To investigate treatment preferences and factors influencing treatment decisions of vital permanent teeth with carious pulp exposure. An electronic questionnaire was randomly sent to dentists in public hospitals in Thailand. The questionnaire consisted of two parts; 1) four case scenarios with choices of treatment and 2) inquiry of individual participant data. The relationship of the treatment preferences and participants’ background characteristics variables were statistically analyzed using the binary multivariable logistic regression analysis. The response rate of this study was 53.3 % (504 out of 1002 dentists). In teeth with reversible pulpitis, the majority of dentists preferred vital pulp therapy (75.8 %), especially direct pulp capping (61.2 %). Pulpectomy (>70 %) was the treatment of choice for teeth with symptomatic irreversible pulpitis. There was no uniform treatment preference of symptomatic immature tooth: apexification (40.8 %), vital pulp therapy (32.2 %) and reference to a specialist (26.9 %). Dentists with postgraduate education preferred vital pulp therapy to apexification in symptomatic immature teeth. In teeth with symptomatic irreversible pulpitis, dentists without experience of root canal treatment on molar teeth preferred to refer cases to a specialist for further treatment. Treatment decisions have been influenced by clinical signs and symptoms and stage of root development. Various factors from participants including age, gender, clinical experiences and postgraduate education affected decision making. Clinical practice guidelines of vital immature tooth with carious pulp exposure is needed to assist dentists in making decisions about appropriate treatment.