Exploring declared and taught curricula at a UK dental school through the lens of pulp management.

Exploring declared and taught curricula at a UK dental school through the lens of pulp management. | 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 Exploring declared and taught curricula at a UK dental school through the lens of pulp management. Laura Brooks, David Edwards, James Field, Janice Ellis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2802369/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction : This paper explores the declared and taught endodontic curriculum within an undergraduate dental programme in the UK, as part of a wider study which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines. Method : The declared curriculum was identified through existing course guides, seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum. Results : Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines, the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum. Conclusion : This study highlights disparities between current evidence-based guidelines, the declared and the taught curriculum in relation to pulp management in a UK dental school. Recommendations: all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, and engagement with clinical lecturers to enable more standardised teaching. Health sciences/Diseases/Dental diseases/Dental caries Health sciences/Health care/Dentistry/Dental education/Dental clinical teaching Health sciences/Diseases/Dental diseases/Pulpitis Figures Figure 1 Keypoints Disparities exist between current evidence-based guidelines, the declared and taught endodontic curriculum at a UK dental school. The main deviation occurred within the informal taught curriculum during patient encounters in the clinical environment. Recommendations include: Clear delivery of current guidelines during lectures; all policies, procedures and protocols to be updated and aligned to a contemporaneous evidence base annually; clinical teacher training to allow for more standardised teaching in the clinical environment. Introduction Evidence based practice is defined as, ‘an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences’. 1 In the United Kingdom (UK), the importance of an evidence-based approach to dental care is acknowledged by the General Dental Council (GDC), in their ‘Standards for the Dental Team’ which states in standard 7.1 that “You must provide good quality care based on current evidence and authoritative guidance”. 2 Similarly, in relation to dental education, providers are required to underpin their curriculum with an evidence base, and in order to graduate as a safe beginner students must be able to ‘Explain, evaluate and apply the principles of an evidence-based approach to learning, clinical and professional practice and decision making’. Further to this, the Association for Dental Education in Europe (ADEE) provides a framework, ‘The Graduating European Dentist’ that reflects best academic practice for European undergraduate dental education to support educators to deliver a contemporaneous curriculum to dental students. 3 It would therefore be realistic to expect that the curriculum of dental programmes would be founded on the current evidence base, and would need to be reflexive to changes in that evidence base. Whilst the changing nature of the evidence base may pose a challenge for providers of dental education programmes in updating and aligning their curriculum these are hypothetically more easily controlled than the ‘informally’ taught curricula. A curriculum is ‘the planned and guided learning experiences and intended learning outcomes, formulated through the systematic reconstruction of knowledge and experience, under the auspices of the school, for the learner’s continuous and willful growth in personal social competence’. 4 The declared curriculum is the stated and intended curriculum, which an institution claims is being taught and is described in a course syllabus or guide. 5 However it is also recognised that important learning takes place via interactions within the workplace and organisational culture and this is often described as the informal, or hidden curriculum’. 5 Student learning can be influenced by informal learning through peers, clinicians and the increasing use of social media, which may or may not align with current best practice. 6,7 Gaining an understanding of how and why the declared and informal curriculum may differ from the evidence base and also from each other is an important aspect of quality assurance of programmes. A recent UK cross sectional survey identified outdated endodontic practices such as the use of calcium hydroxide for a direct pulp cap were common in UK primary care, irrespective of the number of years since graduation, 8 and anecdotal evidence suggests that undergraduate students may also undertake the same practice. This study therefore aims to explore potential differences between the formally declared and formal and informally taught curriculum in a dental undergraduate programme using the lens of endodontics in relation to current guidelines. Objectives include: Identify the declared and formal and informal taught curriculum at a UK Dental School in relation to deep caries management, direct pulp caps and symptomatic irreversible pulpitis. Identify any differences between the declared and formal and informal taught curriculum in relation to current guidelines, and potential reasons for such discrepancies. Ethical approval was awarded by Newcastle University Research Ethics Committee (REF: 12993/2020). Context: At the School of Dental Sciences, Newcastle University, restorative dentistry (particularly in relation to endodontics) is taught via a mixture of lectures, seminars, practical teaching sessions using models, three-dimensional printed teeth, extracted teeth and clinical attachments where students provide treatment for patients under the supervision of clinical educators including restorative consultants, registrars or associate clinical lecturers and specialty doctors. Recent evidence based guidelines in relation to deep caries management and irreversible pulpitis have been by the international caries consensus collaboration (ICCC), 9 the European Society of Endodontology (ESE) 10 and the American Association of Endodontists. 11 The changing nature of the evidence base in endodontics poses a particular challenge for educators in aligning the declared and the formal and informally taught curricula resulting in students deviating from best practice such as using calcium hydroxide (CH) instead of calcium silicate cements (CSCs) for direct pulp caps (DPCs). 9,10 The recent guidelines therefore provide a useful model for investigating the declared and taught curriculum and are summarised in figure 1. 9-11 Method The declared endodontic curriculum To identify the declared curriculum, relevant course guides, seminar plans and practical session plans were obtained from the course leads for undergraduate BDS students. Recognising that the curriculum content may have changed since having been delivered to the students in earlier stages of the programme, the version of documents pertinent to the current final year students were obtained. Learning outcomes were noted in relation to caries management, direct pulp caps and symptomatic irreversible pulpitis. The formal taught endodontic curriculum The formal taught endodontic curriculum was identified by sourcing all lectures, practical teaching sessions, seminars and handouts given to current final year dental students in relation to deep caries management, direct pulp caps and symptomatic irreversible pulpitis. Their content was cross-checked against current guidelines with a focus on alignment or deviation. The informal taught endodontic curriculum A questionnaire was designed aimed at exploring clinical teachers’ advice to students at Newcastle Dental Hospital clinical vignettes based on deep caries management and management of the exposed pulp (Fig. 1). The questionnaire consisted of closed questions supported by a radiograph of deep caries and pictures of carious exposures (supplemental information). The questionnaire was designed and distributed electronically using JISC Online Survey in June 2021. 12 A questionnaire pilot was delivered to 10 hospital dentists not involved in teaching, including general professional trainees, dental core trainees and specialty trainees. Following this feedback, minor amendments were made before the questionnaire was emailed to all 40 restorative clinical teachers responsible for delivering undergraduate clinical supervision (including dentists working in general practice, the community setting, specialist in practice, staff grades, restorative registrars and consultants). A reminder email was sent 1 week later. The aim of the questionnaire was to explore the informal taught curriculum. Following the checking and removal of any duplicate responses, data were pseudonymised, cleaned, coded and analysed with IBM SPSS (Version 25, Chicago, IL, USA). Descriptive statistics were used to explore key themes. Variables investigated included if the clinical teachers worked mainly in the hospital or primary care setting, if they had a formal postgraduate qualification and their awareness of the ESE position statement. Univariate analyses of differences in responses to questions using X 2 was undertaken. Exact p- values were calculated without Bonferroni correction. Where assumptions of cell counts were violated in cross tabulations (< 5 in ≥ 20%), Fisher’s exact test was used. 13 Results The declared endodontic curriculum Table 1 shows all learning outcomes identified in the declared curriculum in relation to caries management, direct pulp caps and symptomatic irreversible pulpitis in the final year students’ education from September 2016 to July 2021. Learning objectives were generally broad based and did not directly reference current national guidelines. They did not state specific materials or techniques in different clinical scenarios. Table 1 Learning outcomes from the declared endodontic curriculum. Learning outcomes 1.Discuss and practice the principles governing the removal and management of caries. 2. Describe how the pulp may be endangered by dental caries and its operative management. 3. Discuss basic elements of caries management. 4. Remove simulated caries from plastic teeth. 5. Discuss the impact of caries and instrumentation on a vital pulp. 6. Discuss the role of vital pulp therapies in the management of deeply carious teeth 7. Have an understanding of vital pulp therapies for the preservation of pulp health, including pulp capping and pulpotomy procedures. 8. Discuss the technique of cavity preparation, lining and restoration taught in the Clinical Simulation Unit in relation to preserving pulpal health. 