Treatment time, pain experience and acceptability of the technique for caries removal in primary teeth using the ART approach with or without Brix3000™ papain gel: a preliminary randomised controlled clinical trial

Abstract

Purpose To compare the Atraumatic Restorative Treatment (ART) associated with Brix3000™ to ART considering treatment time, pain experienced, and acceptability to children. Methods This study was accepted in Research Ethics Committee in July 2019 (number 3469402). Healthy patients ( n = 20) aged 3–9 years, with at least one primary molar with occlusal dentine caries without cusp involvement were randomly allocated to either the ART + Brix3000™ group or the ART-only group. The sample was characterised by sex, age, tooth location and caries experience. Time spent and pain experience scores were recorded at prophylaxis, caries removal and restoration. The pain experience (intense, moderate, or mild) was evaluated by the Face, Legs, Activity, Cry, Consolability-revised scale (FLACC-r). Acceptability was assessed by a five-point hedonic facial scale (dichotomised into ‘like’ and ‘indifferent/dislike’ bins) and by an open-question interview. Mann–Whitney, Chi-square, and Fisher’s exact tests were applied to discern differences in time, pain/sample characterisation and acceptability, respectively. Results The ART + Brix3000™ group required 8.6 ± 3.1 min to remove caries tissue, whereas the ART group required only 4.8 ± 2.0 min ( p = 0.03). The total time spent with treatments was 13.1 ± 4.0 min for ART + Brix3000™, and 9.8 ± 2.7 min for ART ( p = 0.03). There was no difference in pain experience and acceptability found among the groups ( p > 0.05). Conclusion Although the ART + Brix3000™ technique demanded more treatment time than the ART alone, there were no differences in either pain experience or acceptability.

The Impact of Minimal Intervention Dentistry on Patient-Reported and Observation-Based Outcomes in the Pediatric Population: A Systematic Review and Meta-Analysis

“…Out of the 56 texts, 30 were excluded due to the following reasons: irrelevance ( n = 2), non-randomized controlled trial ( n = 2), no retrieval of English full text ( n = 7), registered protocol only ( n = 1), reporting oral health-related quality of life ( n = 8), clinical success ( n = 5), subjects were adolescents (1) or with special healthcare needs (1) and caregiver-reported outcomes ( n = 3). Subsequently, only 26 [ 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] studies were included for the final qualitative and quantitative analysis and data extraction (Kappa k: 1) ( Supplementary Table S2 ). A summary of the PRISMA flowchart [ 50 ] for identification and screening the eligibility of the papers, final inclusion of the studies and reasons for exclusion are illustrated in Figure 1 .…”

“…Ultimately, the 26 included studies [ 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] represented 4699 participants from 5 Asian countries [ 34 , 37 , 38 , 43 , 45 ], 1 Australasian country [ 29 ], 8 European countries [ 14 , 27 , 31 , 35 , 42 , 46 , 47 , 48 ], 11 Southern American countries [ 25 , 26 , 28 , 30 , 32 , 33 , 39 , 40 , 41 , 44 , 49 ] and 1 African country […”

“…Ten [ 25 , 27 , 29 , 30 , 31 , 32 , 36 , 42 , 44 , 49 ] of the studies used Facial Image Scale (FIS) or variants of this scale (e.g., Delighted Terrible Faces scale, Visual Analogue scale) to measure the participant’s level of anxiety. An additional seven [ 26 , 28 , 33 , 38 , 40 , 42 , 44 ] studies employed the WBFS or the Hedonic scale to assess the child’s pain, discomfort and acceptance during the treatment. Eight studies [ 37 , 41 , 42 , 43 , 45 , 46 , 47 , 48 ] utilized FS, VS or Venham Picture Test (VPT) to evaluate the child’s cooperation.…”

Minimally invasive treatment of dental caries, an update

“…ART avoids the unnecessary use of rotary instruments and local anesthesia, which reduces patient distress, anxiety and fear [16] . It is performed using a sharp hand instrument to remove the decayed tooth structure, followed by restoration with ionomer [7] .…”

“…The technique consists of removing the decomposed tissue by applying natural or synthetic agents to dissolve and facilitate the removal of the infected tissue [23] . Papain promotes proteolysis of the collagen fibrils exposed in the decayed tissue, which further softens the decayed tissue, facilitating its removal with hand instruments [16] . After use, the gel often changes color and becomes cloudy or produces bubbles, making it easier to identify the reaction, completion or absence (i.e., no decomposed tissue remains) [25] .…”