A new survey of final-year dental students has revealed striking gaps between what young dentists-in-training believe they know about vital pulp therapy and the clinical choices they report making when a tooth’s living tissue is at stake. The study, published in BMC Medical Education, offers one of the most detailed snapshots to date of how undergraduate dental education translates— or fails to translate—into clinical decision-making at the very threshold of professional practice.

Vital pulp therapy refers to a family of procedures designed to preserve the living dental pulp—the soft tissue containing nerves and blood vessels inside a tooth—when it has been injured by decay or trauma. Rather than removing all of the pulp and performing a root canal, these treatments attempt to keep the tooth alive. They range from indirect pulp capping, where a protective material is placed over nearly-exposed pulp, to direct pulp capping, where a dressing is applied directly to a small exposure, to partial and total pulpotomy, where progressively more of the inflamed coronal pulp is surgically removed before a biocompatible dressing is placed. Modern evidence supports these conservative approaches in carefully selected cases, but they demand precise diagnosis, meticulous isolation, and sound judgment about how much tissue to remove.

The cross-sectional survey was conducted in June 2025 among final-year dental students at a single dental faculty in Türkiye. Of the 100 students eligible to participate, 88 completed a 17-item questionnaire, yielding an 88 percent response rate. The instrument probed several domains: how students rated their own knowledge of vital pulp therapy, where they had learned about it, which procedures they recognized as belonging to this family of treatments, what they would choose to do in specific clinical scenarios, and details of their technique—rubber dam use, hemostatic agents, and restorative materials.

The headline finding was one of modest confidence. Sixty percent of students rated their self-perceived knowledge of vital pulp therapy as moderate, suggesting neither overconfidence nor complete self-doubt, but a tacit acknowledgment that their training left uncertainties. When asked where their knowledge came from, 42 percent pointed to theoretical courses and 36.4 percent to clinical practice—a distribution that hints at how undergraduate curricula actually shape endodontic thinking: lectures form the foundation, but chairside experience supplies the nuance.

Recognition of specific procedures was uneven in ways that may matter clinically. Direct pulp capping was correctly identified as a vital pulp therapy by 94.3 percent of respondents, partial pulpotomy—the so-called Cvek technique, widely used after traumatic exposures in young teeth—by 89.8 percent, and indirect pulp capping by 86.4 percent. But total pulpotomy, a procedure whose status in contemporary practice has evolved considerably, was recognized by only 53.4 percent of students. That nearly half the cohort did not classify total pulpotomy as vital pulp therapy suggests that the boundaries of this treatment category are not being communicated consistently in the classroom.

The scenario-based questions exposed how treatment philosophy shifts with the size of the pulp exposure—shifts that largely mirror contemporary evidence-based guidance, though with revealing wrinkles. For tiny exposures of up to one millimeter, most students reported choosing direct pulp capping. When exposures grew to between one and two millimeters, preference swung toward partial pulpotomy. And for exposures exceeding two millimeters, students shifted again, this time toward total pulpotomy or full root canal treatment. In mature permanent teeth, direct pulp capping was reported more frequently than either partial or total pulpotomy. On the surface, this graduated escalation seems sensible: bigger wounds, more aggressive debridement. Yet the authors note that students’ self-reported approaches varied considerably, particularly around pulpotomy procedures and simplified exposure scenarios, indicating that the decision thresholds are applied inconsistently from one future practitioner to the next.

Perhaps the most operationally significant finding concerned rubber dam isolation. Only 15.9 percent of students reported placing the rubber dam at the beginning of treatment—the moment when infection control matters most. Rubber dam isolation is considered a cornerstone standard in endodontics; it prevents salivary contamination of the exposed pulp and, critically, protects patients from aspiration or ingestion of instruments. That fewer than one in six students reported early placement suggests a disconnect between textbook standards and reported chairside habits—a pattern documented in dental education literature worldwide and one that educators have long struggled to correct.

Hemostasis revealed its own inconsistencies. When bleeding must be controlled at a pulp exposure to allow assessment and dressing placement, agents such as ferric sulfate and aluminum chloride are commonly used. When asked which agent they would choose, the most frequent response—selected by 46.6 percent—was a combined option lumping ferric sulfate and aluminum chloride together. The popularity of a bundled answer hints that students may not distinguish confidently between individual hemostatic agents, their mechanisms, or their appropriate concentrations and application times.

The authors are careful to frame what these numbers can and cannot tell us. Because the data are self-reported, they capture what students believe and claim, not necessarily what they do under observation. The findings, they emphasize, should be interpreted as self-reported educational indicators rather than objective evidence of clinical competence or broad curricular inadequacy. A student may underreport rubber dam use simply because the questionnaire asked about “the beginning of treatment,” or may overstate familiarity with procedures they have only read about. Still, at a single institution with an 88 percent response rate, the internal patterns—uneven procedure recognition, variable decision thresholds, and weak adoption of early isolation—are consistent enough to warrant attention.

The study arrives amid a broader renaissance in vital pulp therapy. Bioceramic materials such as calcium silicate cements have dramatically improved outcomes for pulp capping and partial pulpotomy in permanent teeth, and clinical guidelines increasingly favor preserving pulp vitality over routine root canal treatment whenever feasible. If the next generation of dentists is to deliver on that promise, education must keep pace. The researchers call for multicenter studies using case-based and performance-based assessments—methods that would test students against realistic clinical vignettes and observed technical skill rather than self-description alone. Until then, the survey stands as a reminder that the transition from dental lecture hall to dental chair is where much of the real learning—and the real risk—begins.