1
|
Timms L, Rodd H, Deery C, Brocklehurst P, Marshman Z. Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study. Pilot Feasibility Stud 2024; 10:95. [PMID: 38915111 PMCID: PMC11194932 DOI: 10.1186/s40814-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need. The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible. METHODS This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1-8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination. DISCUSSION The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.
Collapse
Affiliation(s)
- Laura Timms
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Paul Brocklehurst
- Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| |
Collapse
|
2
|
Miotti LL, Vissotto C, De Nardin L, de Andrades Manjabosco B, Tuchtenhagen S, Münchow EA, Emmanuelli B. Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review. Clin Oral Investig 2023; 27:7143-7156. [PMID: 37932637 DOI: 10.1007/s00784-023-05372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). MATERIAL AND METHODS Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. RESULTS For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). CONCLUSION Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. CLINICAL RELEVANCE Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.
Collapse
Affiliation(s)
- Leonardo Lamberti Miotti
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil.
| | - Cariane Vissotto
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Letícia De Nardin
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Bianca de Andrades Manjabosco
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Simone Tuchtenhagen
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Eliseu Aldrighi Münchow
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Bruno Emmanuelli
- Stomatology Department, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul (RS), Brazil
| |
Collapse
|
3
|
Anwar A, J Keightley A, M Roebuck E. The value of bitewing radiographs in the management of carious primary molars - the impact on treatment planning. Br Dent J 2023:10.1038/s41415-023-6496-z. [PMID: 37978217 DOI: 10.1038/s41415-023-6496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 11/19/2023]
Abstract
Introduction Bitewing radiographs (BWs) with visual examination (VE) are critical for the early detection of caries in primary molars. However, their influence on treatment planning is not extensively studied. Given they involve exposure to ionising radiation, it is essential to understand their impact on treatment decisions.Aim To explore the impact of BWs in the management of carious primary molars.Design Cross-sectional study.Materials and methods A total of 30 children (mean age 6.2 years) referred for caries management in a dental hospital setting were recruited. One of six paediatric dental specialists performed VEs and scored pre-BW treatment needs (TN) for each primary molar, followed by reviewing the BWs, re-scoring TN and recording their opinion on treatment modality. Data were assessed using descriptive analyses. Five treatment planning descriptors detailing the reasons for change were identified.Results In total, 240 primary molars were examined. BWs resulted in an overall change in treatment plan for 24/30 (80.0%) children, with the majority (20/30; 66.7%) becoming more invasive. General anaesthesia was the commonest proposed modality (13/30; 43.3%) children), followed by inhalation sedation (10/30; 33.3%) and local anaesthesia (6/30; 20.0%), with only one child (3.3%) in the 'no analgesia' modality.Conclusion BWs play an important role in treatment planning carious primary molars.
Collapse
Affiliation(s)
- Aneeka Anwar
- Postgraduate Trainee in Paediatric Dentistry, Edinburgh Dental Institute, Edinburgh, UK.
| | | | - Elizabeth M Roebuck
- Consultant in Paediatric Dentistry, Edinburgh Dental Institute, Edinburgh, UK
| |
Collapse
|
4
|
Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
Collapse
Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Wolf TG, Campus G. Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1865. [PMID: 37893583 PMCID: PMC10608526 DOI: 10.3390/medicina59101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case-control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.
Collapse
Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, 55116 Mainz, Germany
| | - Guglielmo Campus
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro, 07100 Sassari, Italy;
| |
Collapse
|
6
|
Timms L, Rodd H, Deery C, Brocklehurst P, Marshman Z. 'You just don't have the time to keep bringing them back, bringing them back': the experience of primary care dental professionals in England when treating young children with carious teeth. Br Dent J 2023:10.1038/s41415-023-6229-3. [PMID: 37666984 DOI: 10.1038/s41415-023-6229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 05/04/2023] [Indexed: 09/06/2023]
Abstract
Introduction Caries in the primary dentition affects around one-quarter of children in England. There is uncertainty and varying practice regarding the management of these children within NHS primary dental care. Silver diamine fluoride (SDF) is an approach that is not well-adopted nationally. This study aims to explore the factors affecting treatment choices for caries management in young children within primary dental care, including the use of SDF.Methods Semi-structured interviews were carried out via video conferencing with general dental practitioners and therapists working in NHS primary care. The topic guide covered factors which influence the management of caries in primary teeth, with SDF-specific questions. These were transcribed verbatim and analysed using thematic analysis.Results A total of 13 interviews were conducted with dental professionals working across Yorkshire and the East Midlands. Decision-making for caries management was dependent on inter-related factors, which also influenced SDF use. Treatment decisions were taken on a case-by-case basis, but were influenced by the child, their parents, the dental professional and service factors, along with the clinical technique.Conclusion Many individual- and system-level factors influence treatment decisions for early childhood caries. However, issues relating to remuneration and governance appear to be specific barriers to adoption of SDF in primary dental care.
