Caries management in young children: successful multicentre implementation of a minimally invasive, risk-based approach.

Protocol for the Hall Technique study: A trial to measure clinical effectiveness and cost-effectiveness of stainless steel crowns for dental caries restoration in primary molars in young children

BackgroundDental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need.The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible.MethodsThis mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1–8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination.DiscussionThe ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators.Trial registrationClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.

Dental general anesthesia (DGA) is an efficient treatment modality for young pediatric dental patients. The aim of this study was to identify the reasons for DGA, characteristics of patients receiving treatment under DGA, and treatment performed under DGA for children under school age in Kaunas, Lithuania. The study population comprised all patients younger than 6 years treated under GA for dental reasons (n=144) at the University Hospital during a 3-year period from 2010 to 2012. The data were collected by means of clinical dental examinations, a survey of the parents, and the patients' dental records and included personal background, reasons for DGA, dental status, and treatment provided. More than half (54%) of the children were younger than 4 years; 40% of them resided in cities. The dental caries experience was high: the mean dmft and d were 12.9 (SD, 3.5) and 12.1 (SD 3.9), respectively. The majority (81%) of the children had multiple reasons for DGA, with the need for excessive treatment (93%), followed by dental fear and uncooperativeness (66%), being the most common. The extent of treatment increased with age and was greater among patients from rural areas. Of the 1975 primary teeth treated under GA, 50% were restored, 32% extracted, and 18% targeted with preventive procedures. Young children with very high levels of untreated tooth decay are treated under DGA at the Lithuanian University of Health Sciences Hospital. The need for complex treatment as well as dental fear and uncooperativeness are the major reasons for DGA. Multiple caries treatments and extractions are performed for these patients. This study highlights a great need to develop the healthcare system with regard to the appropriate management of caries among young children and postoperative DGA care.

Early childhood caries (ECC) has been regarded as one of the most prevalent chronic diseases in children. Conventional restorative management of ECC is difficult to perform in very young and apprehensive children. Silver diamine fluoride (SDF) can be a useful tool in the management of dental caries by arresting the carious lesion in primary teeth. After SDF treatment, the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children. This study aimed to evaluate the clinical effectiveness of biannual application of 38% SDF followed by 5% sodium fluoride (NaF) varnish for arresting dental caries in children and its parental acceptance. Twenty-six children aged 2-5 years with 107 active caries lesions in primary teeth were enrolled. At the baseline examination, status of carious lesions was recorded and scored according to the International Caries Detection and Assessment System II. Lesion activity was assessed by visual inspection and tactile detection. Carious lesions with score 3, 4, 5, and 6 were treated with 38%SDF application, followed by 5% NaF varnish. Children were re-evaluated at 3 weeks, 3 months, 6 months, and 12 months. Parental acceptance of SDF treatment was evaluated. This study demonstrated that 38% SDF was 92.31% effective in arresting dental caries in primary teeth and was well accepted by parents. Chi-square test was used to assess the significant difference among the arrested lesions which was statistically significant (P < 0.05). Thirty-eight percent SDF can be effectively used in arresting caries in primary teeth in young and uncooperative children.

Risk assessment is an essential component in the decision-making process for the correct prevention and management of dental caries. Multiple risk factors and indicators have been proposed as targets in the assessment of risk of future disease, varying sometimes based on the age group at which they are targeted. Multiple reviews and systematic reviews are available in the literature on this topic. This chapter focusses primarily on results of reviews based on longitudinal studies required to establish the accuracy of caries risk assessment. These findings demonstrate that there is a strong body of evidence to support that caries experience is still, unfortunately, the single best predictor for future caries development. In young children, prediction models which include a variety of risk factors seem to increase the accuracy of the prediction, while the usefulness of additional risk factors for prediction purposes, as measured until now in the literature, is at best questionable in schoolchildren, adolescents and adults. That is not to say these additional factors should not be assessed to help understand the strength of their associations with the disease experience in a particular patient, and aid in the development of an individualized and targeted preventive and management plan.

