Management Of Carious Lesions Research Articles

Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review

Background: Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth. Objectives: The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions. Methods: Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included. Results: The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam. Conclusion: Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.

\u201cI guess it looks worse to me, it doesn\u2019t look like there\u2019s been a problem solved but obviously there is\u201d: a qualitative exploration of children\u2019s and their parents\u2019 views of silver diamine fluoride for the management of carious lesions in children

BackgroundDespite growing evidence to support the use of silver diamine fluoride (SDF) for managing carious lesions, and the increased interest in SDF worldwide, uptake in the UK remains limited. This study explored parents’ and children’s views and acceptability of SDF for the management of carious lesions in children.MethodsEleven semi-structured face-to-face interviews were conducted with 11 parent–child dyads recruited from patients attending Dundee Dental Hospital and School. Interviews were transcribed verbatim, coded and thematically analysed.ResultsPrevious dental experience varied across all child participants. Of the 11 children, five had undergone general anaesthesia (GA) for multiple primary tooth extractions. Two had received SDF treatment. Child participants expressed concerns about being picked on by their peers, if they had discoloured anterior teeth. Younger children appeared less concerned about the discolouration and child’s gender did not appear to influence parents’ decision-making, nor the child’s preferences regarding the use of SDF. Parents considered SDF to be particularly useful for anxious or uncooperative children but raised concerns about potential bullying at schools due to the unacceptable dental aesthetics when SDF is applied to anterior teeth. They believed they may be judged by others as neglecting their child’s oral health due to the black staining. Both parents and children were more accepting of the SDF when applied to less-visible posterior teeth. Parents accepted the use of SDF if such treatment avoided extractions under GA.ConclusionDespite the unfavourable aesthetics of SDF (black staining), parents appreciated SDF treatment, especially for uncooperative or younger children. However, both parents and children shared concerns about bullying at schools as a consequence of the black staining. Raising awareness about SDF was identified as one approach to encourage the uptake of SDF.

Deep carious lesions management in children and adolescents: a questionnaire survey among dentists practicing paediatric dentistry in France

While many questionnaire surveys have been undertaken worldwide to investigate practices toward deep carious lesion (DCL) management in adults, very few are related to children and adolescents. The present cross-sectional study aimed to assess DCL management in children and adolescents among dentists practicing paediatric dentistry in France (Fr-DPPDs). The secondary objective was to compare practices between Fr-DPPDs and dentists registered in the European Academy of Paediatric Dentistry (EAPD). A questionnaire was electronically administrated to members of the CEOP (College des Enseignants en Odontologie Pediatrique), the SFOP (Societe Francaise d’Odontologie Pediatrique), and the EAPD. Descriptive analyses, Chi-square and McNemar tests, ANOVA, crude and adjusted binary logistic regression analyses were performed. A total of 99 Fr-DPPDs and 146 EAPD members answered the questionnaire. Among the Fr-DPPDs, the preferred caries removal (CR) methods were the complete CR in one step for primary teeth and mature permanent teeth (respectively, 70% and 48%) and in two steps for immature permanent teeth (39%). EAPD members were more likely, than Fr-DPPDs, to choose selective CR versus complete CR in primary teeth (odds ratio = 2.60; 95% CI 1.39–4.85). Moreover, for primary or immature permanent teeth, general practitioners were less likely to choose selective CR than specialists and exclusive practitioners in paediatric dentistry, (p < 0.001). Tooth type [primary, permanent (immature or mature)] seemed to influence DCL management. Fr-DPPS should prioritise pulpal vitality when managing DCL.

Evaluation of success of stainless steel crowns placed using the hall technique in children with high caries risk: A randomized clinical trial.