9. Enable students to investigate the relationship between advanced caries and the pulp. 10. Manage the wider carious lesion including access to the pulp space. 11. Be competent in evaluating the pulp and periradicular area, establishing a diagnosis and prognosis and formulating a treatment plan. 12. Design, safely execute, criticise and refine access cavity preparation to the pulp space of uncomplicated anterior and posterior teeth. 13. Justify the selection of materials for the inter-appointment temporisation of teeth undergoing root canal treatment. 14. Describe situations when it may be necessary to access the pulp space of primary and permanent teeth. The formal taught endodontic curriculum Twelve lectures and seminars relating to deep caries management, management of the cariously exposed pulp and symptomatic irreversible pulpitis were identified. The ESE 2019 position statement was quoted and listed as suggested reading, but guidance from the ICCC was not mentioned. Three of these lectures/seminars taught students the wrong information in relation to current guidelines or they did not discuss all the methods and materials that could be used (Table 2 ). Table 2 Teaching that deviated from evidence based best practice in formal teaching (lectures) Lecture Title Learning Point which Deviated from Best Practice Evidence Based Best Practice 9 , 10 Managing the Vital Pulp in Operative Dentistry For indirect pulp caps recommends a selective/stepwise caries removal technique and calcium silicate cements (CSCs) but stated CH could be used as an alternative. For pulp exposures, the lecture recommends sodium hypochlorite (NaOCl) to achieve haemostasis and CSCs for DPCs but also stated CH can be used. CH should not be recommended as a ‘lining’ or ‘indirect pulp cap’ due to its poor bonding, poor compressive strength, high solubility At the time of the lecture there was significant evidence that CSC offers a far superior outcome. Long-term outcomes from CH DPC are poor 27 – 30 Restorative Dental Materials’ handout Stated GIC or CH can be used for indirect pulp caps, and CH can be used for direct pulp caps. CSCs were not mentioned. Although GIC may be used for indirect pulp cap 31 , CH cannot be recommended (as above). CH should not be used for DPC, and CSCs should be recommended. Vital Pulp Treatments Discussed only CH and did not mention CSCs As above The informal taught endodontic curriculum- clinician questionnaire Participant demographics for the questionnaire are shown in Table 3 . Valid responses were received from 25/40 (62.5%) supervising clinicians (Table 4 ). Table 3: Participant demographics. Clinicians N (%) Gender n =25 Male Female Prefer not to say Main work n= 25 Mainly NHS primary care (70-100% NHS) Mainly mixed primary care (40-60% NHS) Mainly private primary care (70-100%) Mainly hospital (20 years Place qualified n= 25 Newcastle Other UK Non-UK+Non-EU Number of years involved in teaching n= 25 20 years Formal postgraduate training n= 25 Nil Formal qualification Aware of ESE position statement n= 25 No Yes 19 (76) 5 (20) 1 (4) 6 (24) 2 (8) 4 (16) 12 (48) 1 (4) 12 (48) 13 (52) 2 (8) 5 (20) 5 (20) 13 (52) 18 (72) 5 (20) 2 (8) 3 (12) 8 (32) 1 (4) 6 (24) 1 (4) 6 (24) 15 (60) 10 (40) 16 (64) 9 (36) Table 4 Clinician responses to questionnaire and clinicians’ responses in relation to main place of work, post-graduate training and awareness of the ESE position statement. Clinician responses Scenario Questions All n = 25 (%) Mainly hospital n = 12/25 (%) Mainly primary care n = 13/25 (%) p value PGT n = 10/25 (%) No PGT n = 15/25 (%) p value Aware of ESE n = 9/25 (%) Not aware of ESE n = 16/25 (%) p value Deep caries management- Caries removal technique a radiograph shows caries Non-selective 4 (16) 2 (16.7) 2 (15.4) 1.000 1 (10) 3 (20) 0.626 2 (22.2) 2 (12.5) 0.602 present into the inner ¼ of Selective 14 (56) 5 (41.7) 9 (69.2) 0.165 6 (60) 8 (53.3) 0.742 6 (66.7) 8 (50.0) 0.677 dentine of UR6. Stepwise 7 (28) 5 (41.7) 2 (15.4) 0.144 3 (30) 4 (26.7) 0.856 1 (11.1) 6 (37.5) 0.355 Lining material with no exposure + composite restoration No lining 11 (44) 8 (66.7) 3 (23.1) 0.028 4 (40) 7 (46.7) 1.000 3 (33.3) 8 (50) 0.677 CH 7 (28) 2 (16.7) 5 (38.5) 0.378 2 (20) 5 (33.3) 0.659 2 (22.2) 5 (31.3) 1.000 CSC 2 (8) 2 (16.7) 0 (0) 0.220 2 (20) 0 (0) 0.150 2 (22.2) 0 (0) 0.120 RMGIC 4 (16) 0 (0) 4 (30.8) 0.096 2 (20) 2 (13.3) 1.000 2 (22.2) 2 (12.5) 0.602 GIC 1 (4) 0 (0) 1 (7.7) 1.000 0 (0) 1 (6.7) 1.000 0 (0) 1 (6.3) 1.000 IRM/ZOE 0 (0) 0 (0) 0 (0) 1.000 0 (0) 0 (0) 1.000 0 (0) 0 (0) 1.000 Direct pulp cap- following Control of post exposure caries removal on an haemorrhage asymptomatic vital tooth the CW + NaOCl/CHX 12 (48.0) 8 (66.7) 4 (30.8) 0.073 6 (60) 6 (40) 0.428 7 (77.8) 5 (31.3) 0.041 pulp becomes exposed. It is CW + ferric sulphate 0 (0.0) 0 (0.0) 0 (0.0) 1.000 0 (0.0) 0 (0.0) 1.000 0 (0.0) 0 (0.0) 1.000 bleeding but no profusely. CW + saline 3 (12.0) 2 (16.7) 1 (7.7) 0.593 1 (10) 2 (13.3) 1.000 0 (0.0) 3 (18.8) 0.280 CW + pressure 8 (32.0) 2 (16.7) 6 (46.2) 0.202 2 (20) 6 (40) 0.402 1 (11.1) 7 (43.8) 0.182 Wait 0 (0.0) 0 (0.0) 0 (0.0) 1.000 0 (0.0) 0 (0.0) 1.000 0 (0.0) 0 (0.0) 0.000 Other 2 (8.0) 0 (0.0) 2 (15.4) 0.480 1 (10.0) 1 (6.7) 1.000 1 (11.1) 1 (6.3) 1.000 Which material would you apply to the exposed pulp? CH 13 (52) 4 (33.3) 6 (46.2) 0.688 3 (30) 7 (46.7) 0.678 0 (0) 10 (62.5) 0.003 CSC 10 (40) 6 (50) 7 (53.8) 0.848 7 (70) 6 (40) 0.226 8 (88.9) 5 (31.3) 0.011 GIC 2 (8) 2 (16.7) 0 (0) 0.220 0 (0) 2 (13.3) 0.500 1 (11.1) 1 (6.3) 1.000 Irreversible pulpitis- a How would you manage patient presents with this case? symptoms of irreversible Emergency pulpotomy 10 (40) 4 (33.3) 6 (46.2) 0.688 5 (50) 5 (33.3) 0.442 8 (88.9) 2 (12.5) < 0.001 pulpitis during an emergency Pulpectomy 15 (60) 8 (66.7) 7 (53.8) 0.688 5 (50) 10 (66.7) 0.442 1 (11.1) 14 (87.5) < 0.001 appointment. After caries Before providing a removal the pulp is exposed. temporary restoration The patient wishes to save would you place a the tooth. dressing? No 4 (16) 2 (16.7) 2 (15.4) 1.000 2 (20) 2 (13.3) 1.000 3 (33.3) 1 (6.3) 0.116 Ledermix/Odontopaste 8 (32) 2 (16.7) 6 (46.1) 0.202 3 (30) 5 (33.3) 1.000 1 (11.1) 7 (43.8) 0.182 CH 13 (52) 8 (66.7) 5 (38.5) 0.158 5 (50) 8 (53.3) 1.000 8 (50.0) 5 (55.6) 1.00 Abbreviations: PGT = post graduate training, CH = calcium hydroxide, CSC = calcium silicate cement, RMGIC = resin modified glass ionomer cement, GIC = glass ionomer cement, IRM/ZOE = intermediate restorative material/zinc oxide eugenol, CW = cotton wool pledget, NaOCl = sodium hypochlorite, CHX = chlorhexidine. Significant at the p < 0.05 level Deep caries management When shown a bitewing radiograph (supplemental information) of a deep carious lesion of the UR6, the majority of clinicians (14/25; 56%) stated that they would teach a selective caries removal technique, 7/25 (28%) would teach a stepwise technique and 4/25 (16%) would teach a non-selective technique (Table 4 ). Clinicians working mainly in primary care were more likely to choose a selective technique than those working in hospital (9/13 [69.2%] v 5/12 [41.7%]), however this was not statistically significant ( p = 0.165). In deep caries management, 11/25 (44%) clinicians stated they would not use a lining/indirect pulp cap when restoring the tooth with a composite restoration. For those that would place a lining, 3/14 (21.4%) would teach the use of either GIC or CSC, meaning 11/14 (78.6%) would not teach aligned with the recent consensus statement. 10 Direct pulp cap About half of clinicians (12/25; 48%) stated they would teach the use of a cotton wool pledget soaked in CHX or sodium hypochlorite (NaOCl) to arrest haemorrhage after a pulp exposure, following current recommendations. 10 Clinicians who were aware of the ESE position statement were more likely to teach cotton wool/NaOCl compared to those with no knowledge of the ESE position statement ( p = 0.041). Regarding which material to use for a direct pulp cap, CH was the most popular choice (13/25; 52%), going against current recommendations, whereas CSC would be taught by 10/25 (40%) of clinicians, aligning with current guidelines. 10 Those aware of the ESE position statement were more likely to use CSCs and those clinicians who were not aware were more likely to use CH ( p = 0.011 and p = 0.003 respectively, Table 4 ). Symptomatic Irreversible pulpitis When presented with the emergency appointment scenario of a tooth displaying symptoms of symptomatic irreversible pulpitis, most clinicians (15/25; 60%) would manage the case with a pulpectomy rather than a pulpotomy. Around half (13/25; 52%) would choose CH to dress the tooth rather than using an antibiotic/corticosteroid dressing, despite recent guidelines by the British Endodontic Society recommending such dressings, 14 although it is acknowledged there is a dearth of evidence around the effectiveness of antibiotic/corticosteroid dressings. Discussion The findings of this study show that there are likely to be disparities between the content of current evidence based endodontic guidelines, the formal and informal taught curriculum. The declared curriculum Learning outcomes are, ‘broad statements of what is achieved and assessed at the end of a course of study’. 15 For students, learning outcomes provide building blocks to construct their knowledge and skills around a subject and they guide teachers on the delivery of a course. 16 Learning outcomes form only a part of the curriculum however since there is an interplay between the learner and the clinical environment, which is later described. In the UK, the GDC defines the learning outcomes for a dental graduate but allows education providers autonomy in planning and delivering the undergraduate curriculum in a way that suits their circumstances. 17 The learning outcomes described in Preparing for Practice tend to be very broad and non-specific for example the learning outcome pertaining to endodontics states that graduates should be able to; 1.14.6 Assess, diagnose and manage the health of the dental pulp and periradicular tissues, including treatment to prevent pulpal and periradicular disease. However, there are numerous learning outcomes which refer to the need ‘apply the principles of an evidence-based approach to learning, clinical and professional practice and decision making’, maintain contemporaneous knowledge and comply to guidelines, for example: 1.8.5 Comply with current best practice guidelines 7.1 Be familiar with and act within the GDC’s standards and within other professionally relevant laws, ethical guidance and systems 9.4 Develop and maintain professional knowledge and competence and demonstrate commitment to lifelong learning 9.5 Recognise and evaluate the impact of new techniques and technologies in clinical practice. In writing such broad learning outcomes the GDC are almost certainly acknowledging that specific legislation, guidelines and best practice cannot be explicitly referenced because such content is liable to frequent change and that the responsibility lies with the practitioner to maintain their own knowledge. Similarly, the present learning outcomes at Newcastle University are also very broad and do not make specific reference to guidelines and techniques (Table 1 ). This enables teaching to react and adapt to emerging evidence, consensus statements and guidelines, without being overly prescriptive. It has been suggested that to assure the delivery of teaching aligns to current guidelines, a system of learning outcomes can be cross referenced against current guidelines on a yearly basis. 