Collapse
Affiliation(s)
- Laura Timms
- School of Clinical Dentistry, University of Sheffield, United Kingdom.
| | - Helen Rodd
- Consultant in Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, United Kingdom
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, United Kingdom
| | - Paul Brocklehurst
- Consultant in Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, United Kingdom
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, United Kingdom
| |
Collapse
|
7
|
Preston J, Biglino G, Harbottle V, Dalrymple E, Stalford H, Beresford MW. Reporting involvement activities with children and young people in paediatric research: a framework analysis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:61. [PMID: 37525218 PMCID: PMC10388467 DOI: 10.1186/s40900-023-00477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The active involvement of patients and the public in the design and delivery of health research has been increasingly encouraged, if not enforced. Knowledge of how this is realised in practice, especially where children and young people (CYP) are concerned, is limited, partly due to the low level of reporting of patient and public involvement (PPI) in general. The aim of this work was to assess how researchers funded by the National Institute for Health and Care Research (NIHR) report the involvement of CYP in the design and conduct of child health research to better understand the opportunities offered to CYP, and the realities of involvement in practice. METHODS A participation matrix, analysis framework and accompanying tools were adapted from existing frameworks, including a child-rights informed framework, the Guidance for Reporting Involvement of Patients and the Public Checklist Short Form (GRIPP2SF), and NIHR reporting expectations. Child-focused research reports were identified from the NIHR Journals Library, including any interventional or observational study involving CYP aged 0-< 24 years. In two co-design workshops with healthcare professionals and CYP, we tested and refined the participation matrix, analysis framework and accompanying tools. RESULTS Only thirty-two NIHR reports out of 169 (19%) were identified as relevant and included reporting of PPI with CYP. We identified significant variability in the way PPI with CYP was reported. Only 4/32 (12%) reports fully met NIHR (and GRIPP2SF) reporting criteria. Only 3/32 (9%) reports formally evaluated or self-reflected on PPI activities with CYP, whilst 15/32 (47%) provided minimal information about CYP involvement. The most common approach to involving CYP (23/32, 72%) was through the medium of existing groups or networks. CONCLUSION Despite the NIHR's commitment to increase the quality, transparency, and consistency of reporting PPI, the reporting of involvement with CYP remains sub-optimal. Neglecting to report key details of involvement methods and impacts deprives the research community of knowledge to advance the field of delivering 'meaningful' PPI with CYP. Practical guidance on how researchers can report the processes and outputs of CYP involvement more rigorously may help child health researchers to involve them more meaningfully. This research offers practical tools informed by CYP to aid the reporting process.
Collapse
Affiliation(s)
- Jennifer Preston
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | | | - Victoria Harbottle
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
- Rehabilitation Department, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Emma Dalrymple
- Institute of Child Health, University College London, London, UK
| | - Helen Stalford
- School of Social Justice and Law, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
8
|
Chua DR, Tan BL, Nazzal H, Srinivasan N, Duggal MS, Tong HJ. Outcomes of preformed metal crowns placed with the conventional and Hall techniques: A systematic review and meta-analysis. Int J Paediatr Dent 2023; 33:141-157. [PMID: 36151937 DOI: 10.1111/ipd.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preformed metal crowns (PMCs) have been used to restore carious primary molars and have a high success and survival rate. There are two methods currently employed for PMC placement - the conventional technique (CT) and Hall technique (HT). AIM This systematic review aims to compare the outcomes of PMCs placed using the CT and HT. DESIGN This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A literature search of five databases was performed up to 23 August 2022. Clinical studies comparing carious primary molars restored with PMCs using either technique with a minimum 12-month follow-up were included. Risk of bias (RoB) assessment was performed using the National Institutes of Health Quality Assessment tool. RESULTS Five articles met the inclusion criteria, and four were included for meta-analysis. The 12- and 24-month success and survival rates were above 85% for both groups, with no significant differences shown at 12 and 24 months. The HT requires a shorter treatment duration, is more cost-effective and has a high level of acceptability among parents when compared to the CT. Four articles were rated fair, and one article was rated good in the RoB assessment. CONCLUSION Greater consideration may be given towards using the HT as part of standard treatment procedures in managing carious primary molars. Future studies should standardise reporting of outcomes to facilitate a more homogeneous pool of data for future meta-analysis.
