Norwegian dentists’ pulp treatment driven by availability

Dental Tribune International

Fri. 27 March 2026

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TROMSØ, Norway: Despite evidence that hydraulic calcium silicate cements generally achieve better outcomes in vital pulp therapy, calcium hydroxide has remained widely used. The factors influencing this choice are incompletely understood. A new Norwegian survey study has explored how public sector dentists manage pulp exposure in asymptomatic permanent teeth, focusing on which treatments and materials they choose and why. The findings suggest a gap between clinical evidence and everyday practice.

The study, based on responses from 218 dentists in the public dental service, found that direct pulp capping was the most commonly preferred treatment for both carious and non-carious pulp exposure. Beyond direct pulp capping, treatment preferences diverged by exposure type: for non-carious exposure, dentists preferred pulpotomy over pulpectomy, whereas for carious exposure, they selected pulpectomy more often than pulpotomy.

When it comes to direct pulp capping materials, most of the dentists favoured chemically setting options. Around half of the respondents selected calcium hydroxide as their first choice, while about two-fifths preferred calcium silicate-based materials, despite evidence suggesting these offer better clinical outcomes. Dentists most often justified their material choice by stating that they were satisfied with the clinical results.

The key finding was that the availability of materials in clinics was the strongest factor influencing dentists’ choice. In contrast, years of experience and engagement with scientific literature had little to no predictive value when considered together with the other influencing factors. Although a higher proportion of less experienced dentists had recently read scientific literature on dental materials used for direct pulp capping, and those who had were somewhat more inclined towards calcium silicate-based cements, these influences did not outweigh availability in final decision-making. The authors suggested that cost may partly explain differences in material availability.

The study also examined respondents’ perceived long-term success of their treatment and material choice. Dentists estimated that cases treated with light-polymerising materials carried a slightly lower risk of later requiring root canal treatment, but this difference was not statistically significant. There were also no statistically significant differences in the self-assessed risk of root canal treatment when calcium silicate-based cements were compared with all other materials combined or with calcium hydroxide specifically.

Overall, the research concluded that the Norwegian dentists surveyed continue to rely heavily on calcium hydroxide, even though other materials may perform better. The dominant influence of material availability suggests that improving access to recommended options could help align clinical practice more closely with current evidence.

Set against current European Society of Endodontology guidance, which emphasises pulp preservation, asepsis and evidence-based material selection in vital pulp therapy, the Norwegian survey suggests that the distance between recommendation and routine care may depend as much on what is actually stocked in public clinics as on what clinicians know from the literature. The study thus adds a real-world perspective to the wider shift towards biologically based, pulp-preserving care reflected in Dental Tribune International’s recent coverage of practical guidance on pulp capping and therapeutic pulpotomy as a conservative alternative to root canal treatment.

The study, titled “Therapy and material choices in pulp exposure among public dentists in Norway”, was published online on 18 March 2026 in Acta Odontologica Scandinavica.