3 The formal taught curriculum Whilst the majority of teaching material aligned with current guidelines, guidance from the ICCC 9 was not mentioned in lectures, although the ESE 2019 position statement was quoted and listed as suggested reading. Incorrect information was occasionally delivered in lectures and seminars such as use of CH for direct and indirect pulp caps, but the majority of formal teaching material delivered relevant and up-to-date information. The ADEE suggest dental schools should ensure that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base. 3 In line with this we recommend that lecture content is checked against the latest guidelines when delivered and for staff regularly lecturing on specific topics, this should be completed at least yearly. At Newcastle, the ‘Update in Endodontics’ lecture given in final year is an ideal opportunity to discuss the latest relevant guidelines to adequately prepare students for their final examinations and be best prepared for practice. This approach could be used in other disciplines and would be effective at other institutions. The informal taught curriculum It was found that the informal taught curriculum appears to be highly variable with clinical teachers deviating from accepted clinical guidelines. More than half would advise students to use CH for a direct pulp cap and some would advise non-selective caries removal to manage deep caries. However, in a recent study of primary dental care practitioners in the UK, 41.4% of dentists would use a non-selective caries removal technique to manage deep caries 8 and respected researchers continue to use this approach, 18 particularly in cases of extremely deep caries. 19 This is reasonable given the extensive bacterial presence in the pulp, and its inflammatory status in ‘extremely deep caries’ where there appears to be caries into pulp, 19 but in cases of deep caries where there appears to be intact dentine present, as in the clinical vignette used, selective techniques offer superior clinical outcomes. 20 , 21 For many years CH was considered the ‘gold standard’ for a DPC 22 and considering that 52% of the clinical supervisors have been qualified for > 20 years, they would have plenty of experience and expertise with this material. Although differences in opinion from clinical supervisors may confuse students, if channeled correctly it will allow them to become reflective and take charge of their own learning and practice by implementing an evidence-based approach. Importantly, where teaching does not follow evidenced based guidelines, the pragmatic approach of general practitioners compared to ‘by the book’ strategy of hospital-based clinicians may enrich student’s education by preparing them for ‘real world’ practice whilst being a ‘safe beginner’. Limited availability of materials is one of many issues new graduates will have to contend with when treating patients in primary care. In fact, this experience may help to bridge the ‘tension’ gap between dental schools and dental foundation trainers, however this should not come at the expense of good clinical outcomes for patients. For example, using CH for a DPC deviates significantly from accepted best practice and may result in sub-optimal outcomes for patients. Research has found that treatment options and the environment in UK dental schools did not correspond to those prevalent in the NHS for some clinical situations, 23 but students should strive for best practice. As clinicians have been teaching students information that conflict with current guidelines, one suggestion from this study is for clinical supervisors to have formal training at the start of their position to standardise techniques and protocols and provide uniform teaching. Another suggestion would be to conduct an annual CPD teachers training day with updates on topics such as dental materials. ADEE recommends structured and regular staff training to achieve these aims. 3 It has been shown that the majority of clinicians (75%) involved in teaching undergraduate students feel their teaching would benefit from additional training. 24 However, what is not clear is the nature of training that would be most beneficial, for example training around pedagogy or ensuring content alignment? Nonetheless the delivery of training, whilst hopefully improving student experience and outcomes, may also result in clinical teachers (particularly those working less than full time in the educational environment) feeling more valued by providers and encouraged to further develop their careers as teachers, which frequently does not happen and is a major complaint of clinicians. 24 , 25 Currently in the UK, there is a shortage of clinical academic staff 23 and the above approach may also increase staff retention. Limitations As with all questionnaire surveys, bias and self-reporting can be problematic. One question in the questionnaire referred to the use of a liner under a posterior composite restoration, which are not routinely placed under the publicly funded National Health Service in England and Wales 26 and is only used for pregnant patients and children. Clinicians may not have been so familiar with the best approach to using this material. Conclusion Our findings suggest that in this one example there are some disparities between current evidence-based guidelines, the declared and taught endodontic curriculum. Most of the deviation from best practice appears to be delivered through the informal taught curriculum in the clinical environment. Further research is needed to explore if and to what degree this influences students’ knowledge of current guidelines and hence the learned curriculum requires investigation. Recommendations from this research include: in lectures, a clear delivery of what the current guidelines are, ensure all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base ideally annually and improved clinical teacher training to allow for more standardised teaching. The authors suggest the above measures can be implemented by other dental schools within the UK to ensure a curriculum that is both contemporaneous and evidence- based is delivered to undergraduate students. Declarations Conflict of Interest The authors have no conflict of interest to declare. Author Contribution Statements The authors confirm contribution to the paper as follow: study conception and design: LB, DE, JF, JE; data collection: LB, DE; analysis and interpretation of results: LB, DE; draft manuscript preparation: LB. All authors reviewed the results and approved the final version of the manuscript. Consent Statement All participants consented to participate in the study and for their data to be used as part of the research and published. References Rabb-Waytowich D. You ask, we answer:Evidence-based dentistry: Part 1. an overview. J Can Dent Assoc . 2009;75(1):27-8. General Dental Council. Standards for the Dental Team . General Dental Council website. https://www.gdc-uk.org/docs/default-source/standards-for-the-dental-team/standards-printer-friendly-black-white3e2c002f471e475eac4a4fcc1e4945a2.pdf?sfvrsn=3963b738_5. Published 2019. Accessed 19th April 2022 Field JC, Cowpe JG, Walmsley AD. The Graduating European Dentist: A New Undergraduate Curriculum Framework. Eur J Dent Educ. 2017;21(1):2-10. Tanner D, Tanner L. Curriculum development: Theory into practice . New York:Macmillan; 1980. Dent JA, Harden RM. A Practical Guide for Medical Teachers . 4 th ed. London; New York: Churchill Livingstone/Elsevier; 2013. Scott KR, Hsu CH, Johnson NJ, Mamtani M, Conlon LW, DeRoos FJ. Integration of social media in emergency medicine residency curriculum. Ann Emerg Med. 2014;64(4):396-404. Zhang J, Peterson RF, Ozolins IZ. Student approaches for learning in medicine: What does it tell us about the informal curriculum? BMC Med Educ . 2011;11(1):87. Edwards D, Bailey O, Stone S, Duncan H. The management of deep caries in UK primary care: A nationwide questionnaire-based study. Int Endo J . 2021;54(10):1804-1818. Schwendicke F, Frencken JE, Bjørndal L, et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res . 2016;28(2):58-67. Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019;52(7):923-934. American Association of Endodontists. Position Statement on Vital Pulp Therapy . American Association of Endodontists website. https://f3f142zs0k2w1kg84k5p9i1o-wpengine.netdna-ssl.com/wp-content/uploads/2021/05/VitalPulpTherapyPositionStatement_v2.pdf. Published 2021. Accessed 16th October 2021. Jisc. Jisc Online Surveys . Jisc Website. https://www.jisc.ac.uk. Accessed 17th June 2021. Field A. Discovering statistics using IBM SPSS statistics . 5 th ed. Sussex UK: SAGE Publications Ltd; 2017. British Endodontic Society. Diagnosis and Management of Endodontic Emergencies, a British Endodontic Society Position Paper for Primary Dental Care and other healthcare providers during the COVID-19 pandemic . British Endodontic Society website. https://www.nhsggc.org.uk/media/259572/bes-emergency-protocol-final-document-29-march-2020.pdf?msclkid=db2d031fbaa311ecaa25c79dec0f494d. Published 2020. Accessed 19th April 2022. Harden RM. Learning outcomes and instructional objectives: is there a difference? Med Teach . 2002;24(2):151-5. Bateman HL, McCracken GI, Thomason JM, Ellis JS. Learning outcomes: Exploring implications of adopting a different level of detail. Eur J Dent Educ . 2018;22(2):86-91. General Dental Council. Dental Education . General Dental Council website. https://www.gdc-uk.org/education-cpd/quality-assurance. Published 2015. Accessed 9th October 2021. Ricucci D, Siqueira JF, Jr., Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent . 2019;86:41-52. Demant S, Dabelsteen S, Bjørndal L. A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response. Int Endod J. 2021;54(3):319-330. Bjørndal L, Fransson H, Bruun G, et al. Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up. J Dent Res . 2017;96(7):747-753. Maltz M, Koppe B, Jardim JJ, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clin Oral Investig . 2018;22(3):1337-1343. Baume LJ, Holz J. Long term clinical assessment of direct pulp capping. Int Dent J . 1981;31(4):251-60. McGleenon EL, Morison S. Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland. Br Dent J . 2021;230(1):39-45. Bartle EK, McGowan KM. Clinical supervisors' reflections on their role, training needs and overall experience as dental educators. Eur J Dent Educ . 