Collapse
Affiliation(s)
- Doris Ruyi Chua
- Paediatric Dentistry Unit, National Dental Centre Singapore, Singapore City, Singapore
| | - Bing Liang Tan
- Youth Preventive Dental Service, Health Promotion Board, Singapore City, Singapore
| | - Hani Nazzal
- Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar.,College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Huei Jinn Tong
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| |
Collapse
|
9
|
Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
Collapse
Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | | |
Collapse
|
10
|
Maldupa I, Slepcova O, Vidulskane I, Brinkmane A, Senakola E, Uribe SE. COVID-19 as an opportunity for minimally-invasive dentistry: a national cross-sectional survey. BMC Oral Health 2022; 22:394. [PMID: 36096784 PMCID: PMC9465652 DOI: 10.1186/s12903-022-02432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background During the COVID19 pandemic, the Latvian government issued first absolute restrictions (elective treatments prohibited, only emergency care) and later relative restrictions (preference for non-aerosol-generating procedures (AGP) and emergency care) on dental care. This study aims to assess the impact of these restrictions on the decision made by Latvian dentists about caries treatment. Methods A Survey-based cross-sectional study was used. A minimum sample size of 174 dentists was estimated for national representativeness (N = 1524). The questionnaire was developed by experts and sent three times via email to Latvian dentists from July to September 2020 and was also delivered in printed form at two national conferences in September and October 2020. Descriptive statistics were calculated. Results We received 373 completed questionnaires, with a total response rate of 24.5%. Under the recommendation to reduce AGP for the treatment of uncomplicated caries, 10% of the dentists stated that they would stop attending, 54% would only attend emergencies, and 36% would attend as usual. Under prohibition, the percentages are 15%, 74%, and 11%, respectively. Regarding the type of treatment, more than 75% would opt to proceed with selective caries removal for both primary and permanent teeth and 10% for extraction. Conclusion Latvian dentists are willing to treat patients with caries during the pandemic and state that they prefer to use non- or minimally invasive and less aerosol-generating methods for caries treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02432-7.
Collapse
Affiliation(s)
- Ilze Maldupa
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Olga Slepcova
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Ilona Vidulskane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Anda Brinkmane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Egita Senakola
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia
| | - Sergio E Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Dzirciema iela 20, Riga, 1007, Latvia. .,School of Dentistry, Universidad Austral de Chile, Valdivia, Chile. .,Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia.
| |
Collapse
|
11
|
Gaunt F, Brough L. Fluoride application in paediatric patients attending general anaesthetic in Carlisle and Eden. Int J Paediatr Dent 2022; 32 Suppl 1:76-78. [PMID: 36097665 PMCID: PMC9543484 DOI: 10.1111/ipd.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Gaunt
- Paediatric DentistryNorth Cumbria Integrated Care TrustCarlisleUK,North Cumbria Integrated Care TrustCarlisleUK
| | - Laura Brough
- Paediatric DentistryNorth Cumbria Integrated Care TrustCarlisleUK,North Cumbria Integrated Care TrustCarlisleUK
| |
Collapse
|
12
|
Bibliometric Analysis of the Current Landscape of Global Scientific Production on the Development of Vaccines against Dental Caries. Int J Dent 2022; 2022:7678891. [PMID: 35547398 PMCID: PMC9085340 DOI: 10.1155/2022/7678891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/07/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. To perform a bibliometric analysis of the scientific research on the development of vaccines against dental caries. Methods. An extraction of the scientific production published on the development of vaccines against dental caries between 2011 and 2020 was carried out from the Scopus database. Microsoft Excel was used for the elaboration of tables and SciVal for the bibliometric analysis of the data, which were divided into indicators of production, impact, and collaboration. Finally, VOSviewer was used for co-occurrence analysis of keywords and collaborative networks. Results. 106 studies were retrieved from the Scopus database, which were conducted on the development of dental caries vaccines within the years 2011–2020. Wuhan University, in China, was the university with the highest scientific production on the subject, with 4 publications. Regarding the most productive journals, the first place was occupied by the Journal of Dental Research with 7 publications. Regarding the most productive journals, the first place was occupied by the Journal of Dental Research with 7 publications. The highest percentage of the documents analyzed was in quartile 1 journals and in the national collaboration pattern. Conclusion. Most of the manuscripts regarding the development of vaccines against dental caries were published in China and in Q1 quartile journals. In addition, Yan Huimin, Yang Jingyi, Zhou Dihan, Yang Yi, Li Yuhong and Fan Mingwen were found to top the list of most productive authors. The Journal of Dental Research was also identified as the most productive and cited journal.