This study aimed to compare the clinical efficacy and survival rates of the hall technique (HT), and conventional restoration (CR) for the management of occlusoproximal carious lesions in primary molars. This clinical study observed 35 children (aged 4-8 years). Exclusion criteria included symptoms of pulpal or periradicular pathology or systemic conditions requiring special dental considerations. For each child, at least one tooth was treated with HT and one with CR. The primary outcome measures were minor and major clinical failure rates. Plaque and gingival scores of the teeth were also evaluated. Friedman test and Wilcoxon signed ranks test were used to compare the plaque and gingival index scores for each arm. Chi-square tests were used for comparisons of clinical outcomes, plaque-gingival index, and distribution of ICDAS categories among treatment arms (P < 0.05). Thirty-three of 35 (94.2%) participants returned for 1-year follow-up. HT showed statistically significantly higher treatment survival rate and fewer minor failures than CR (P = 0.040). The rate of major failures was minimal (2 of 84 teeth) and did not differ between treatments (P = 0.092). In both treatment groups, the gingival score and plaque score were significantly decreased at the 1-year follow-up (P < 0.05). HT was a more successful method for managing caries in primary molars than CR, both for symptoms of pulpal disease and longevity of the restorations. HT is a simplified method of managing carious primary molars using SSCs cemented with no local anesthesia, caries removal, or tooth preparation.

English

Despite huge developments in oral health, dental caries still remains a community health issue globally. Dental caries is prevalent worldwide amongst adults and school children; nearly 100 % of the population is affected in most of the countries. Caries harms the outer dental structures, eventually reaching the dental pulp, making the teeth undermined and ultimately compromising functional abilities. It is the major reason for loss of tooth. For the management of carious lesions, the tissues which are decayed should be removed and replaced by dental restorations. Increased potential for causing dental anxiety and uneasiness in many patients has been reported with the usage of routine caries removal systems such as diamond and tungsten carbide rotating burs. Moreover, with the use of high and low rotating speed drills, which is used for complete dentin removal, over excavation of caries (when the deeper dentin layers are involved) may happen eventually leading to increased risk of exposing and damaging the pulp irreversibly. These disadvantages have led to exploration of new alternatives such as stepwise, minimal or no dentinal caries removal procedures that illustrate clinical benefit over comprehensive caries removal in the treatment of dentinal caries. Laser technology has reformed the management of dental caries. Laser has been found to be the latest, most recent, conservative, less traumatic and minimally invasive caries removal procedure. The energy of laser is absorbed which is then transformed to heat, leading to microstructural and chemical alterations in the surface of enamel which is irradiated thereby improving enamel acid resistance. Laser also helps to maintain a dry surrounding that improves the dentist’s vision of the working field thereby resulting in an improved outcome. KEY WORDS Lasers, White Spot Lesions, Dental Caries, Laser Fluorescence, Orthodontic Therapy, Carbon-Dioxide Laser

Acidity, fluoride and silver ion concentrations in silver diamine fluoride solutions: a pilot study.

There has been renewed interest in the use of silver diamine fluoride (SDF) for the management of carious lesions in high-risk groups. Previous studies have found a difference in clinical efficacy among different concentrations of SDF and discrepancies between ionic concentrations of fluoride (F) and silver (Ag) in SDF preparations. The aim of this study was to measure the free F, Ag ion concentrations and pH of a variety of commercially available SDF preparations. Seven SDF products used globally were evaluated for F and Ag ion concentrations using a calibrated ion-selective electrode and optical emission spectrometry respectively. Acidity was determined with a pH electrode. The 30% SDF solution contained almost half the F concentration and a much higher Ag concentration than expected (16343ppmF and 246000ppmAg). Comparatively, the mean F concentration of the remaining six 38% solutions was 74802ppm (expected mean 44800ppm) ranging from 36457ppm to 120760ppm. The mean Ag concentration was 326000ppm (expected mean 253870ppm) and ranged from 246000ppm to 425451ppm. All solutions were found to be neutral or mildly alkaline in nature (pH 7-10.3). Wide variations between claimed and measured F and Ag ion concentrations exist among the different brands of commercially available SDF products.