2021;25(2):282-290. Martin N, Fairclough A, Smith M, Ellis L. Clinical educators' views on the quality of undergraduate clinical restorative dentistry in the UK and ROI. Eur J Dent Educ . 2011;15(4):216-22. National Health Service. What dental services are available on the NHS? NHS website. https://www.nhs.uk/nhs-services/dentists/what-dental-services-are-available-on-the-nhs/. Published 2020. Accessed 9 th Ocotber 2021. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. J Endod . 2000;26(9):525-8. Hilton TJ, Ferracane JL, Mancl L. Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. J Dent Res . 2013;92(7):16-22 Kundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E. Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J . 2017;50(10):924-932. Suhag K, Duhan J, Tewari S, Sangwan P. Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up. J Endod . 2019;45(7):840-847. Hashem D, Mannocci F, Patel S, Manoharan A, Watson TF, Banerjee A. Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial-2-year results. Clin Oral Investig. 2019;23(4):1931-1939. Harms CS, Schäfer E, Dammaschke T. Clinical evaluation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3 years. Clin Oral Investig . 2019;23(9):3491-3499. Edwards DC, Burns L, Witton R, Tredwin C. MTA and calcium hydroxide for direct pulp capping in fully developed permanent teeth: a systematic review. Endod Prac Today. 2020;14(2):91-102. Cushley S, Duncan HF, Lappin MJ, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis. Int Endod J . 2021;54(4):556-571. American Association of Endodontists. Colleagues for Excellence-Endodontic Diagnosis. AAE website. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/endodonticdiagnosisfall2013.pdf. Published March 2021. Accessed 8 th May 2022. Eren B, Onay EO, Ungor M. Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J . 2018;51 Suppl 3:e227-e237. Gemmell A, Stone S, Edwards D. Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. Br Dent J . 2020;228(7):521-526. Edwards D, Bailey O, Stone SJ, Duncan H. How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care?. Int Endod J . 2021;54(12):2256-2275. Additional Declarations There is no duality of interest Supplementary Files Supplementalinformation.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 20 Jun, 2023 Review # 2 received at journal 14 Jun, 2023 Review # 1 received at journal 15 May, 2023 Reviewer # 2 agreed at journal 12 May, 2023 Reviewer # 1 agreed at journal 02 May, 2023 Reviewers invited by journal 20 Apr, 2023 Editor assigned by journal 12 Apr, 2023 Submission checks completed at journal 12 Apr, 2023 First submitted to journal 11 Apr, 2023 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-2802369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":193674610,"identity":"d6943bfd-28c6-443f-924f-29ccab740187","order_by":0,"name":"Laura Brooks","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIie3RMcrCMBiA4a8I6RLMGqmHiAQUoXiWhEJdyu/g4igInXIAvUXBCwQKnURXQYdOnRzq1kF+DNTFwdTRIS+ELH3IlxTA5frB+u2mzUIAAofAugh6I+UwfhHxJfHKMP+C+Idx3cB1Qfw0qkVy+psQjcp7YyE44TsF1XSnioKKw2U53Qp/tLUOlnDAkDN2nqcg1UVmZ0ABthFy496jJZta/h9ldtIoeNgITXivPSXWVGAtMy1QYL0+rZa9IavYQBWxIZEZTKYDFX8mhER777a6MvNi/N7gmRksL2gTfiZt73/cW3d973K5XK6OngiuT9Uu/A4rAAAAAElFTkSuQmCC","orcid":"","institution":"Kent Community Healthcare","correspondingAuthor":true,"prefix":"","firstName":"Laura","middleName":"","lastName":"Brooks","suffix":""},{"id":193674611,"identity":"752a6e4a-2bea-4a44-a50b-bc64068f32c8","order_by":1,"name":"David Edwards","email":"","orcid":"https://orcid.org/0000-0002-0462-7463","institution":"Newcastle Dental Hospital","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Edwards","suffix":""},{"id":193674612,"identity":"31f72ef0-e6e0-4c0c-a005-feaaa9ffa6fb","order_by":2,"name":"James Field","email":"","orcid":"https://orcid.org/0000-0002-5462-4156","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Field","suffix":""},{"id":193674613,"identity":"3ea9162f-6401-4dcf-8891-515589fbed14","order_by":3,"name":"Janice Ellis","email":"","orcid":"","institution":"Newcastle University","correspondingAuthor":false,"prefix":"","firstName":"Janice","middleName":"","lastName":"Ellis","suffix":""}],"badges":[],"createdAt":"2023-04-11 22:15:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2802369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2802369/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":36223639,"identity":"3232fb59-6b01-4cd1-8336-318b58256f6c","added_by":"auto","created_at":"2023-04-24 14:22:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":198117,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1JPEG.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2802369/v1/968bb479263b5a7dab8aac0c.jpg"},{"id":36223665,"identity":"ad39f30d-d791-4fdc-b97a-c90cee774f3a","added_by":"auto","created_at":"2023-04-24 14:22:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":635431,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2802369/v1/0dd31e07-e0f7-44ae-a760-f5545fa4851c.pdf"},{"id":36223640,"identity":"440e8419-e4f7-4fce-9fbe-1570a16139cd","added_by":"auto","created_at":"2023-04-24 14:22:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":627708,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Supplementalinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-2802369/v1/c1be9e2a7f8f32e5c7341f82.docx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Exploring declared and taught curricula at a UK dental school through the lens of pulp management.","fulltext":[{"header":"Keypoints","content":"\u003cul\u003e\n \u003cli\u003eDisparities exist between current evidence-based guidelines, the declared and taught endodontic curriculum at a UK dental school.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe main deviation occurred within the informal taught curriculum during patient encounters in the clinical environment.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRecommendations include: \u0026nbsp;Clear delivery of current guidelines during lectures; all policies, procedures and protocols to be updated and aligned to a contemporaneous evidence base annually; clinical teacher training to allow for more standardised teaching in the clinical environment.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eEvidence based practice is defined as, \u0026lsquo;an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient\u0026rsquo;s oral and medical condition and history, with the dentist\u0026rsquo;s clinical expertise and the patient\u0026rsquo;s treatment needs and preferences\u0026rsquo;.\u003csup\u003e1\u003c/sup\u003e In the United Kingdom (UK), the importance of an evidence-based approach to dental care is acknowledged by the General Dental Council (GDC), in their \u0026lsquo;Standards for the Dental Team\u0026rsquo; which states in standard 7.1 that \u0026ldquo;You must provide good quality care based on current evidence and authoritative guidance\u0026rdquo;.\u003csup\u003e2\u003c/sup\u003e Similarly, in relation to dental education, providers are required to underpin their curriculum with an evidence base, and in order to graduate as a safe beginner students must be able to \u0026lsquo;Explain, evaluate and apply the principles of an evidence-based approach to learning, clinical and professional practice and decision making\u0026rsquo;. Further to this, the Association for Dental Education in Europe (ADEE) provides a framework, \u0026lsquo;The Graduating European Dentist\u0026rsquo; that reflects best academic practice for European undergraduate dental education to support educators to deliver a contemporaneous curriculum to dental students.\u003csup\u003e3\u003c/sup\u003e It would therefore be realistic to expect that the curriculum of dental programmes would be founded on the current evidence base, and would need to be reflexive to changes in that evidence base. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhilst the changing nature of the evidence base may pose a challenge for providers of dental education programmes in updating and aligning their curriculum these are hypothetically more easily controlled than the \u0026lsquo;informally\u0026rsquo; taught curricula. A curriculum is \u0026lsquo;the planned and guided learning experiences and intended learning outcomes, formulated through the systematic reconstruction of knowledge and experience, under the auspices of the school, for the learner\u0026rsquo;s continuous and willful growth in personal social competence\u0026rsquo;.\u003csup\u003e4\u003c/sup\u003e The declared curriculum is the stated and intended curriculum, which an institution claims is being taught and is described in a course syllabus or guide.\u003csup\u003e5\u003c/sup\u003e However it is also recognised that important learning takes place via interactions within the workplace and organisational culture and this is often described as the informal, or hidden curriculum\u0026rsquo;.\u003csup\u003e5\u003c/sup\u003e Student learning can be influenced by informal learning through peers, clinicians and the increasing use of social media, which may or may not align with current best practice.\u003csup\u003e6,7\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGaining an understanding of how and why the declared and informal curriculum may differ from the evidence base and also from each other is an important aspect of quality assurance of programmes. A recent UK cross sectional survey identified outdated endodontic practices such as the use of calcium hydroxide for a direct pulp cap were common in UK primary care, irrespective of the number of years since graduation,\u003csup\u003e8\u003c/sup\u003e and anecdotal evidence suggests that undergraduate students may also undertake the same practice. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study therefore aims to explore potential differences between the formally declared and formal and informally taught curriculum in a dental undergraduate programme using the lens of endodontics in relation to current guidelines. Objectives include:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eIdentify the declared and formal and informal taught curriculum at a UK Dental School in relation to deep caries management, direct pulp caps and symptomatic irreversible pulpitis.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIdentify any differences between the declared and formal and informal taught curriculum in relation to current guidelines, and potential reasons for such discrepancies.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEthical approval was awarded by Newcastle University Research Ethics Committee (REF:\u003c/p\u003e\n\u003cp\u003e12993/2020).