British Society of Paediatric Dentistry: a policy document on management of caries in the primary dentition

Kandiah, Thayalan; Johnson, Joseph W.; Fayle, S

doi:10.1046/j.1365-263x.2001.011002153.x

Cited by 78 publications

(4 citation statements)

References 17 publications

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“…Until recently, the BSPD recommended that the optimum treatment of carious lesions in primary teeth is complete removal of the carious tissue, followed by the placement of a conventional restoration (filling) to repair lost tooth tissue. 22,23 However, these recommendations were largely based on evidence from studies conducted in either a secondary care or a specialist paediatric dental practice setting, 24 rather than the primary dental care environment, where the vast majority of children are treated. More recently, the Scottish Dental Clinical Effectiveness Programme (SDCEP) has recognised the growing evidence for minimally invasive, biologically based approaches to carious lesion management and has developed national guidance for the management of caries in children, 25 which is based on this approach.…”

Section: The Evidence For Effective Management Of Carious Lesions In mentioning

confidence: 99%

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

Maguire

Clarkson

Douglas

et al. 2020

Health Technol Assess

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Background Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. Objectives The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression. Design This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit. Setting This trial was set in primary dental care in Scotland, England and Wales. Participants Participants were NHS patients aged 3–7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis. Interventions Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth). Main outcome measures The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period. Results A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8–36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was –0.02 (97.5% confidence interval –0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval –0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis. Conclusions There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period. Future work Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care. Trial registration Current Controlled Trials ISRCTN77044005. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.

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Section: The Evidence For Effective Management Of Carious Lesions In mentioning

confidence: 99%

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

Maguire

Clarkson

Douglas

et al. 2020

Health Technol Assess

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“…If untreated, this can lead to cavernous sinus thrombosis and/or a brain abscess resulting in death. 1 This is the case of a 13-year-old male with a 2-day history of dental pain which rapidly progressed to an abscess involving the periorbital tissues. Specialists were consulted in a timely fashion by the pediatric emergency physician.…”

Section: Introductionmentioning

confidence: 99%

Odontogenic Subperiosteal Abscess of the Lateral Orbit: Timely Recognition and Management

et al. 2021

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Orbital abscess is a rare entity due to an odontogenic infection. The progression from a toothache to serious complications such as blindness or death can be sudden and severe. The authors present the case of a 13-year-old male patient with a 2-day history of dental pain, which progressed to involve the periorbital tissues. He was experiencing visual symptoms. Computed tomographic imaging revealed a canine space abscess associated with a carious right maxillary molar in continuity with a subperiosteal abscess of the right lateral orbit. Surgical drainage was performed under general anesthesia via intraoral and extraoral approaches. The postoperative course was uncomplicated and vision improved. Multidisciplinary and timely management is crucial for successful outcomes in managing orbital abscesses of odontogenic origin. Therefore, it is crucial for emergency and primary care physicians to recognize when specialist consultation is indicated and expedite this process.

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“…In particular, the apparent failure of current practice in UK Primary Dental Care to prevent pain and infection in children [1] has prompted much debate. Teaching in UK dental schools is based on guidance from the British Society of Paediatric Dentistry (BSPD) which includes the recommendation that the optimum treatment of caries in primary teeth should be its removal, followed by the placement of a conventional restoration (filling) to replace lost tooth tissue [2,3]. However, these recommendations are largely based on evidence for the effectiveness of restorations obtained from studies conducted in either a secondary care or specialist paediatric dental practice setting [4].…”

Section: Introductionmentioning

confidence: 99%

The FiCTION dental trial protocol – filling children’s teeth: indicated or not?

et al. 2013

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BackgroundThere is a lack of evidence for effective management of dental caries (decay) in children’s primary (baby) teeth and an apparent failure of conventional dental restorations (fillings) to prevent dental pain and infection for UK children in Primary Care. UK dental schools’ teaching has been based on British Society of Paediatric Dentistry guidance which recommends that caries in primary teeth should be removed and a restoration placed. However, the evidence base for this is limited in volume and quality, and comes from studies conducted in either secondary care or specialist practices. Restorations provided in specialist environments can be effective but the generalisability of this evidence to Primary Care has been questioned.The FiCTION trial addresses the Health Technology Assessment (HTA) Programme’s commissioning brief and research question “What is the clinical and cost effectiveness of restoration caries in primary teeth, compared to no treatment?” It compares conventional restorations with an intermediate treatment strategy based on the biological (sealing-in) management of caries and with no restorations.Methods/DesignThis is a Primary Care-based multi-centre, three-arm, parallel group, patient-randomised controlled trial. Practitioners are recruiting 1461 children, (3–7 years) with at least one primary molar tooth where caries extends into dentine. Children are randomized and treated according to one of three treatment approaches; conventional caries management with best practice prevention, biological management of caries with best practice prevention or best practice prevention alone.Baseline measures and outcome data (at review/treatment during three year follow-up) are assessed through direct reporting, clinical examination including blinded radiograph assessment, and child/parent questionnaires.The primary outcome measure is the incidence of either pain or infection related to dental caries.Secondary outcomes are; incidence of caries in primary and permanent teeth, patient quality of life, cost-effectiveness, acceptability of treatment strategies to patients and parents and their experiences, and dentists’ preferences.DiscussionFiCTION will provide evidence for the most clinically-effective and cost-effective approach to managing caries in children’s primary teeth in Primary Care. This will support general dental practitioners in treatment decision making for child patients to minimize pain and infection in primary teeth. The trial is currently recruiting patients.Trial registrationProtocol ID: NCTU: ISRCTN77044005

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British Society of Paediatric Dentistry: a policy document on management of caries in the primary dentition

Cited by 78 publications

References 17 publications

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

Odontogenic Subperiosteal Abscess of the Lateral Orbit: Timely Recognition and Management

The FiCTION dental trial protocol – filling children’s teeth: indicated or not?

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