SDF: Enhanced preventive, operative care: Call based on caries risk

Dental caries remains severe oral health problem, despite being the most preventable disease. The fact regarding this disease is that even though several efforts are made towards its total eradication, it is still prevalent. It was easier to work on the resultant effect of the disease rather than imagining the unseen pathological mechanism, which led to the resultant obvious effect. However, conventional management of carious lesion requires patient’s cooperation, which is the most important consideration in pediatric dentistry, the lack of which leads to progression of disease and subsequent tooth loss. The possibility of detecting non-cavitated stage carious lesions and also the possibility to remineralize/arrest these lesions have noticeably reduced the clinical situations that necessitate restorations. Preventive interventions can be used as an alternative to traditional restorative procedures and one of them is Fluorides, which resulted in significant decrease in prevalence of dental caries. The perfect alternative treatment for dental caries for many circumstances is the application of Silver Diamine Fluoride. The use of SDF provided appropriate care for low income, socially vulnerable children and also in some unique clinical circumstances that may not permit traditional cavity preparation. This article highlights the change in perception of Pediatric dentists towards caries management, preventive care and the role of ‘Magic bullet’ SDF in arresting carious lesions thereby improving the quality of life of children.

Caries burden and suitability for atraumatic restorative treatment among schoolchildren in Indonesia

Objectives: Dental caries remains among the most prevalent chronic conditions in childhood and remains highly prevalent among schoolchildren in Indonesia. Globally, atraumatic restorative treatment (ART) has been used to good effect in the management of carious lesions among high-risk cohorts, particularly in challenging environments. However, in settings, where labor, time, facilities, and materials are particularly limited, strategic triaging of teeth suitable for ART restorations may be valuable to better direct public health expenditure. Therefore, this study aims to (i) describe the prevalence of dental caries among Indonesian schoolchildren and (ii) evaluate the proportion of lesions indicated for ART. Materials and Methods: A cross-sectional cohort study of elementary schoolchildren from West Java, Indonesia, was examined and categorized according to Hellman’s dental development stages (Groups 1–4 corresponding to the early mixed dentition through to complete permanent dentition). Descriptive statistics and proportional analysis were conducted with the following variables being evaluated: Teeth with early caries (EC), late/advanced caries (LC), recurrent caries (RC), and total caries experience (TC = EC+ART+LC+RC). In evaluating the suitability for ART, additional variables of ART indicated carious lesions (ART) and lower molars with lesions indicated for ART (LM) were assessed. Results: A total of 437 children ranging from 8 to 14 years of age were examined. Out of 8882 teeth examined, 996 had active carious lesions and only 57 had received satisfactory restorative treatment. Children in Hellman’s Group 1 stage of development had the highest prevalence of EC (62%) and ART indicated caries (32%). Meanwhile, older children in Group 4 experienced the highest portion of advanced caries (15%). The proportion of lower molars indicated for ART was 87%, 76%, 70%, and 67% in Groups 1–4, respectively. Conclusion: Indonesian schoolchildren face a high burden of untreated dental caries from a young age. The younger the developmental stage, the higher the prevalence of early and ART-indicated lesions with the majority being found in lower permanent molars. Although ART and preventive strategies show the highest potential in the early mixed dentition, they alone cannot completely meet the dental needs of populations such as this where the severity and disease burden are extremely high.

Restorative thresholds for carious lesions in primary molars: French dentist's decisions.

Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to carious lesion management, particularly in adults. The primary objective of this cross-sectional survey was to investigate restorative thresholds (RTs) used for carious lesions in primary molars by dentists practising paediatric dentistry in France. Dentists were surveyed by a specifically developed questionnaire based on clinical and radiographic caries classifications. The secondary objective was to explore restorative management strategies in primary molars. A structured questionnaire assessing RTs and management strategies for occlusal and approximal carious lesions of primary molars was anonymously and electronically administered via SurveyMonkey® to dentists who were members of the Société Française d'Odontologie Pédiatrique. Descriptive analyses, Chi-square test, McNemar test, and logistic regression analyses considering dependent RT variables for occlusal and approximal carious lesions were performed. Among 250 dentists surveyed, 201 responded (response rate 80.4%). Overall, 43% (n = 87) and 75% (n = 151) of respondents would place their RTs in enamel for occlusal and approximal lesions, respectively. Dentists with an exclusive practice of paediatric dentistry more frequently would choose a RT in dentine for approximal lesions than did other dentists (p = 0.010). A preparation technique including sound dental tissues was less frequent for occlusal than approximal lesions (n = 31; 15% vs n = 60; 30%). Overall, 75% (n = 151) of respondents used the same restorative material for occlusal and approximal lesions. In general, dentists practising paediatric dentistry in France overtreated lesions on primary molars, which contradicts minimal intervention recommendations. RTs are too often indicated for enamel-confined carious lesions.

Management of Deep Carious Lesion with Single Visit Indirect Pulp Capping: A Case Report

Background: Preservation of pulp vitality is of utmost importance during management of deep caries cases.There remains a possibility of pulp tissue to repair upon excavation of caries with no pulpal exposure.However, in case of exposure of pulp, such type of minimally invasive management becomes doubtful&amp; impulsive. Indirect pulp capping(IPC) treatment plays an essential role in these cases to prevent pulpalexposure.Case Presentation: This case report describes the single visit indirect pulp therapy in mandibular molar.Patient reported with a chief complaint of food lodgement and mild intermittent pain. There was no historyof night pain and/or spontaneous pain. The clinical and radiological evaluation revealed no peri-radicularpathosis and no pulpal involvement. The tooth was examined for vitality using electric pulp test and revealedvital pulp. The treatment was done with the protocol of Single Visit Indirect Pulp therapy using light curecalcium hydroxide and cavity was disinfected with 2% chlorhexidine. Cavity was lined with Glass IonomerCement and final restoration was done using Composite resin restoration. The patient was followed up till6 months and showed satisfactory outcome eliminating the need for more invasive approach as root canaltherapy.Conclusion: Indirect pulp therapy is a safe, economical and proven treatment option in the teeth that havenot involved pulp and with sound peri-radicular tissues. The success of Indirect Pulp Capping relies onproper case selection and diagnosis, complete isolation, caries removal and disinfection with selection ofsuitable pulp capping material

Managing dental caries against the backdrop of COVID-19: approaches to reduce aerosol generation.

The COVID-19 pandemic resulted in severe limitation and closure of dental practices in many countries. Outside of the acute (peak) phases of the disease, dentistry has begun to be practised again. However, there is emerging evidence that SARS-CoV-2 can be transmitted via airborne routes, carrying implications for dental procedures that produce aerosol. At the time of writing, additional precautions are required when a procedure considered to generate aerosol is undertaken.This paper aims to present evidence-based treatments that remove or reduce the generation of aerosols during the management of carious lesions. It maps aerosol generating procedures (AGPs), where possible, to alternative non-AGPs or low AGPs. This risk reduction approach overcomes the less favourable outcomes associated with temporary solutions or extraction-only approaches. Even if this risk reduction approach for aerosol generation becomes unnecessary in the future, these procedures are not only suitable but desirable for use as part of general dental care post-COVID-19.Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-020-2153-y für autorisierte Leser zusätzliche Dateien abrufbar.

Can minimal intervention dentistry help in tackling the global burden of untreated dental caries?

The latest estimates from the Global Burden of Disease study show that dental caries remains a neglected global health issue, with over two billion people suffering the consequences of this highly preventable disease globally. The two main goals of a national health system are to improve population health and reduce health inequalities, which are often achieved through prevention and promotion for everyone, as well as treatment and rehabilitation for the sick. Oral health promotion should be integrated with national policies for the prevention of non-communicable diseases, especially those targeting the intake of free sugars. The ongoing debate on universal health coverage (UHC) offers a unique opportunity to align dental care with essential health services, which all countries are expected to provide. Minimal intervention dentistry (MID) protocols for management of carious lesions, such as the atraumatic restorative technique, silver diamine fluoride and the Hall Technique, could help tackle the global burden of untreated caries as they are cost-effective in the long run. However, the successful implementation in primary dental care and training the new cadre of dentists adequately are pending issues if MID is to facilitate the inclusion of dental care as part of the UHC agenda.