Silver diamine fluoride (SDF) is employed as an adjunct cariostatic agent in the management of dental caries in high-risk population. Other than fluorides, chlorhexidine (CHX) is the most potent antimicrobial and efficacious agent against Streptococcus mutans. The aim of this study is to evaluate and differentiate the efficacy of 38% silver diamine fluoride, CHX varnish, and fluoride varnish on carious primary teeth. Ninety children having a count of ≥1 carious lesion were recruited. Thirty-eighty percent silver diamine fluoride or fluoride varnish and CHX varnish were topically applied on the lesion. The primary outcome measured was the arrest of carious lesion (lesion rendered inactive as per the Nyvad criteria) after a follow-up of 14-21 days. Dental biofilm sample was obtained from each child and subsequently assessed for microbial composition by colony-forming unit method before and after treatment followed by protein analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis method. Average proportion of arrested caries lesions in the SDF group was higher followed by CHX and fluoride varnish groups. Decreased total protein amount was found in SDF group. This proves that there is decrease in microbial load posttreatment in SDF group. Thirty-eight percent SDF is more effective than CHX varnish and fluoride varnish in arresting dentin carious lesions in young children.

Looking to discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management, Gao et al . provide an overview of SDF use in different countries and allow dental professionals to obtain a general idea about SDF use worldwide. The authors concluded that at least two ongoing regional-wide large-scale oral health programs using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, it is simple, non-invasive, and inexpensive. Thus, SDF is a valuable strategy for caries management in young children, older adults, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol-producing procedure should be emphasized under the COVID-19 outbreak.We hope that this work set will stimulate further research on the development of bioactive materials for dental applications by providing an overview of the latest and most exciting advances in emerging approaches for bioactivity. In addition, this topic may help readers to understand the basics and latest developments in this field.The authors declare no conflict of interest.

This review aimed to summarize the preventive, non-restorative and restorative minimal intervention dentistry (MID) interventions for managing dental caries during the primary dentition stage, after selecting the highest quality evidence. A comprehensive literature search for relevant studies was performed in PubMed (MEDLINE), Embase, Cochrane Library and Google Scholar, published between 2007 and 2022. Only clinical randomized controlled trials, clinical guidelines with literature review, systematic reviews and meta-analyses conducted in the primary dentition were included. One hundred fifty-three MID-associated references were found, and 63 of them were considered for the present review. Of these, 24 were clinical randomized controlled trials, 21 were systematic reviews, 3 umbrella reviews and 11 practice guidelines with a literature review. The retrieved evidence was divided into (and discussed) three general caries management strategies: (i) carious lesion diagnosis and individual risk assessment; (ii) preventive measurements and non-cavitated lesions management; and (iii) cavitated lesions management. MID is an attractive alternative management that promotes prevention rather than intervention to achieve a long-lasting oral health in young children through easy and cost-benefit preventive, non-invasive, minimally invasive or conservative invasive restorative measures. This philosophy of management is suitable for treating young children, considered friendlier and less anxiety-provoking than traditional methods.

The aim of this study was to evaluate outcomes in young children of risk-based management of dental caries in comparison with routine prevention. The study was carried out in two municipal health centers in Central Finland. The risk-based prevention group consisted of 299 children from Vanha Korpilahti, and the routine prevention group of 226 children from Saarijärvi. The children were 2 yr old at baseline, and they were followed up for 3 yr. All children received regular annual oral health care. In the risk-based prevention group, the presence of mutans streptococci (MS) in plaque (Dentocult-SM strip mutans -test, Orion Diagnostica, Espoo, Finland) and incipient caries lesions were the screening criteria. Additional prevention was targeted at MS-positive subjects twice a year, consisting of health education and application of fluoride varnish. For those who had incipient lesions, 'the high-risk category', additional prevention was given four times a year and this included also chlorhexidine varnish treatments. The screening and the preventive measures were successfully carried out by specially trained dental assistants. The proportion of children with cavitated caries or fillings was significantly lower in the risk-based than in the routine prevention group. The treatment effect was strongest within the high-risk category: two subjects had to be treated with intensive care for 3 yr to avoid restorative treatment of dental caries by the age of 5 yr in one subject (number needed to treat (NNT) = 2.0; 95% CI 1.4-3.8). The accuracy of screening was evaluated in the routine prevention group and found acceptable. The results indicate that in young children, risk-based management of caries seems practical, and prevention of caries can be targeted efficiently to individuals at risk.