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eContext:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAt the School of Dental Sciences, Newcastle University, restorative dentistry (particularly in relation to endodontics) is taught via a mixture of lectures, seminars, practical teaching sessions using models, three-dimensional printed teeth, extracted teeth and clinical attachments where students provide treatment for patients under the supervision of clinical educators including restorative consultants, registrars or associate clinical lecturers and specialty doctors. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecent evidence based guidelines in relation to deep caries management and irreversible pulpitis have been by the international caries consensus collaboration (ICCC),\u003csup\u003e9\u003c/sup\u003e the European Society of Endodontology (ESE) \u003csup\u003e10\u003c/sup\u003e and the American Association of Endodontists.\u003csup\u003e11\u003c/sup\u003e The changing nature of the evidence base in endodontics poses a particular challenge for educators in aligning the declared and the formal and informally taught curricula resulting in students deviating from best practice such as using calcium hydroxide (CH) instead of calcium silicate cements (CSCs) for direct pulp caps (DPCs).\u003csup\u003e9,10\u003c/sup\u003e The recent guidelines therefore provide a useful model for investigating the declared and taught curriculum and are summarised in figure 1.\u003csup\u003e9-11\u003c/sup\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eThe declared endodontic curriculum\u003c/h2\u003e \u003cp\u003eTo identify the declared curriculum, relevant course guides, seminar plans and practical session plans were obtained from the course leads for undergraduate BDS students. Recognising that the curriculum content may have changed since having been delivered to the students in earlier stages of the programme, the version of documents pertinent to the current final year students were obtained. Learning outcomes were noted in relation to caries management, direct pulp caps and symptomatic irreversible pulpitis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThe formal taught endodontic curriculum\u003c/h2\u003e \u003cp\u003eThe formal taught endodontic curriculum was identified by sourcing all lectures, practical teaching sessions, seminars and handouts given to current final year dental students in relation to deep caries management, direct pulp caps and symptomatic irreversible pulpitis. Their content was cross-checked against current guidelines with a focus on alignment or deviation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe informal taught endodontic curriculum\u003c/h2\u003e \u003cp\u003eA questionnaire was designed aimed at exploring clinical teachers\u0026rsquo; advice to students at Newcastle Dental Hospital clinical vignettes based on deep caries management and management of the exposed pulp (Fig.\u0026nbsp;1). The questionnaire consisted of closed questions supported by a radiograph of deep caries and pictures of carious exposures (supplemental information). The questionnaire was designed and distributed electronically using JISC Online Survey in June 2021.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e A questionnaire pilot was delivered to 10 hospital dentists not involved in teaching, including general professional trainees, dental core trainees and specialty trainees. Following this feedback, minor amendments were made before the questionnaire was emailed to all 40 restorative clinical teachers responsible for delivering undergraduate clinical supervision (including dentists working in general practice, the community setting, specialist in practice, staff grades, restorative registrars and consultants). A reminder email was sent 1 week later. The aim of the questionnaire was to explore the informal taught curriculum. Following the checking and removal of any duplicate responses, data were pseudonymised, cleaned, coded and analysed with IBM SPSS (Version 25, Chicago, IL, USA). Descriptive statistics were used to explore key themes. Variables investigated included if the clinical teachers worked mainly in the hospital or primary care setting, if they had a formal postgraduate qualification and their awareness of the ESE position statement.\u003c/p\u003e \u003cp\u003eUnivariate analyses of differences in responses to questions using \u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e was undertaken. Exact \u003cem\u003ep-\u003c/em\u003evalues were calculated without Bonferroni correction. Where assumptions of cell counts were violated in cross tabulations (\u0026lt;\u0026thinsp;5 in \u0026ge;\u0026thinsp;20%), Fisher\u0026rsquo;s exact test was used.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eThe declared endodontic curriculum\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eshows all learning outcomes identified in the declared curriculum in relation to caries management, direct pulp caps and symptomatic irreversible pulpitis in the final year students\u0026rsquo; education from September 2016 to July 2021. Learning objectives were generally broad based and did not directly reference current national guidelines. They did not state specific materials or techniques in different clinical scenarios.\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLearning outcomes from the declared endodontic curriculum.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLearning outcomes\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.Discuss and practice the principles governing the removal and management of caries.\u003c/p\u003e\n \u003cp\u003e2. Describe how the pulp may be endangered by dental caries and its operative management.\u003c/p\u003e\n \u003cp\u003e3. Discuss basic elements of caries management.\u003c/p\u003e\n \u003cp\u003e4. Remove simulated caries from plastic teeth.\u003c/p\u003e\n \u003cp\u003e5. Discuss the impact of caries and instrumentation on a vital pulp.\u003c/p\u003e\n \u003cp\u003e6. Discuss the role of vital pulp therapies in the management of deeply carious teeth\u003c/p\u003e\n \u003cp\u003e7. Have an understanding of vital pulp therapies for the preservation of pulp health, including pulp capping and pulpotomy procedures.\u003c/p\u003e\n \u003cp\u003e8. Discuss the technique of cavity preparation, lining and restoration taught in the Clinical Simulation Unit in relation to preserving pulpal health.\u003c/p\u003e\n \u003cp\u003e9. Enable students to investigate the relationship between advanced caries and the pulp.\u003c/p\u003e\n \u003cp\u003e10. Manage the wider carious lesion including access to the pulp space.\u003c/p\u003e\n \u003cp\u003e11. Be competent in evaluating the pulp and periradicular area, establishing a diagnosis and prognosis and formulating a treatment plan.\u003c/p\u003e\n \u003cp\u003e12. Design, safely execute, criticise and refine access cavity preparation to the pulp space of uncomplicated anterior and posterior teeth.\u003c/p\u003e\n \u003cp\u003e13. Justify the selection of materials for the inter-appointment temporisation of teeth undergoing root canal treatment.\u003c/p\u003e\n \u003cp\u003e14. Describe situations when it may be necessary to access the pulp space of primary and permanent teeth.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eThe formal taught endodontic curriculum\u003c/h2\u003e\n \u003cp\u003eTwelve lectures and seminars relating to deep caries management, management of the cariously exposed pulp and symptomatic irreversible pulpitis were identified. The ESE 2019 position statement was quoted and listed as suggested reading, but guidance from the ICCC was not mentioned. Three of these lectures/seminars taught students the wrong information in relation to current guidelines or they did not discuss all the methods and materials that could be used (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTeaching that deviated from evidence based best practice in formal teaching (lectures)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLecture Title\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLearning Point which Deviated from Best Practice\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvidence Based Best Practice \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManaging the Vital Pulp in Operative Dentistry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor indirect pulp caps recommends a selective/stepwise caries removal technique and calcium silicate cements (CSCs) but stated CH could be used as an alternative.\u003c/p\u003e\n \u003cp\u003eFor pulp exposures, the lecture recommends sodium hypochlorite (NaOCl) to achieve haemostasis and CSCs for DPCs but also stated CH can be used.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCH should not be recommended as a \u0026lsquo;lining\u0026rsquo; or \u0026lsquo;indirect pulp cap\u0026rsquo; due to its poor bonding, poor compressive strength, high solubility\u003c/p\u003e\n \u003cp\u003eAt the time of the lecture there was significant evidence that CSC offers a far superior outcome. Long-term outcomes from CH DPC are poor \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRestorative Dental Materials\u0026rsquo; handout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStated GIC or CH can be used for indirect pulp caps, and CH can be used for direct pulp caps. CSCs were not mentioned.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlthough GIC may be used for indirect pulp cap \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, CH cannot be recommended (as above). CH should not be used for DPC, and CSCs should be recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVital Pulp Treatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiscussed only CH and did not mention CSCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAs above\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eThe informal taught endodontic curriculum- clinician questionnaire\u003c/h2\u003e\n \u003cp\u003eParticipant demographics for the questionnaire are shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Valid responses were received from 25/40 (62.5%) supervising clinicians (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Participant demographics.