Outcomes assessment

Difference in pain was measured using Visual Analogue Scale (VAS) at baseline, after one month and a six months period. The scale is represented by a 100-mm-long horizontal line labeled “no pain” at one end and “worst pain” at the other end. Participants were asked to mark the place on the line representing their level of pain [28].

Satisfaction with treatment was assessed using two questions: the first question was immediately following treatment: “Was the treatment carried out according to your expectations?” The second question was after 6 months” “Has the treatment solved the problem of your teeth?” Each question was answered on a 10-point scale, with lower values indicating a negative perspective and higher values indicating a positive experience [36].

Time to remove dental caries was recorded using a stop watch from the start of excavation up to complete dental caries removal [37]

To control for potential confounders, information about age, education level, pregnancy stage, brushing frequency and last dental visit as well as clinical oral health indicators like number of decayed teeth, gingival index and plaque index were collected using the Arabic version of the WHO oral health assessment questionnaire for adults which was previously validated [38]. Clinical examination assessed the number of decayed teeth based on WHO criteria [39]. The amount of dental plaque and the gingival condition were both assessed using Silness and Loe [40] and Loe and Silness criteria [30].