Collapse
|
13
|
Durham J. Health and science: evidence, policy and advocacy. Br Dent J 2022; 232:489. [PMID: 35459803 PMCID: PMC9028898 DOI: 10.1038/s41415-022-4203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Justin Durham
- Professor of Orofacial Pain, Head, School of Dental Sciences, Newcastle University, UK
| |
Collapse
|
14
|
Wang J, Zhang B, Chen Y, Wang L, Du Y, Wang X. A comparison of the mechanical proprieties of different types of primary tooth restorations: an in vitro study. Clin Oral Investig 2022; 26:4419-4426. [PMID: 35157134 DOI: 10.1007/s00784-022-04404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the different restoration types of primary teeth to determine which type is appropriate for extensive caries of primary molars and incisors based on mechanical properties. MATERIALS AND METHODS A total of 160 primary teeth were evaluated in this study, including 80 incisors and 80 molars. Each category was divided into four groups: the control group, composite resin group, pre-veneered stainless steel crown (stainless steel crown) group, and zirconia crown group. Compressive strength test and fatigue strength test were performed. RESULTS The compressive strength and fatigue strength of the composite resin group were significantly decreased compared with the control group (P < 0.05). The prefabricated crown groups showed increased fatigue and compressive strength compared with the control group, and the zirconia crown group was higher than that of the pre-veneered stainless steel crown group (P < 0.05). The zirconia crown group was less than the stainless steel crown group (P < 0.05) in the compressive strength but more than the stainless steel crown group (P < 0.05) in the fatigue strength. CONCLUSIONS The compressive strength and fatigue strength of crown restoration were superior to that of the composite resin filling. The fatigue strength of the zirconia crown also performed better than the pre-veneered stainless steel crown and the stainless steel crown. The compressive strength of the zirconia crown was less than that of the stainless steel crown. CLINICAL RELEVANCE The zirconia crown is a new restoration method for primary teeth that may be commonly applied in clinical practice.
Collapse
Affiliation(s)
- Junhui Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Baize Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yujiang Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Lulu Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yang Du
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Xiaojing Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Disease & Shaanxi Clinical Research Center for Oral Diseases, Department of Children, School of Stomatology, The Fourth Military Medical University, No.145, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| |
Collapse
|
15
|
The value of bitewing radiographs in the management of carious primary molars. Br Dent J 2021; 231:575-579. [PMID: 34773029 DOI: 10.1038/s41415-021-3570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/14/2021] [Indexed: 11/09/2022]
Abstract
Introduction Bitewing radiographs (BWs) are under-utilised for children, and reliance on visual diagnosis alone is likely to under-diagnose caries. Quantification of the level of the under-reporting of caries and the vital role of BWs would be beneficial when providing dental care to the paediatric population.Aim To quantify the diagnostic value of bitewings in the management of proximal caries in primary molars.Design Cross-sectional study.Materials and methods Thirty children (mean age 6.2 ± 1.3 years) were recruited. A visual inspection (VI) of the primary molars was carried out and bitewings were taken. Radiographic assessment (RA) for primary molar proximal caries was completed separately. VI and RA were compared statistically against three caries thresholds, using the Fisher's exact test. A p value <0.05 was considered statistically significant. Sensitivity and specificity analyses were performed.Results A total of 480 proximal surfaces were assessed. Bitewings detected 44.6% of additional proximal carious lesions (p <0.0001). At d3 threshold, VI under-reported 51.2% proximal caries (p <0.0001) and 34.1% dentinal proximal caries (p = 0.0012). VI showed high specificity (99%) and low sensitivity (53%).Conclusion Bitewings play a vital role in proximal caries diagnoses of primary molars.
Collapse
|
16
|
Seifo N, Cassie H, Radford JR, Innes NPT. "I guess it looks worse to me, it doesn't look like there's been a problem solved but obviously there is": a qualitative exploration of children's and their parents' views of silver diamine fluoride for the management of carious lesions in children. BMC Oral Health 2021; 21:367. [PMID: 34301214 PMCID: PMC8298692 DOI: 10.1186/s12903-021-01730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background Despite 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. Methods Eleven 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. Results Previous 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. Conclusion Despite 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01730-w.
