We are seeing a move towards more conservative methods of managing caries and also an increasing need to consider the patients perspectives of treatment. This study aimed to compare children’s behaviour and pain perception when approximal dentinal caries lesions in primary molars (in children aged 3–8 years old) were managed with three treatment strategies; conventional restorations (CR), the hall technique (HT), and non-restorative caries treatment (NRCT). The acceptability of the techniques to parents and dentists was also investigated.
Treatments were provided by12 different dentists (seven paediatric specialists and five post-graduate paediatric students). Children aged 3–8 years old, and their parents, were invited to participate if at least one primary molar tooth had caries into dentine involving two dental surfaces. Only one tooth per child was included.
Parents were present when treatment was carried out and children randomised to CR, HT or NRCT. Local anaesthesia was only used for CR. Immediately following treatment, the childrens’, parents’, and dentists’ perceptions and opinions of the treatment at that particular appointment were assessed: Child’s behaviour during the operative session was assessed by the dentists using the Frankl Behavior Rating Scale. Pain was assessed using the visual analogue scale of faces (VASOF). Five-point Likert scales were used to assess parents’ perceptions of their child’s behaviour, comfort during treatment and satisfaction with treatment undertaken and dentists’ ease of treatment provision/ material, patients’ discomfort and the relative time for the procedure.
- 169 treatment ‘events’ carried out (52 HT, 52, NRCT and 65 CRs).
- Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52)
- Pain intensity was rated ‘very low’ or ‘low’ in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12)
- NRCT and HT were ‘very easy’ or ‘easy’ to perform for >77% of dentists, compared to 50% in CR group (P < 0.000)
- There were no statistically significant differences in parents’ rating of their child’s level of comfort (P = 0.46, CI = 0.45 to 0.48).
The authors concluded
Children treated with NRCT and the HT showed better behaviour as rated by dentists, compared to those treated with CR. When children themselves were asked about comfort of the procedure they had undergone, none of the three treatments were rated as less comfortable than another. NRCT and HT were rated as easier to perform, compared to CR (P < 0.000), by dentists. The techniques compared in this study were, generally, viewed favourably by clinicians, children, and their parents. Their clinical effectiveness should be further evaluated.
We have previously highlighted studies showing good long term outcomes using the Hall technique ( Dental Elf -17th Jan 2012) and this study suggests that HT and NRCT were view easier to preform and elicited better behaviour from the children. These findings are positive. However, the study was performed in a secondary care environment by dentists with a particular interest in the treatment of children and it would be interesting to see whether the findings are similar in the primary care environment.
Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Alkilzy M, Splieth CH. Acceptability of different caries management methods for primary molars in a RCT. Int J Paediatr Dent. 2014 Mar 7. doi: 10.1111/ipd.12097. [Epub ahead of print] PubMed PMID: 24602167.
Dental Elf 30th Apr 2014 – Trial found similar outcomes with total and partial caries removal in primary molars
Dental Elf -17th Jan 2012 – Hall technique for managing carious primary molars shows good long term outcomes