Inconsistent Decision Making in Dental Caries Diagnosis and Treatment: A Case‐Based Questionnaire Survey

I am writing to express my thoughts and concerns regarding the article by Henneberg et al. [1], published recently in your journal. While this study provides valuable insights into the variability in decision-making regarding caries diagnosis and treatment, I would like to address several limitations that I believe were underexplored or overlooked by the authors. First, the authors highlight the moderate interrater agreement on caries diagnosis and a weaker agreement on treatment decisions, yet they attribute this mostly to differences in clinical experience and knowledge of new interventions like sealing and stepwise excavation. However, the study does not account for the influence of diagnostic tools, such as the quality of radiographic images and the interpretation differences caused by inherent variability in the image's clarity. Radiographic interpretation can vary significantly between practitioners, and this might have contributed more heavily to the observed disagreements than suggested. Another concern lies in the generalizability of the findings. The sample is restricted to Danish dentists, and the study's low response rate (approximately 5%) could introduce a nonresponse bias. This might skew the results toward a particular subgroup of dentists who are either more engaged in research or have a particular interest in the subject, leading to less representation of the broader dental community. Additionally, this raises the question of whether the findings would apply to other populations of dentists, particularly in different countries where educational and clinical practice standards may vary. The study also emphasizes a lack of familiarity with sealing and stepwise excavation as significant contributors to variability in treatment. However, this overlooks potential systemic factors, such as financial incentives in the dental care system that may discourage the use of such minimally invasive treatments. For instance, private practice dentists might favor interventions that are more profitable, such as root canals or fillings, rather than less invasive treatments like sealing or stepwise excavation, which might not be as lucrative. This economic influence was briefly mentioned but deserves more attention, as it could be a driving factor behind decision-making discrepancies. Moreover, while the authors focus on the need for better access to continuing education, they neglect to discuss the barriers that prevent dentists from implementing new knowledge into practice, even when it is accessible. Cognitive biases, resistance to change, and overreliance on past experiences are all psychological factors that play a substantial role in clinical decision-making but were not adequately considered in the analysis [2]. Finally, while the study discusses the potential of stepwise excavation and sealing in preventing invasive treatments, it does not adequately address the potential risks or failure rates associated with these procedures. There is an implicit assumption that these newer treatments are universally beneficial, but the long-term success rates and patient outcomes for these procedures should be explored in more detail to ensure that clinicians are making fully informed decisions [3]. In conclusion, while Henneberg et al.'s study provides a valuable perspective on the variability in dental decision-making, several key concerns—such as diagnostic tools, nonresponse bias, economic incentives, psychological barriers to change, and the risks associated with minimally invasive treatments—warrant further exploration. Addressing these issues in future research would provide a more comprehensive understanding of the factors contributing to inconsistent decision-making and could help develop more effective strategies to bridge the gap between evidence and practice. Mohamed Jayte: conceptualization, writing–review and editing; writing–original draft. The author has read and approved the final version of the manuscript. He has full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis. The author received no specific funding for this work. The author declares no conflicts of interest. The author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. The author has nothing to report.