Collapse
Affiliation(s)
- N Seifo
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK
| | - H Cassie
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK
| | - J R Radford
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK
| | - N P T Innes
- School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK.
| |
Collapse
|
17
|
Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, Fontana M, Gomez Rossi J, Göstemeyer G, Levey C, Müller A, Ricketts D, Robertson M, Santamaria RM, Innes NP. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev 2021; 7:CD013039. [PMID: 34280957 PMCID: PMC8406990 DOI: 10.1002/14651858.cd013039.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
Collapse
Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Thomas Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - Waraf Al-Yaseen
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lars Bjørndal
- Cariology and Endodontics, Section of Clinical Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janet E Clarkson
- Division of Oral Health Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Michigan, USA
| | - Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Colin Levey
- Division of Restorative Dentistry, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ruth M Santamaria
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Nicola Pt Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
18
|
Martignon S, Cortes A, Douglas GVA, Newton JT, Pitts NB, Avila V, Usuga-Vacca M, Gamboa LF, Deery C, Abreu-Placeres N, Bonifacio C, Braga MM, Carletto-Körber F, Castro P, P Cerezo M, Chavarría N, Cifuentes OL, Echeverri B, Jácome-Liévano S, Kuzmina I, Lara JS, Manton D, Martínez-Mier EA, Melo P, Muller-Bolla M, Ochoa E, Osorio JR, Ramos K, Sanabria AF, Sanjuán J, San-Martín M, Squassi A, Velasco AK, Villena R, Zandona AF, Beltrán EO. CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol. BMC Oral Health 2021; 21:329. [PMID: 34210281 PMCID: PMC8248759 DOI: 10.1186/s12903-021-01674-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/14/2021] [Indexed: 01/27/2023] Open
Abstract
Background Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time.
Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01674-1.
Collapse
Affiliation(s)
- Stefania Martignon
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia.
| | - Andrea Cortes
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Gail V A Douglas
- Dental Public Health, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - J Timothy Newton
- Dental Innovation and Impact, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Nigel B Pitts
- Dental Innovation and Impact, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Viviana Avila
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Margarita Usuga-Vacca
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Luis F Gamboa
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Christopher Deery
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Ninoska Abreu-Placeres
- Biomaterials and Dentistry Research Center (CIBO-UNIBE), Academic Research Department, Universidad Iberoamericana UNIBE, Santo Domingo, Dominican Republic
| | - Clarisa Bonifacio
- Department of Pediatric Dentistry, Academic Center for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Mariana M Braga
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fabiana Carletto-Körber
- Comprehensive Children and Adolescents Clinic, Paediatric Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Patricia Castro
- School of Dentistry, Corporación Universitaria Rafael Núñez, Cartagena, Colombia
| | - María P Cerezo
- School of Dentistry, Universidad Autónoma de Manizales, Manizales, Colombia
| | - Nathaly Chavarría
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Olga L Cifuentes
- School of Dentistry, Universidad Autónoma de Manizales, Manizales, Colombia
| | - Beatriz Echeverri
- School of Dentistry, Universidad Cooperativa de Colombia, Envigado, Colombia
| | - Sofía Jácome-Liévano
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Irina Kuzmina
- Department of Preventive Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - J Sebastián Lara
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - David Manton
- Centrum Voor Tandheelkunde en Mondzorgkunde, UMCG, University of Groningen, Groningen, The Netherlands
| | - E Angeles Martínez-Mier
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Paulo Melo
- EpiUnit, Faculty of Dental Medicine, Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Emilia Ochoa
- School of Dentistry, Universidad Cooperativa de Colombia, Envigado, Colombia
| | | | - Ketty Ramos
- School of Dentistry, Universidad de Cartagena, Cartagena, Colombia
| | - Angie F Sanabria
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Johanna Sanjuán
- Paedriatric Dentistry Department, Fundación Universitaria de Colegios de Colombia (UNICOC), Bogotá, Colombia
| | - Magdalena San-Martín
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia.,School of Dentistry, Universidad Católica de Uruguay, Montevideo, Uruguay
| | - Aldo Squassi
- School of Dentistry, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - A Karina Velasco
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| | - Rita Villena
- Paediatric Dentistry Department, Universidad San Martín de Porres, Lima, Peru
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Edgar O Beltrán
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Av. Cra. 9 No. 131 A - 02, 110121, Bogotá, Colombia
| |
Collapse
|
19
|
Nociti FH. Systems Integration: A Key Step Toward Strengthening Oral Health. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.704624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Sapountzis F, Mahony T, Villarosa AR, George A, Yaacoub A. A retrospective study of the Hall technique for the treatment of carious primary teeth in Sydney, Australia. Clin Exp Dent Res 2021; 7:803-810. [PMID: 33830674 PMCID: PMC8543483 DOI: 10.1002/cre2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 01/07/2023] Open
Abstract
Objectives The aim of this retrospective study was to evaluate the outcome of preformed metallic crowns (PMC) utilizing the HT in carious primary molars for children treated within public dental clinics across the Sydney region. Materials and Methods A retrospective cohort study was designed, whereby two investigators evaluated 113 primary molars treated with HT PMCs involving 71 participants (aged between 5 and 11 years) after a minimum of 6 months post treatment. The mean time elapsed between crown placement (treatment) and the review was 1.42 years (17 months). The outcome of the HT was assessed by clinical and radiographic criteria. Results One hundred thirteen HT PMCs were reviewed from 71 participants. The overall success rate of PMCs placed utilizing the HT was 99%, with only one case presenting with confirmed failure. Conclusions HT PMCs have an overall high success rate as a treatment option in carious primary molars.