\u201cIt\u2019s really no more difficult than putting on fluoride varnish\u201d: a qualitative exploration of dental professionals\u2019 views of silver diamine fluoride for the management of carious lesions in children

BackgroundDespite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.MethodsFifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach.ResultsThirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.ConclusionDental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage and had preconceived ideas that this could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.

Chemo-mechanical characterization of carious dentine using Raman microscopy and Knoop microhardness.

One of the aims in the clinical operative management of dental carious lesions is to remove selectively the highly infected and structurally denatured dentine tissue, while retaining the deeper, repairable affected and intact, healthy tissues for long-term mechanical strength. The present study examined the correlation of chemical functional groups and the microhardness through the different depths of a carious lesion using Raman spectroscopy and Knoop microhardness testing. The null hypothesis investigated was that there was no correlation between Raman peak ratios (amide I : phosphate ν1) and equivalent Knoop microhardness measurements. Ten freshly extracted human permanent teeth with carious dentine lesions were sectioned and examined using high-resolution Raman microscopy. The ratio of absorbency at the amide I and phosphate bands were calculated from 139 scan points through the depth of the lesions and correlated with 139 juxtaposed Knoop microhardness indentations. The results indicated a high correlation (p < 0.01) between the peak ratio and the equivalent Knoop hardness within carious dentine lesions. This study concluded that Raman spectroscopy can be used as a non-invasive analytical technology for in vitro studies to discriminate the hardness of carious dentine layers using the peak ratio as an alternative to the invasive, mechanical Knoop hardness test.

Dentists' decisions for deep carious lesions management in primary teeth.

Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to deep carious lesion (DCL) management in permanent teeth, and there is a lack of data in primary teeth. A cross-sectional questionnaire survey was undertaken to describe the management strategies for DCL of vital primary teeth, focusing on the different caries removal techniques, among dentists practicing pediatric dentistry (DPPDs) in France. Their behavior was compared to members one registered to European Academy of Pediatric Dentistry (EAPD). A questionnaire was electronically administrated (2018-2019) to members of the Collège des Enseignants en Odontologie Pédiatrique (CEOP), the Société Française d'Odontologie Pédiatrique (SFOP), and the EADP. Descriptive and statistical analyses were performed. Response rate was, respectively, for CEOP, SFOP, and EAPD about 74%, 29%, and 15%. About half of the respondents (53%) would perform a complete caries removal into one step when 12% would indicate a stepwise technique: 68% of the DPPDs practicing in France would perform complete caries removal in one step when the preferred option in the other EAPD members was the selective excavation (44%) (P<.001). Complementary education of French dentists in the domain of caries management appears necessary regarding current recommendations.

Dental professionals\u2019 experiences of managing children with carious lesions in their primary teeth \u2013 a qualitative study within the FiCTION randomised controlled trial

BackgroundThe lack of evidence for the effective management of carious lesions in children’s primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals’ (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry.MethodsOverall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis.ResultsParticipants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children.ConclusionsRCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials.

Acceptability of silver diamine fluoride as interim measure towards untreated dental caries and its impact on ohrqol among children with HIV: Pilot study.

