Decision making patterns in tooth extraction versus restoration among Pakistani early carrier dental practitioners: a cross-sectional study

Abstract Background Deciding between tooth extraction and restoration remains a common clinical challenge in dentistry, particularly in low- and middle-income countries where economic and patient-related factors may influence treatment choices. Evidence on how early-career dentists approach this decision in Pakistan is limited. Objective To assess self-reported decision-making patterns and factors influencing the choice between tooth extraction and restoration among early-career general dental practitioners in Pakistan. Methods A descriptive cross-sectional online survey was conducted between June and September 2025 among licensed general dental practitioners with ≤ 10 years of clinical experience. A structured, self-administered questionnaire assessed demographic characteristics, treatment preferences, clinical and patient-related determinants, and perceived barriers to restorative care. Data were analysed using descriptive statistics, chi-square tests, ANOVA, and binary logistic regression (restoration = 1, extraction = 0). Statistical significance was set at p < 0.05. Results A total of 214 complete responses were analysed. When both treatment options were considered clinically feasible, 59.8% of respondents reported always preferring restoration. Remaining tooth structure was the strongest predictor of restorative preference (OR = 6.23; 95% CI: 3.12–12.45; p < 0.001), followed by patient preference (OR = 4.35; 95% CI: 1.69–11.18; p = 0.002). Treatment cost and systemic health showed moderate associations with decision-making. Greater clinical experience was significantly associated with a higher likelihood of choosing restoration (p = 0.012). Conclusion Early-career dental practitioners in this survey reported a preference for restorative management when feasible, with decisions shaped by tooth-related, patient-related, and socioeconomic factors. These findings reflect self-reported decision-making tendencies and should be interpreted cautiously given the study’s cross-sectional design and sampling limitations.