Collapse
Affiliation(s)
- Fani Sapountzis
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Tanya Mahony
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Amy R Villarosa
- Centre for Oral Health Outcomes and Research Translation (COHORT), Western Sydney University, Penrith, New South Wales, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), Western Sydney University, Penrith, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Kingswood, New South Wales, Australia
| |
Collapse
|
21
|
Crisp J, Mihas P, Sanders AE, Divaris K, Wright JT. Influences on dentists' adoption of nonsurgical caries management techniques: A qualitative study. J Am Dent Assoc 2021; 152:463-470. [PMID: 33461729 DOI: 10.1016/j.adaj.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonsurgical caries management techniques (NSCMT) offer a simple, conservative approach to treating caries. Despite evidence supporting and potential advantages of NSCMT, dentists can be reluctant to adopt these techniques. To better understand this phenomenon, the authors interviewed dentists who primarily treat children regarding their thoughts, attitudes, and adoption of 3 NSCMT. METHODS The 3 NSCMT were fluoride varnish, silver diamine fluoride, and Hall stainless steel crowns. The authors interviewed dentists in North Carolina whose practices were restricted mostly to children. A nonprobabilistic maximum-variation design was used in the sampling. Using a semistructured interview guide, the authors recorded the interviews digitally and analyzed them thematically. The authors stratified the analysis according to years of practice, geographic location, and type of practice. Reporting was based on emerging and recurring themes and insightful quotes. RESULTS Factors most likely to promote the adoption of NSCMT were related to clinical practice, family preference, patient safety, and provider philosophy. Barriers to adoption included previous practitioner negative experiences using the techniques, high-risk caries population, and perceived likelihood of negative outcomes. Characteristics of the practice environment, patient population, communication with families, and financial considerations were influential in the clinician's determination as to whether to use these techniques. CONCLUSIONS These findings provide valuable insight into practitioners' influences, motivations, and clinical decision making in the adoption and use of management and treatment approaches for carious lesions in the pediatric population. PRACTICE IMPLICATIONS The primary factors and barriers identified in this study are possible targets for education and quality improvement programs aimed at increasing NSCMT use.
Collapse
|
22
|
Goldsmith R, Taylor G, Waterhouse P. Do composite restorations in primary molar teeth have a higher survival rate following total or selective caries removal? Evid Based Dent 2021; 22:38-39. [PMID: 33772134 DOI: 10.1038/s41432-021-0166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Study design A double-blind randomised clinical trial, conducted between June 2009 and June 2011, in a paediatric dental department in a Brazilian dental school.Study selection Children aged 3-8 years, in good general health, with deep carious lesions (caries radiographically located in the inner quarter of dentine) affecting either one or two surfaces in primary molars were eligible for inclusion. Teeth were excluded if clinical or radiographic evidence of pulpal inflammation or necrosis or clinical mobility were observed. Pre-cooperative children were also excluded.Clinical procedures and success criteria Following a coin toss, 120 teeth were randomly assigned to two groups: 55 in the total caries removal (TCR) group and 65 in the selective caries removal (SCR) group. Procedures were carried out by three paediatric dentists under local anaesthesia and restored, using a layering technique, with composite under rubber dam. Restorations were evaluated at 3, 6, 12, 18, 24 and 36 months, using the US Public Health Service (USPHS) scale, by a single-blinded and calibrated examiner. A Charlie or Delta score, on the USPHS scale, at the margins of the restorations was considered as restoration failure. Gingival bleeding score, type of cavity (one or two surfaces) and presence of caries (active or inactive) were recorded as secondary outcomes; however, presence alone did not constitute restoration failure.Results Average survival rate of restorations across all teeth was 68% after 36 months, with SCR statistically significantly lower at 57% compared to TCR at 81% (p = 0.004). Annual failure rates for SCR and TCR were 17.3% and 6.7%, respectively. Two-surface restorations had lower survival rates (58%) compared to single-surface restorations (87%) (p = 0.02). Type of cavity and gingival bleeding statistically influenced the chance of restoration failure at 36 months.Conclusions Composite restorations placed after SCR in primary molars were found to fail more often compared to those restored after TCR. Two-surface cavities and poor gingival health negatively impacted restoration success.