Children with HIV are a special group with limited access to care and high prevalence of dental caries. Silver Diamine Fluoride (SDF) is approved universally for the management of asymptomatic carious lesions but research on the psychological impact of black staining is scarce. Effect of silver diamine fluoride (SDF) application as an interim caries management on the child's oral health-related quality of life of children with HIV over a period of 4 months until definitive care was provided. A pilot study conducted among children with HIV in a care home. It was a pilot trial to check the acceptability of SDF among these children. Forty-two children (12.3 ± 3.5 years) participated in this pilot study. Prevalence of caries (DMFT), candidiasis, gingival inflammation, and cervical lymphadenitis was evaluated. OHRQoL inventory (COHIP-SF) was completed by the students at baseline, immediately, 4 months after SDF application. One-way ANOVA with post hoc Tukey HSD test. Poor oral hygiene was universal and mean DMFT was 3.2 ± 2.5. OHRQoL was not significantly affected at baseline (26.2 ± 6.4), but immediately following SDF application, OHRQoL was significantly poor (48.7 ± 8.2), remained poor even after 4 months (42.6 ± 6.1). Emotional wellbeing was significantly impacted negatively following SDF application (p < 0.001); whereas oral health, functional wellbeing dimensions were not impacted. SDF should be used with caution among special children as the black discoloration of the teeth can cause emotional trauma and negatively impacting their OHRQoL while trying to improve the same.

Clinical and patient-reported outcomes in children with learning disabilities treated using the Hall Technique: a cohort study.

Introduction Preformed metal crowns (PMC) placed using the Hall Technique (HT) are effective for managing carious lesions in primary molars and might be tolerable and successful for children with learning disabilities (CLD), possibly avoiding the need for sedation/ anaesthesia.Aim To investigate the effectiveness of the HT for management of carious lesions in children with learning disabilities through a prospective service evaluation.Methods Sixteen, 4-12-year-old CLD had 27 carious lesions managed using the HT and were followed-up. Outcomes were: 1) incidence of dental pain/infection; 2) success of treatment outcomes as judged by patients and parents/carers; and 3) adverse outcomes.Results Twenty seven teeth treated with HT were followed up for five to 87 months (mean = 24) with no episodes of pain and/or infection in treated teeth. Treatment was rated as causing no discomfort in 80% of children and as successful by 98% of children; 96% of parents/carers, and 100% of dentists. Other adverse outcomes; occlusal surface perforation (n = 8; 30%).Conclusion The HT was acceptable to, and effective in treating carious lesions in CLD who were unable to accept traditional restorative treatment. This alternative treatment option may avoid the need for general anaesthesia.

Child Caries Management: A Randomized Controlled Trial in Dental Practice

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).

Oral health among children attending an oncology clinic in Trinidad.

ObjectivesLittle is known about the oral health of paediatric oncology patients in the Caribbean. Poor oral health can complicate oncology treatment, negatively affecting a child's health. In children undergoing chemotherapy or bone marrow transplant, odontogenic infections can progress to life‐threatening sepsis. The aim of this study is to investigate the oral health among children attending an oncology clinic in Trinidad.Material and MethodsSample population included paediatric oncology patients attending a children's hospital in Trinidad. Subsequent to obtaining informed consent, a 14‐item questionnaire was administered to parents/caregivers. An intra‐oral examination was undertaken by two dentists to assess soft tissues, gingival health, and dentition status, using visual examination only.ResultsSeventy‐one children and their caregivers participated in the study. The children consisted of both patients warded or attending as outpatients; 53.5% of patients were male and the mean age 6.64 (SD 3.33) years with a range of 1 to 15 years. Gingivitis and mucositis were present among 41.3% and 3% of patients, respectively. The prevalence of visible dental caries was 54.3%. Caries experience (dmft) was 2.28 (SD 3.63), and for those children with some caries experience (dmft > 0), this was 5.59 (SD 3.72). The majority (62.5%) had never visited a dentist. The most common dental treatment needs were dental prophylaxis (98.4%) and restorative treatment (50.8%). Acute lymphocytic leukaemia (39.1%) was the most common malignancy among this sample, and patients were at varying stages of cancer treatment.ConclusionsOral health among this sample of paediatric oncology patients was generally poor, with untreated caries being common, and the majority of children not having had any previous dental care. Preventive dental care for these patients should include oral hygiene instruction, dietary advice, topical fluoride application along with management of carious lesions, and odontogenic infections. This preliminary study highlights the need for closer collaboration between general dental practitioners, paediatric dentists, and paediatric oncology physicians, in caring for these patients.