The fate of the carious primary teeth of children who regularly attend the general dental service

Abstract

Objective To describe the care and resultant outcomes of the carious primary teeth of children who regularly attend the General Dental Service (GDS). Setting Four districts in the North West of England Subjects and Materials A retrospective study of the case notes of 677 children who received their dental care from 50 general dental practitioners (GDPs). Each dentist must have had a minimum of 10 patients and a maximum of 20 patients whose care had been provided by the same dentist from or before the age of five to the age of 14. All of the children included in the study had a history of approximal caries. The outcomes of interest were extraction due to pain or sepsis, or exfoliation and whether or not a tooth had given rise to the prescription of a course of antibiotics. Teeth that did not have a history of extraction were assumed to have exfoliated naturally. Logistic regression models, taking into account the clustering of the teeth within patients, were fitted to compare the outcomes for restored and unrestored teeth according to size of lesion (one or two surface), age caries was first recorded and by tooth type. Results A total of 4,056 teeth had been either recorded as carious or had received an intervention of some kind. Some 44.1% (N=1,789) of these teeth were extracted, however only 475 (11.7%) were extracted due to pain or sepsis. Of the teeth with a documented history of caries or restoration and for which an outcome was recorded (N=3,145), most first (81.1%) and second (84.3%) carious primary molars were filled during their lifetime, but only 40.5% of primary carious anterior teeth were filled. The majority of carious primary teeth exfoliated naturally. There was no difference in the proportions of teeth extracted due to pain or sepsis whether a carious tooth was restored or left unrestored, either by cavity type or by tooth type, after controlling for age when caries was first recorded. There was also no difference in the number of filled or unfilled carious teeth that caused a course of antibiotics to be prescribed. Conclusions Treatment by extraction was common, but GDPs restored the majority of carious primary molar teeth of their regularly attending child patients. The bulk of carious teeth exfoliated naturally irrespective of whether they were filled or not. The reasons for these findings require further investigation.