Collapse
Affiliation(s)
- Rachel Goldsmith
- Dental Core Trainee (DCT2) in Paediatric Dentistry, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Greig Taylor
- NIHR Doctoral Research Fellow/StR in Paediatric Dentistry, School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paula Waterhouse
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK; Senior Lecturer/Honorary Consultant in Paediatric Dentistry, School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
23
|
Gilchrist F, Marshman Z. Patient-reported Outcomes (PROs) in clinical trials in paediatric dentistry. Int J Paediatr Dent 2020; 31 Suppl 1:31-37. [PMID: 33458920 DOI: 10.1111/ipd.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 01/13/2023]
Abstract
Patient-reported outcomes (PROs) are reports directly from patients without interpretation by clinicians or others and captured using validated patient-reported outcome measures (PROMs). These measures are increasingly employed in clinical practice and can be incorporated into clinical trials. Benefits of using PROs include reducing observer bias; eliciting unique views on aspects important to patients and increasing public accountability. Despite inclusion in clinical trials PRO data is often under-reported and the results may not be adopted into clinical practice due to concerns about the data generated. This review discusses what PROs are and how to measure them; the benefits of using PROs; how to choose an appropriate PROM to answer the research question; considerations for using PROs in paediatric dentistry and reporting guidelines. Finally, some examples of how PROs have been included in paediatric dentistry trials are given along with discussion of the development of core outcome sets and how these may improve reporting of PROs in the future.
Collapse
Affiliation(s)
- Fiona Gilchrist
- Paediatric Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- Dental Public Health, University of Sheffield, Sheffield, UK
| |
Collapse
|
24
|
Brocklehurst PR, Baker SR, Langley J. Context and the evidence-based paradigm: The potential for participatory research and systems thinking in oral health. Community Dent Oral Epidemiol 2020; 49:1-9. [PMID: 32813938 DOI: 10.1111/cdoe.12570] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
The implementation of research evidence to promote oral health is critical, given the intransigent and emerging challenges for policymakers at a population level. Despite this, little attention has been paid to implementation research within the evidence-based paradigm. This is important as getting research evidence into clinical practice is not a linear path that consists of simple sequential steps. In this article, we argue that we need to consider a broader range of conceptual and methodological approaches to increase the value of information generated. This should be undertaken either in parallel with empirical and experimental designs, or in some cases, instead of. This is important if we are going to understand the complexity and contextual knowledge of the 'system', within which interventions are implemented. Involving key stakeholders alongside empirical and experimental designs is one helpful approach. Examples of these approaches include Patient and Public Involvement and the development of Core Outcome Sets, where the views of those that will be potentially affected by the research, are included. The use of theoretical frameworks and process evaluations alongside trials are also important, if they are fully integrated into the approach taken to address the research question. A more radical approach is using participatory designs and 'systems thinking'. Participatory approaches include subject matter 'experts by experience'. These include patients, their families, carers, healthcare professionals, services managers, policymakers, commissioners and researchers. Participatory approaches raise important questions about who facilitates the process, when it should happen and how the diverse actors become meaningfully engaged so that their involvement is active, democratic and ongoing. We argue that the issues of control, power and language are central to this and represent a paradigmatic shift to conventional approaches. Systems thinking captures the idea that public health problems commonly involve multiple interdependent and interconnected factors, which interact with each other dynamically. This approach challenges the simplicity of the hierarchy of evidence and linear sequential logic, when it does not account for context. In contrast, systems thinking accepts complexity de novo and emphasizes the need to understand the whole system rather than its individual component parts. We conclude with the idea that participatory and systems thinking help to unpack the diverse agents that are often involved in the generation and translation of evidence into clinical dental practice. It moves our conception of research away from a simple exchange between 'knowledge producers' and 'knowledge users' and raises both methodological and epistemological challenges.
