Abstract
The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.
Highlights
New studies have pointed to a reduction in the prevalence of dental caries in childhood (Srisilapanan et al, 2017; Jones et al 2018), a systematic review reported that more than half of children are still affected by this disease (Gimenez et al, 2016), resulting in a negative impact on the quality of life of children (Abanto et al, 2014; Gradella et al, 2011), especially when in presence of extensive lesions with dentine involvement (Guedes et al, 2016a; Mickenautsch et al, 2016)
Cavitated caries lesions present a higher risk of progression to more severe conditions, which could evolve to endodontic treatment needs or even to tooth loss (Guedes et al, 2016b)
Study design and ethical approval This study reports a secondary outcome from a non-inferiority randomized, controlled, double-blind clinical trial with two parallel arms (1:1 allocation rate), in which the primary outcome is the pulp vitality
Summary
Cavitated caries lesions present a higher risk of progression to more severe conditions, which could evolve to endodontic treatment needs or even to tooth loss (Guedes et al, 2016b). In addition to the pain and aesthetics impairment (Gomes et al, 2021), the presence of cavitation can result in discomfort during mastication, leading to a children’s preference for a soft and cariogenic diet. Previous studies have focused on alternative restorative techniques for cavitated caries lesions as auxiliaries to reduce children’s discomfort (Kumar et al, 2012; Eren et al, 2013). Atraumatic restorative treatment (ART), which requires fewer clinical steps, as no necessity of rubber dam isolation, and local anesthesia in most cases, is one of the main approaches that show higher acceptability of the patients (Leal et al, 2009)
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