorded. For statistical analysis, the Mann-Whitney U test was used for group comparisons. The study was approved by the Ethics Committee (CEI_24_125_S43).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe sample consisted of 494 students, with 70.4% being women and 69.3% from public universities. Although 69.5% of participants self-perceived their knowledge of Minimally Invasive Dentistry as \"good\" or \"excellent,\" the overall average score on the objective assessment was 5.8 (on a scale of 0 to 10). Significant differences (p\u0026thinsp;=\u0026thinsp;0.018) were observed in the scores, with students from public universities scoring higher than those from private universities. No statistically significant differences were identified by gender.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eMost of the participants gave their knowledge a \"good\" to \"excellent\" self-rating. The level of knowledge about management of caries lesions according to Minimally Invasive Dentistry among final-year students is low to intermediate, suggesting the need to reinforce the teaching of this discipline during professional training.\u003c/p\u003e\u003ch2\u003eClinical relevance:\u003c/h2\u003e \u003cp\u003eIncreased curricular time and clinical training in minimally invasive dentistry are needed to move away from a curative approach and reduce overtreatment and unnecessary loss of healthy tooth structure.\u003c/p\u003e","manuscriptTitle":"Knowledge and Self-perception Level of Dental Students Regarding the Minimally Invasive Approach: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 08:11:15","doi":"10.21203/rs.3.rs-8903805/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa3bd0e1-f280-4a76-9c2b-8c0c787ba1d2","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-08T23:08:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 08:11:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8903805","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8903805","identity":"rs-8903805","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}