\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.572379367720465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinicians\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.427620632279535%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.572379367720465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender \u003cem\u003en\u003c/em\u003e=25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Prefer not to say\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMain work \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly NHS primary care (70-100% NHS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly mixed primary care (40-60% NHS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly private primary care (70-100%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly hospital (\u0026lt;5 sessions outside hospital)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly Community\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMainly hospital or primary care \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly hospital\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Mainly primary care\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYear qualified \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 6-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 11-15 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 16-20 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt;20 years\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePlace qualified \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Newcastle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Other UK\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Non-UK+Non-EU\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years involved in teaching \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt;1 year\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 1-5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 6-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 11-15 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 16-20 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt;20 years\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFormal postgraduate training \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Nil\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Formal qualification\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAware of ESE position statement \u003cem\u003en=\u003c/em\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.427620632279535%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (76)\u003c/p\u003e\n \u003cp\u003e5 (20)\u003c/p\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (24)\u003c/p\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003cp\u003e4 (16)\u003c/p\u003e\n \u003cp\u003e12 (48)\u003c/p\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (48)\u003c/p\u003e\n \u003cp\u003e13 (52)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003cp\u003e5 (20)\u003c/p\u003e\n \u003cp\u003e5 (20)\u003c/p\u003e\n \u003cp\u003e13 (52)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (72)\u003c/p\u003e\n \u003cp\u003e5 (20)\u003c/p\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (12)\u003c/p\u003e\n \u003cp\u003e8 (32)\u003c/p\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003cp\u003e6 (24)\u003c/p\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003cp\u003e6 (24)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (60)\u003c/p\u003e\n \u003cp\u003e10 (40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (64)\u003c/p\u003e\n \u003cp\u003e9 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinician responses to questionnaire and clinicians\u0026rsquo; responses in relation to main place of work, post-graduate training and awareness of the ESE position statement.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClinician responses\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScenario\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuestions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMainly hospital \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMainly primary care \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePGT \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo PGT \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAware of ESE \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNot aware of ESE \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16/25 (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDeep caries management-\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCaries removal technique\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ea radiograph shows caries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-selective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epresent into the inner \u0026frac14; of\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edentine of UR6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStepwise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLining material with no\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eexposure\u0026thinsp;+\u0026thinsp;composite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003erestoration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo lining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMGIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIRM/ZOE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect pulp cap-\u003c/strong\u003e following\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl of post exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecaries removal on an\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ehaemorrhage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003easymptomatic vital tooth the\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCW\u0026thinsp;+\u0026thinsp;NaOCl/CHX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epulp becomes exposed. It is\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCW\u0026thinsp;+\u0026thinsp;ferric sulphate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ebleeding but no profusely.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCW\u0026thinsp;+\u0026thinsp;saline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCW\u0026thinsp;+\u0026thinsp;pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWait\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich material would you\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eapply to the exposed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epulp?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIrreversible pulpitis-\u003c/strong\u003e a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow would you manage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epatient presents with\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ethis case?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esymptoms of irreversible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency pulpotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epulpitis during an emergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePulpectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eappointment. After caries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore providing a\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eremoval the pulp is exposed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003etemporary restoration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe patient wishes to save\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ewould you place a\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ethe tooth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003edressing?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLedermix/Odontopaste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eAbbreviations: PGT\u0026thinsp;=\u0026thinsp;post graduate training, CH\u0026thinsp;=\u0026thinsp;calcium hydroxide, CSC\u0026thinsp;=\u0026thinsp;calcium silicate cement, RMGIC\u0026thinsp;=\u0026thinsp;resin modified glass ionomer cement, GIC\u0026thinsp;=\u0026thinsp;glass ionomer cement, IRM/ZOE\u0026thinsp;=\u0026thinsp;intermediate restorative material/zinc oxide eugenol, CW\u0026thinsp;=\u0026thinsp;cotton wool pledget, NaOCl\u0026thinsp;=\u0026thinsp;sodium hypochlorite, CHX\u0026thinsp;=\u0026thinsp;chlorhexidine.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eSignificant at the \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eDeep caries management\u003c/h2\u003e\n \u003cp\u003eWhen shown a bitewing radiograph (supplemental information) of a deep carious lesion of the UR6, the majority of clinicians (14/25; 56%) stated that they would teach a selective caries removal technique, 7/25 (28%) would teach a stepwise technique and 4/25 (16%) would teach a non-selective technique (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Clinicians working mainly in primary care were more likely to choose a selective technique than those working in hospital (9/13 [69.2%] v 5/12 [41.7%]), however this was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.165).\u003c/p\u003e\n \u003cp\u003eIn deep caries management, 11/25 (44%) clinicians stated they would not use a lining/indirect pulp cap when restoring the tooth with a composite restoration. For those that would place a lining, 3/14 (21.4%) would teach the use of either GIC or CSC, meaning 11/14 (78.6%) would not teach aligned with the recent consensus statement.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eDirect pulp cap\u003c/h2\u003e\n \u003cp\u003eAbout half of clinicians (12/25; 48%) stated they would teach the use of a cotton wool pledget soaked in CHX or sodium hypochlorite (NaOCl) to arrest haemorrhage after a pulp exposure, following current recommendations.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Clinicians who were aware of the ESE position statement were more likely to teach cotton wool/NaOCl compared to those with no knowledge of the ESE position statement (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041). Regarding which material to use for a direct pulp cap, CH was the most popular choice (13/25; 52%), going against current recommendations, whereas CSC would be taught by 10/25 (40%) of clinicians, aligning with current guidelines.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Those aware of the ESE position statement were more likely to use CSCs and those clinicians who were not aware were more likely to use CH (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003 respectively, Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSymptomatic Irreversible pulpitis\u003c/h2\u003e\n \u003cp\u003eWhen presented with the emergency appointment scenario of a tooth displaying symptoms of symptomatic irreversible pulpitis, most clinicians (15/25; 60%) would manage the case with a pulpectomy rather than a pulpotomy. Around half (13/25; 52%) would choose CH to dress the tooth rather than using an antibiotic/corticosteroid dressing, despite recent guidelines by the British Endodontic Society recommending such dressings,\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e although it is acknowledged there is a dearth of evidence around the effectiveness of antibiotic/corticosteroid dressings.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The findings of this study show that there are likely to be disparities between the content of current evidence based endodontic guidelines, the formal and informal taught curriculum.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe declared curriculum\u003c/h2\u003e \u003cp\u003eLearning outcomes are, \u0026lsquo;broad statements of what is achieved and assessed at the end of a course of study\u0026rsquo;.