A dentist’s drill may not be the best way to treat tooth decay in children, a new study has found.
A three-year study compared three different treatment options for tooth decay in children’s primary or first teeth. He found no evidence to suggest that conventional fillings were more effective at stopping pain or further decay than other treatment options.
These options included sealing the cavity in the infected tooth or using prevention techniques such as reducing sugar intake.
The study was conducted by researchers at University of LeedsDundee and Newcastle.
There are a number of treatments available to the dentist that can be tailored to an individual child.
The Novel (Filling children’s teeth: Indicated or not) the trial involved 1,140 children in the UK between the ages of three and seven with visible tooth decay. One of three treatment approaches was randomly selected for each child’s dental care for the duration of the trial, which was up to three years.
The first avoided fillings and aimed to prevent new tooth decay by reducing sugar intake, ensuring twice-daily brushing with fluoride toothpaste, application of fluoride varnish and fissure sealants on first permanent molars (back) teeth.
The second option involved drilling out the cavity, which was based on what has been considered the established practice of “drill and fill” for more than 50 years, along with preventive treatments.
The third treatment strategy was a minimally invasive approach where the tooth decay was sealed under a metal crown or filling to stop its progress along with preventive treatments.
Just under half of the children, 450, experienced pain and further decay regardless of the dental treatment they received.
Professor Gail Douglas, Chair of Dental Public Health at the University of Leeds and one of the lead researchers, said: ‘All the children in our study were specifically selected to take part because they had tooth decay. Unfortunately, the study showed that once children already have tooth decay, there is a high chance that it will cause further problems even with a lot of care and attention from a dentist.
“But the study shows that drilling and filling is not the only option for treating tooth decay in baby teeth, there are a number of treatments available to the dentist and he can decide which may be best for each individual child – for for example, some children may be afraid of drilling.”
The findings of the main trial are published today in Journal of Dental Research.
Professor Nicola Innes, Chair of Pediatric Dentistry at the University of Dundee and lead author of the paper, said: “Our study shows that each treatment for tooth decay worked at a similar level, but that children who develop tooth decay at a young age have a high chance of developing toothache and abscesses regardless of how the dentist manages tooth decay.
“What is abundantly clear from our trial is that the best way to manage tooth decay is not by drilling or sealing teeth – but by preventing it in the first place.”
Need for caries prevention
A cost-effectiveness analysis of the three approaches showed that caries sealing supplemented with preventive treatment was most likely to be considered the best approach to managing children’s caries if society was willing to pay at least £130 extra to avoid any episode of pain or infection.
Professor Anne Maguire, Chair of Preventive Dentistry at Newcastle University and one of the lead researchers, said: “FiCTION’s findings have refocused attention on the need to prevent tooth decay before it starts.”
The FICTION study was funded by the Health Technology Assessment (HTA) programme National Institute for Health Research (NIHR).
Further information
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