A Three-Year Randomized Controlled Trial in 6-Year-Old Children on Caries-Preventive Strategies in a General Dental Practice in the Netherlands

Abstract

A parallel-randomized controlled trial on caries-preventive strategies was conducted in a general dental practice with a mixed socioeconomic background patient population. The aim of this study was to test the hypothesis that, compared to regular care consisting of check-ups twice a year with professional fluoride applications and pit and fissure sealants in all permanent molars, a larger caries-preventive effect can be achieved by following a non-operative caries treatment and prevention (NOCTP) strategy or by following, in addition to regular care, an increased number of professional topical fluoride applications (IPFA). A total of 230 children (6.0 years ± 3 months of age) were randomly assigned to the two experimental groups or the control group. After 3 years, 179 participants remained in the study (54 NOCTP, 62 IPFA and 63 control). The children were examined at baseline and at 3 years by the same experienced examiner, who was blinded for the allocation of the children. Caries was scored clinically at the D₃ level. Per protocol analysis revealed a mean DMFS increment after 3 years of 0.15 (95% CI -0.05 to 0.35) for NOCTP, 0.34 (95% CI 0.11 to 0.54) for IPFA and 0.47 (95% CI 0.26 to 0.68) for the control group. To account for missing data, multiple imputation was used, after which the mean DMFS increment was 0.11 (95% CI -0.05 to 0.27) for NOCTP, 0.29 (95% CI 0.11 to 0.46) for IPFA and 0.40 (95% CI 0.21 to 0.55) for the control group. Testing the differences with independent samples t test revealed a lower caries increment in the NOCTP group compared to the control group. ANCOVA was used to correct for differences in baseline dmfs, socioeconomic status and perceived dental hygiene burden. The ΔDMFS effect size between the NOCTP and the control group dropped, losing statistical significance (p = 0.06). Although the results in this study are promising, it has yet to be established in a larger study whether NOCTP has the ability to be effective in regular dental practice with a mixed socioeconomic status population.

Occlusal Caries: Biological Approach for Its Diagnosis and Management

“…Simultaneously, a higher incidence of active lesions was observed in erupting occlusal surfaces in contrast with fully erupted surfaces that mainly presented no or thin plaque scores and inactive lesions [Carvalho et al, 1991[Carvalho et al, , 1992[Carvalho et al, , 2009. These findings were further confirmed by other clinical trials on occlusal caries [Ekstrand et al, 2000;Maltz et al, 2003;Farzão, 2011;Vermaire et al, 2014].…”

Outcomes 18 years after implementation of a nonoperative caries preventive program – the Nexö‐method – on children in Moscow, Russia

“…Outcomes of the Nexö‐method, a nonoperative caries treatment program devised in the late 1980s in Denmark has been described and evaluated under different conditions . The original method has been shown to be effective in reducing caries in children and adolescent when the results obtained with the method have been compared to national data , to randomized control groups , and to historical control groups . When too much modification was brought into the original method, the caries reducing effects were not significantly different compared to the results obtained with other traditional programs .…”

Een omslag in cariësbehandeling bij kinderen: ‘Gewoon Gaaf’

“…Diverse onderzoeken hebben aangetoond dat de Gewoon Gaaf-aanpak tot goede resultaten leidt (Carvalho et al, 1992;Ekstrand et al, 2000;Ekstrand et al, 2003;Hausen et al, 2007;Curtis et al, 2008;Fejerskov 2013;Ng et al, 2014;Vermaire et al 2014).…”

“…Gebitselementen die op zeker moment te veel risico geven op pijn of ontsteking dienen uiteraard te worden gerestaureerd. Bij alle overige Bij de Gewoon Gaaf-behandeling in Nederland werd de cariësrisico-inschatting volgens de criteria van Carvalho et al (1992) gebruikt (Vermaire et al, 2014). Daarbij worden 4 criteria gehanteerd: laesies is monitoring geïndiceerd met het oog op verbetering van de mondverzorging in de nabije toekomst.…”