What should we be doing for children in our general practices?

Area of Science:

• Pediatric Dentistry
• Dental Public Health
• Clinical Trials

Background:

• Childhood caries management involves various strategies, including conventional caries removal and restoration (C+P), biological sealing-in caries (B+P), and prevention alone (PA).
• Evidence comparing these approaches regarding pain, infection, and psychological outcomes is crucial for clinical decision-making.

Purpose of the Study:

• To compare the effectiveness of three distinct dental caries treatment strategies in primary molars among children aged 3-7 years.
• To evaluate outcomes including pain, dental infection, cost-effectiveness, quality of life, and anxiety levels.

Main Methods:

• A multi-centre, patient-randomised controlled trial (FiCTION project) involving 1058 children with dentine caries.
• Participants were allocated to C+P, B+P, or PA strategies, with follow-up for a median of 33.8 months.
• Co-primary outcomes were pain and dental infection; secondary outcomes included cost-effectiveness, quality of life, and anxiety.

Main Results:

• No statistically significant differences were observed in the incidence or number of episodes of dental pain and/or infection between the C+P, B+P, and PA groups.
• Secondary outcomes showed no significant differences in cost-effectiveness, oral health-related quality of life, or general anxiety.
• A notable finding was reduced parent-reported anticipatory anxiety in the PA group compared to the C+P group.

Conclusions:

• The three evaluated caries management strategies demonstrated comparable effectiveness in preventing pain and infection in primary molars.
• Prevention alone (PA) may be associated with lower anticipatory anxiety in children undergoing dental treatment.
• Qualitative data indicated general acceptability of all approaches, with trust in dental professionals being a key factor.