Dental caries is still one of the most prevalent diseases of children in the United Kingdom. Although a significant decline in caries experience in children has been observed over the last few decades, this improvement ceased in the primary dentitions of younger children in the early 1980s and since then the only change has been an increasing polarisation with more of the disease occurring in a smaller proportion of the population. This situation has been compounded by a reduction in the proportion of dental caries treated by fillings, particularly in the younger age groups. The British Society of Paediatric Dentistry believes that dental services in the United Kingdom are failing to meet the needs of many younger children and urgent steps must be taken to improve the standard of dental health among this vulnerable group.

The Interprofessional Role in Dental Caries Management: Impact of the Nursing Profession in Early Childhood Caries

Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial

Aim and objectiveTo evaluate whether silver diamine fluoride (SDF) is effective in the management of dental caries.BackgroundDental caries is most common chronic disease and conventional treatment method could not tackle the problem completely. The use of silver compounds in dentistry is over a 100 years. Silver diamine fluoride has become a newer trend in handling the caries especially in young and apprehensive children. It is a noninvasive method of arresting caries which is painless, safe, and cost effective. This article describes the trends in silver diamine fluoride in arresting caries. The combined effects of remineralizing and antibacterial property make SDF an effective cariostatic agent.Review resultsArticles were searched in electronic data bases for literature. In vivo studies, in vitro studies, systematic reviews and case reports were included.ConclusionSilver diamine fluoride is effective in the management of caries in primary dentition. There is a little effect of silver diamine fluoride in permanent molars.Clinical importanceIn the current scenario of raising importance of minimal invasive dentistry and preventive dentistry, silver diamine fluoride is an efficient tool in the management of caries.How to cite this articleSurendranath P, Krishnappa S, Srinath S. Silver Diamine Fluoride in Preventing Caries: A Review of Current Trends. Int J Clin Pediatr Dent 2022;15(S-2):S247-S251.

The purpose is to report findings of a quality improvement (QI) project implemented at two hospital-based dental clinics that care for children with early childhood caries (ECC). We tested a disease management (DM) approach in children younger than age 60 months with ECC. After 30 months, for the 403 and 234 DM patients at Children's Hospital Boston (CHB) and Saint Joseph Hospital (SJH) who returned for at least two visits, rates of new cavitation, pain, and referrals to the OR were 26.1, 13.4 and 10.9% for CHB and 41.0, 7.3 and 14.9% for SJH. Rates of new cavitation, pain, and referrals to the OR for historical controls were 75.2, 21.7, and 20.9% for CHB and 71.3, 31.3, and 25.0% for SJH. A risk-based DM approach utilizing QI strategies to address ECC can be implemented into practice and has the potential to improve care and health outcomes.

BackgroundTo evaluate the association of sex, type of institution, and satisfaction of educational activities with dental students’ knowledge of International Caries Detection and Assessment System (ICDAS) and International Caries Classification and Management System (ICCMS) in young children.Materials and methodsThis was a cross-sectional study involving final-year dental students from all accredited dental institutions across Malaysia. A self-constructed questionnaire was given through an identified personal contact from each school. The students’ responses on the association of sex and institution type with the satisfaction of education activities and ICDAS and ICCMS knowledge were tested using the independent t-test. The relationship between satisfaction of educational activities and knowledge of ICDAS and ICCMS among dental students was evaluated using Spearman's correlation analysis. Statistical significance was set at p < 0.05.ResultsA total of 440 responses were obtained. Out of this, 312 (70.9%) were female and 126 (28.6%) were male respondents, and 2 with unknown sex. There were 231 responses (52.5%) from the private institution and 209 responses (47.5%) from the government institution. Males had a higher level of satisfaction toward the education activities. No significant difference was observed between the knowledge of ICCMS and ICDAS and sex or institution type.ConclusionMale dental students felt more satisfied with pediatric lectures conducted during preclinical years and were more prepared to treat patients independently upon graduation. Sex and type of institution did not play a role in the knowledge and dental students were more knowledgeable in ICDAS compared to ICCMS.How to cite this articleYin LS, Tamilselvam K, Abdulla AM, et al. Knowledge and Practice of ICDAS and ICCMS in Young Children: A Cross-sectional Study among Final-year Dental Students in Malaysia. Int J Clin Pediatr Dent 2021;14(2):278–285.