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e For students, learning outcomes provide building blocks to construct their knowledge and skills around a subject and they guide teachers on the delivery of a course.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Learning outcomes form only a part of the curriculum however since there is an interplay between the learner and the clinical environment, which is later described.\u003c/p\u003e \u003cp\u003eIn the UK, the GDC defines the learning outcomes for a dental graduate but allows education providers autonomy in planning and delivering the undergraduate curriculum in a way that suits their circumstances.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The learning outcomes described in Preparing for Practice tend to be very broad and non-specific for example the learning outcome pertaining to endodontics states that graduates should be able to;\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e1.14.6 Assess, diagnose and manage the health of the dental pulp and periradicular tissues, including treatment to prevent pulpal and periradicular disease.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e However, there are numerous learning outcomes which refer to the need \u0026lsquo;apply the principles of an evidence-based approach to learning, clinical and professional practice and decision making\u0026rsquo;, maintain contemporaneous knowledge and comply to guidelines, for example:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e1.8.5 Comply with current best practice guidelines\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e7.1 Be familiar with and act within the GDC\u0026rsquo;s standards and within other professionally relevant laws, ethical guidance and systems\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e9.4 Develop and maintain professional knowledge and competence and demonstrate commitment to lifelong learning\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e9.5 Recognise and evaluate the impact of new techniques and technologies in clinical practice.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003e In writing such broad learning outcomes the GDC are almost certainly acknowledging that specific legislation, guidelines and best practice cannot be explicitly referenced because such content is liable to frequent change and that the responsibility lies with the practitioner to maintain their own knowledge. Similarly, the present learning outcomes at Newcastle University are also very broad and do not make specific reference to guidelines and techniques (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This enables teaching to react and adapt to emerging evidence, consensus statements and guidelines, without being overly prescriptive. It has been suggested that to assure the delivery of teaching aligns to current guidelines, a system of learning outcomes can be cross referenced against current guidelines on a yearly basis.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe formal taught curriculum\u003c/h2\u003e \u003cp\u003eWhilst the majority of teaching material aligned with current guidelines, guidance from the ICCC \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e was not mentioned in lectures, although the ESE 2019 position statement was quoted and listed as suggested reading. Incorrect information was occasionally delivered in lectures and seminars such as use of CH for direct and indirect pulp caps, but the majority of formal teaching material delivered relevant and up-to-date information. The ADEE suggest dental schools should ensure that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In line with this we recommend that lecture content is checked against the latest guidelines when delivered and for staff regularly lecturing on specific topics, this should be completed at least yearly. At Newcastle, the \u0026lsquo;Update in Endodontics\u0026rsquo; lecture given in final year is an ideal opportunity to discuss the latest relevant guidelines to adequately prepare students for their final examinations and be best prepared for practice. This approach could be used in other disciplines and would be effective at other institutions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe informal taught curriculum\u003c/h2\u003e \u003cp\u003e It was found that the informal taught curriculum appears to be highly variable with clinical teachers deviating from accepted clinical guidelines. More than half would advise students to use CH for a direct pulp cap and some would advise non-selective caries removal to manage deep caries. However, in a recent study of primary dental care practitioners in the UK, 41.4% of dentists would use a non-selective caries removal technique to manage deep caries \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and respected researchers continue to use this approach,\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e particularly in cases of extremely deep caries.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This is reasonable given the extensive bacterial presence in the pulp, and its inflammatory status in \u0026lsquo;extremely deep caries\u0026rsquo; where there appears to be caries into pulp,\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e but in cases of deep caries where there appears to be intact dentine present, as in the clinical vignette used, selective techniques offer superior clinical outcomes.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e For many years CH was considered the \u0026lsquo;gold standard\u0026rsquo; for a DPC \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e and considering that 52% of the clinical supervisors have been qualified for \u0026gt;\u0026thinsp;20 years, they would have plenty of experience and expertise with this material. Although differences in opinion from clinical supervisors may confuse students, if channeled correctly it will allow them to become reflective and take charge of their own learning and practice by implementing an evidence-based approach. Importantly, where teaching does not follow evidenced based guidelines, the pragmatic approach of general practitioners compared to \u0026lsquo;by the book\u0026rsquo; strategy of hospital-based clinicians may enrich student\u0026rsquo;s education by preparing them for \u0026lsquo;real world\u0026rsquo; practice whilst being a \u0026lsquo;safe beginner\u0026rsquo;. Limited availability of materials is one of many issues new graduates will have to contend with when treating patients in primary care. In fact, this experience may help to bridge the \u0026lsquo;tension\u0026rsquo; gap between dental schools and dental foundation trainers, however this should not come at the expense of good clinical outcomes for patients. For example, using CH for a DPC deviates significantly from accepted best practice and may result in sub-optimal outcomes for patients. Research has found that treatment options and the environment in UK dental schools did not correspond to those prevalent in the NHS for some clinical situations, \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e but students should strive for best practice.\u003c/p\u003e \u003cp\u003e As clinicians have been teaching students information that conflict with current guidelines, one suggestion from this study is for clinical supervisors to have formal training at the start of their position to standardise techniques and protocols and provide uniform teaching. Another suggestion would be to conduct an annual CPD teachers training day with updates on topics such as dental materials. ADEE recommends structured and regular staff training to achieve these aims.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e It has been shown that the majority of clinicians (75%) involved in teaching undergraduate students feel their teaching would benefit from additional training.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e However, what is not clear is the nature of training that would be most beneficial, for example training around pedagogy or ensuring content alignment? Nonetheless the delivery of training, whilst hopefully improving student experience and outcomes, may also result in clinical teachers (particularly those working less than full time in the educational environment) feeling more valued by providers and encouraged to further develop their careers as teachers, which frequently does not happen and is a major complaint of clinicians.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Currently in the UK, there is a shortage of clinical academic staff \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and the above approach may also increase staff retention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAs with all questionnaire surveys, bias and self-reporting can be problematic. One question in the questionnaire referred to the use of a liner under a posterior composite restoration, which are not routinely placed under the publicly funded National Health Service in England and Wales \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e and is only used for pregnant patients and children. Clinicians may not have been so familiar with the best approach to using this material.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Our findings suggest that in this one example there are some disparities between current evidence-based guidelines, the declared and taught endodontic curriculum. Most of the deviation from best practice appears to be delivered through the informal taught curriculum in the clinical environment. Further research is needed to explore if and to what degree this influences students\u0026rsquo; knowledge of current guidelines and hence the learned curriculum requires investigation. Recommendations from this research include:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ein lectures, a clear delivery of what the current guidelines are,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eensure all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base ideally annually and\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eimproved clinical teacher training to allow for more standardised teaching.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eThe authors suggest the above measures can be implemented by other dental schools within the UK to ensure a curriculum that is both contemporaneous and evidence- based is delivered to undergraduate students.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest to declare.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm contribution to the paper as follow: study conception and design: LB, DE, JF, JE; data collection: LB, DE; analysis and interpretation of results: LB, DE; draft manuscript preparation: LB. All authors reviewed the results and approved the final version of the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants consented to participate in the study and for their data to be used as part of the research and published.