Collapse
Affiliation(s)
| | - Sarah R Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Joe Langley
- Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
25
|
El-Yousfi S, Innes NPT, Holmes RD, Freeman R, Cunningham KB, McColl E, Maguire A, Douglas GVA, Clarkson JE, Marshman Z. Children and parents' perspectives on the acceptability of three management strategies for dental caries in primary teeth within the 'Filling Children's Teeth: Indicated or Not' (FiCTION) randomised controlled trial - a qualitative study. BMC Oral Health 2020; 20:69. [PMID: 32164703 PMCID: PMC7069198 DOI: 10.1186/s12903-020-1060-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/03/2020] [Indexed: 11/14/2022] Open
Abstract
Background The Filling Children’s Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children’s primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological management with best practice prevention (B + P) and best practice prevention alone (PA)-based approaches. Recently, the concept of treatment acceptability has gained attention and attempts have been made to provide a conceptual definition, however this has mainly focused on adults. Recognising the importance of evaluating the acceptability of interventions in addition to their effectiveness, particularly for multi-component complex interventions, the trial design included a qualitative component. The aim of this component was to explore the acceptability of the three strategies from the perspectives of the child participants and their parents. Methods Qualitative exploration, based on the concept of acceptability. Participants were children already taking part in the FiCTION trial and their parents. Children were identified through purposive maximum variation sampling. The sample included children from the three management strategy arms who had been treated and followed up; median (IQR) follow-up was at 33.8 (23.8, 36.7) months. Semi-structured interviews with thirteen child-parent dyads. Interviews were transcribed verbatim and analysed using a framework approach. Results Data saturation was reached after thirteen interviews. Each child-parent dyad took part in one interview together. The participants were eight girls and five boys aged 5–11 years and their parents. The children’s distribution across the trial arms was: C + P n = 4; B + P n = 5; PA n = 4. Three key factors influenced the acceptability of caries management in primary teeth to children and parents: i) experiences of specific procedures within management strategies; ii) experiences of anticipatory dental anxiety and; iii) perceptions of effectiveness (particularly whether pain was reduced). These factors were underpinned by a fourth key factor: the notion of trust in the dental professionals – this was pervasive across all arms. Conclusions Overall children and parents found each of the three strategies for the management of dental caries in primary teeth acceptable, with trust in the dental professional playing an important role.
Collapse
Affiliation(s)
- Sarab El-Yousfi
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Nicola P T Innes
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, UK.
| | - Richard D Holmes
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, UK
| | - Kathryn B Cunningham
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Anne Maguire
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Gail V A Douglas
- University of Leeds School of Dentistry, Clarendon Way, Leeds, LS2 9LU, UK
| | - Janet E Clarkson
- Dental Health Services Research Unit, School of Dentistry, Park Place, Dundee, DD1 4HN, UK
| | - Zoe Marshman
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| |
Collapse
|
26
|
Marshman Z, Kettle JE, Holmes RD, Cunningham KB, Freeman R, Gibson BJ, McColl E, Maguire A, Douglas GVA, Clarkson JE, Innes NPT. Dental professionals' experiences of managing children with carious lesions in their primary teeth - a qualitative study within the FiCTION randomised controlled trial. BMC Oral Health 2020; 20:64. [PMID: 32131801 PMCID: PMC7057668 DOI: 10.1186/s12903-020-1051-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background The 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. Methods Overall, 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. Results Participants 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. Conclusions RCTs 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.
Collapse
Affiliation(s)
- Zoe Marshman
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Jennifer E Kettle
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Richard D Holmes
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Kathryn B Cunningham
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, Park Place, Dundee, DD1 4HN, UK
| | - Barry J Gibson
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor, William Leech Building, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Anne Maguire
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Janet E Clarkson
- Dental Health Services Research Unit, School of Dentistry, Park Place, Dundee, DD1 4HN, UK
| | - Nicola P T Innes
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, UK.
| |
Collapse
|
27
|
Homer T, Maguire A, Douglas GVA, Innes NP, Clarkson JE, Wilson N, Ryan V, McColl E, Robertson M, Vale L. Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial). BMC Oral Health 2020; 20:45. [PMID: 32041605 PMCID: PMC7011536 DOI: 10.1186/s12903-020-1020-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). METHODS Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. RESULTS A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (- 0.06; 97.5% CI: - 0.14 to 0.02) and fewer episodes of dental pain and/or infection (- 0.14; 97.5% CI: - 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. CONCLUSIONS The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. TRIAL REGISTRATION The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047).
Collapse
Affiliation(s)
- Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | - Anne Maguire
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Jan E Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Vicky Ryan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | | | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| |
Collapse
|