Most of the participating dentists stated a preference for a minimal intervention approach, including invasive intervention only at a later stage for patients with a proximal carious lesion in the primary molar. Similarly, Laske et al. (2019) reported that the most common stage for intervention was stage 4. For occlusal lesions in primary molars, the results also collaborate with those of Laske et al.’s (2019), by which stage 3 was the stage most preferred for intervention. However, five (11%) of those who stated they would intervene in stage 2 chose a minimal approach, namely, fissure sealing. This finding illustrates the use of the sealing-in method described by Innes and Manton (2017). We report consensus among our respondents regarding the type of restorative material (flowable composite resin). Flowable composite resin restoration survives very well in shallow Class I lesions (Pinto et al. 2014). It is noteworthy that one participant indicated using a preformed metal crown (Hall Technique) to treat both a stage 4 proximal lesion and a stage 4 occlusal lesion.

Late-invasive intervention was also commonly chosen for buccal lesions in primary incisors, probably after exhausting more conservative and preventive options. The presence of Class V lesions is a main indication for flowable composite resin restorative material. This is mainly due to the mechanical properties of the material and its flow within the cavity, and the excellent level of finish and polish (Baroudi and Rodrigues 2015).

In contrast to the late stage of invasive intervention in the other types of caries lesions, for a proximal carious lesion in primary maxillary incisors, most dentists stated they would intervene invasively relatively early (the second of four stages). Nonetheless, about one-third of the dentists who chose to intervene at this stage chose a slicing type of preparation as a minimal intervention method (Fux-Noy et al. 2023).

The innovation of the current study was the adaptation of the questionnaire for pediatric dentistry. We incorporated specific questions about primary anterior dentition; these lesions are more common in primary than permanent teeth. Early childhood caries refers to caries in the primary teeth of children younger than age 6 years. This caries usually starts in the maxillary primary incisors and is followed sequentially in the first molars, the canines and the second molars, following the eruption pattern of the teeth. Strategies for ECC prevention include reducing Streptococcus mutans transmission from caregivers to infants, restricting dietary sugars, tooth brushing, topical fluoride applications and early dental visits (Seow 2018; AAPD 2022). Use of the developed questionnaire can discern attitudes toward more conservative and disease-specific treatment.

The study had several limitations. These include the low number of participants and the low response rate, of about 30%. However, the expected response to an online questionnaire has been described as 25–30% (Fincham 2008). The questionnaire comprised large images, making it difficult to view on mobile devices. Respondents were thus required to use stationary computer screens, and this may have affected the response rate. In addition, the study was conducted on a specific population of dentists, who were all members of ISDC. It therefore does not necessarily represent pediatric dentistry in Israel. Most ISDC members are specialists and residents, and the sample does not represent general practitioners who treat children but are not ISDC members. Finally, there may be a bias in the results due to non-response. Those who chose not to answer the questionnaire may be more likely not to implement a minimal intervention approach. A limitation of the questionnaire developed by Laske et al. (2019) for MID assessment is that it does not address all MID techniques and stages. Specifically, the questionnaire does not include re-orientation and remineralization stages (Innes and Manton 2017), nor repair methods, such as partial caries removal and the Hall technique.