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRabb-Waytowich D. You ask, we answer:Evidence-based dentistry: Part 1. an overview. \u003cem\u003e J Can Dent Assoc\u003c/em\u003e. 2009;75(1):27-8. \u003c/li\u003e\n\u003cli\u003eGeneral Dental Council. \u003cem\u003eStandards for the Dental Team\u003c/em\u003e. General Dental Council website. https://www.gdc-uk.org/docs/default-source/standards-for-the-dental-team/standards-printer-friendly-black-white3e2c002f471e475eac4a4fcc1e4945a2.pdf?sfvrsn=3963b738_5. Published 2019. Accessed 19th April 2022\u003c/li\u003e\n\u003cli\u003eField JC, Cowpe JG, Walmsley AD. The Graduating European Dentist: A New Undergraduate Curriculum Framework. \u003cem\u003eEur J Dent Educ. \u003c/em\u003e2017;21(1):2-10.\u003c/li\u003e\n\u003cli\u003eTanner D, Tanner L. \u003cem\u003eCurriculum development: Theory into practice\u003c/em\u003e. New York:Macmillan; 1980.\u003c/li\u003e\n\u003cli\u003eDent JA, Harden RM. \u003cem\u003eA Practical Guide for Medical Teachers\u003c/em\u003e. 4\u003csup\u003eth\u003c/sup\u003e ed. London; New York: Churchill Livingstone/Elsevier; 2013.\u003c/li\u003e\n\u003cli\u003eScott KR, Hsu CH, Johnson NJ, Mamtani M, Conlon LW, DeRoos FJ. Integration of social media in emergency medicine residency curriculum. \u003cem\u003eAnn Emerg Med.\u003c/em\u003e 2014;64(4):396-404. \u003c/li\u003e\n\u003cli\u003eZhang J, Peterson RF, Ozolins IZ. Student approaches for learning in medicine: What does it tell us about the informal curriculum? \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2011;11(1):87. \u003c/li\u003e\n\u003cli\u003eEdwards D, Bailey O, Stone S, Duncan H. The management of deep caries in UK primary care: A nationwide questionnaire-based study. \u003cem\u003eInt Endo J\u003c/em\u003e. 2021;54(10):1804-1818.\u003c/li\u003e\n\u003cli\u003eSchwendicke F, Frencken JE, Bj\u0026oslash;rndal L, et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. \u003cem\u003eAdv Dent Res\u003c/em\u003e. 2016;28(2):58-67. \u003c/li\u003e\n\u003cli\u003eDuncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. \u003cem\u003eInt Endod J.\u003c/em\u003e 2019;52(7):923-934. \u003c/li\u003e\n\u003cli\u003eAmerican Association of Endodontists. \u003cem\u003ePosition Statement on Vital Pulp Therapy\u003c/em\u003e. American Association of Endodontists website. https://f3f142zs0k2w1kg84k5p9i1o-wpengine.netdna-ssl.com/wp-content/uploads/2021/05/VitalPulpTherapyPositionStatement_v2.pdf. Published 2021. Accessed 16th October 2021.\u003c/li\u003e\n\u003cli\u003eJisc.\u003cem\u003e Jisc Online Surveys\u003c/em\u003e. Jisc Website. https://www.jisc.ac.uk. Accessed 17th June 2021.\u003c/li\u003e\n\u003cli\u003eField A. \u003cem\u003eDiscovering statistics using IBM SPSS statistics\u003c/em\u003e. 5\u003csup\u003eth\u003c/sup\u003e ed. Sussex UK: SAGE Publications Ltd; 2017.\u003c/li\u003e\n\u003cli\u003eBritish Endodontic Society. \u003cem\u003eDiagnosis and Management of Endodontic Emergencies, a British Endodontic Society Position Paper for Primary Dental Care and other healthcare providers during the COVID-19 pandemic\u003c/em\u003e. British Endodontic Society website. https://www.nhsggc.org.uk/media/259572/bes-emergency-protocol-final-document-29-march-2020.pdf?msclkid=db2d031fbaa311ecaa25c79dec0f494d. Published 2020. Accessed 19th April 2022.\u003c/li\u003e\n\u003cli\u003eHarden RM. Learning outcomes and instructional objectives: is there a difference? \u003cem\u003eMed Teach\u003c/em\u003e. 2002;24(2):151-5. \u003c/li\u003e\n\u003cli\u003eBateman HL, McCracken GI, Thomason JM, Ellis JS. Learning outcomes: Exploring implications of adopting a different level of detail.\u003cem\u003e Eur J Dent Educ\u003c/em\u003e. 2018;22(2):86-91. \u003c/li\u003e\n\u003cli\u003eGeneral Dental Council. \u003cem\u003eDental Education\u003c/em\u003e. General Dental Council website. https://www.gdc-uk.org/education-cpd/quality-assurance. Published 2015. Accessed 9th October 2021.\u003c/li\u003e\n\u003cli\u003eRicucci D, Siqueira JF, Jr., Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. \u003cem\u003eJ Dent\u003c/em\u003e. 2019;86:41-52. \u003c/li\u003e\n\u003cli\u003eDemant S, Dabelsteen S, Bj\u0026oslash;rndal L. A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response. \u003cem\u003eInt Endod J.\u003c/em\u003e 2021;54(3):319-330. \u003c/li\u003e\n\u003cli\u003eBj\u0026oslash;rndal L, Fransson H, Bruun G, et al. Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up. \u003cem\u003eJ Dent Res\u003c/em\u003e. 2017;96(7):747-753. \u003c/li\u003e\n\u003cli\u003eMaltz M, Koppe B, Jardim JJ, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. \u003cem\u003eClin Oral Investig\u003c/em\u003e. 2018;22(3):1337-1343. \u003c/li\u003e\n\u003cli\u003eBaume LJ, Holz J. Long term clinical assessment of direct pulp capping. \u003cem\u003eInt Dent J\u003c/em\u003e. 1981;31(4):251-60. \u003c/li\u003e\n\u003cli\u003eMcGleenon EL, Morison S. Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland. \u003cem\u003eBr Dent J\u003c/em\u003e. 2021;230(1):39-45. \u003c/li\u003e\n\u003cli\u003eBartle EK, McGowan KM. Clinical supervisors\u0026apos; reflections on their role, training needs and overall experience as dental educators. \u003cem\u003eEur J Dent Educ\u003c/em\u003e. 2021;25(2):282-290. \u003c/li\u003e\n\u003cli\u003eMartin N, Fairclough A, Smith M, Ellis L. Clinical educators\u0026apos; views on the quality of undergraduate clinical restorative dentistry in the UK and ROI. \u003cem\u003eEur J Dent Educ\u003c/em\u003e. 2011;15(4):216-22. \u003c/li\u003e\n\u003cli\u003eNational Health Service. \u003cem\u003eWhat dental services are available on the NHS?\u003c/em\u003e NHS website. https://www.nhs.uk/nhs-services/dentists/what-dental-services-are-available-on-the-nhs/. Published 2020. Accessed 9\u003csup\u003eth\u003c/sup\u003e Ocotber 2021.\u003c/li\u003e\n\u003cli\u003eBarthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. \u003cem\u003eJ Endod\u003c/em\u003e. 2000;26(9):525-8. \u003c/li\u003e\n\u003cli\u003eHilton TJ, Ferracane JL, Mancl L. Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. \u003cem\u003eJ Dent Res\u003c/em\u003e. 2013;92(7):16-22\u003c/li\u003e\n\u003cli\u003eKundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E. Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. \u003cem\u003eInt Endod J\u003c/em\u003e. 2017;50(10):924-932. \u003c/li\u003e\n\u003cli\u003eSuhag K, Duhan J, Tewari S, Sangwan P. Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up. \u003cem\u003eJ Endod\u003c/em\u003e. 2019;45(7):840-847. \u003c/li\u003e\n\u003cli\u003eHashem D, Mannocci F, Patel S, Manoharan A, Watson TF, Banerjee A. Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial-2-year results. \u003cem\u003eClin Oral Investig.\u003c/em\u003e 2019;23(4):1931-1939. \u003c/li\u003e\n\u003cli\u003eHarms CS, Sch\u0026auml;fer E, Dammaschke T. Clinical evaluation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3 years. \u003cem\u003eClin Oral Investig\u003c/em\u003e. 2019;23(9):3491-3499. \u003c/li\u003e\n\u003cli\u003eEdwards DC, Burns L, Witton R, Tredwin C. MTA and calcium hydroxide for direct pulp capping in fully developed permanent teeth: a systematic review. \u003cem\u003eEndod Prac Today. \u003c/em\u003e2020;14(2):91-102.\u003c/li\u003e\n\u003cli\u003eCushley S, Duncan HF, Lappin MJ, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis. \u003cem\u003eInt Endod J\u003c/em\u003e. 2021;54(4):556-571.\u003c/li\u003e\n\u003cli\u003eAmerican Association of Endodontists. \u003cem\u003eColleagues for Excellence-Endodontic Diagnosis.\u003c/em\u003e AAE website. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/endodonticdiagnosisfall2013.pdf. Published March 2021. Accessed 8\u003csup\u003eth\u003c/sup\u003e May 2022.\u003c/li\u003e\n\u003cli\u003eEren B, Onay EO, Ungor M. Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial. \u003cem\u003eInt Endod J\u003c/em\u003e. 2018;51 Suppl 3:e227-e237.\u003c/li\u003e\n\u003cli\u003eGemmell A, Stone S, Edwards D. Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England. \u003cem\u003eBr Dent J\u003c/em\u003e. 2020;228(7):521-526. \u003c/li\u003e\n\u003cli\u003eEdwards D, Bailey O, Stone SJ, Duncan H. How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care?. \u003cem\u003eInt Endod J\u003c/em\u003e. 2021;54(12):2256-2275.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2802369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2802369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: This paper explores the declared and taught endodontic curriculum within an undergraduate dental programme in the UK, as part of a wider study which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: The declared curriculum was identified through existing course guides, seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines, the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study highlights disparities between current evidence-based guidelines, the declared and the taught curriculum in relation to pulp management in a UK dental school. Recommendations: all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, and engagement with clinical lecturers to enable more standardised teaching.\u003c/p\u003e","manuscriptTitle":"Exploring declared and taught curricula at a UK dental school through the lens of pulp management.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-24 14:22:15","doi":"10.21203/rs.3.rs-2802369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2023-06-20T10:48:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2023-06-14T14:27:46+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2023-05-15T14:18:06+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2023-05-13T02:38:56+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2023-05-02T12:39:47+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2023-04-20T14:41:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-04-12T11:57:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-04-12T11:57:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2023-04-11T22:13:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"183a94d5-0d9d-4359-b4da-b6ade4485daf","owner":[],"postedDate":"April 24th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":20873151,"name":"Health sciences/Diseases/Dental diseases/Dental caries"},{"id":20873152,"name":"Health sciences/Health care/Dentistry/Dental education/Dental clinical teaching"},{"id":20873153,"name":"Health sciences/Diseases/Dental diseases/Pulpitis"}],"tags":[],"updatedAt":"2023-09-15T14:38:05+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-24 14:22:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2802369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2802369","identity":"rs-2802369","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}