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29 January 2020

Carious lesions on primary molars: three different strategies

Alessandra Abbà

Dental caries of primary dentition continues to be one of the major health problem in the world. And even if prevention and acknowledgment of the dental biofilm as main responsible of carious lesions are very improved through the years, there is still much uncertainty amongst DPs over how to most effectively manage this problem. This have encouraged investigation of alternative and easier approaches to caries management, including minimally-invasive techniques.

This  multicenter, 3-arm, parallel-group, patient-randomized controlled trial, published on Journal of Dental Research on November 2019, compared three different strategies to front carious lesions on primary molars.  

1144 children with an age between  3-7 years and with at least one primary molar tooth with a carious lesion extending into dentin, not associated with pain or infection, were enrolled for the study. Participants were randomly allocated to one of three treatment strategies.

1)Best Practice Prevention Alone (PA, n 377), involving dietary investigation, toothbrush with a fluoridated toothpaste and- for over 7 year-olds-fluoride mouth-rinsing, topical fluoride varnish on primary and permanent teeth and fissure sealants on permanent teeth.

2)Conventional with Best Practice Prevention (C+P, n 386), that means conventional carious lesion management providing for local anesthesia (LA) administration, complete mechanical removal of carious tissue and filling with a proper restoration material, and prevention.

3)Biological with Best Practice Prevention (B+P, n 381), providing for sealing in carious tissue with an adhesive restorative material and prevention.

The outcomes of the study were:
- the proportion of participants with at least 1 episode of dental pain and/or infection,
- the number of episodes of dental pain and/or infection during a follow-up period of at least 23 months.  

As regard the first outcome, statistical analysis showed the following proportions of participants with at least one episode of dental pain and/or infection: C+P, 42%; B+P, 40%; PA, 45%. Instead the mean (SD) number of episodes of dental pain and/or infection registered the following data: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98).  

There was no evidence of difference between the three different strategies compared neither for incidence nor for number of episodes of dental pain\infection.  

For additional informations: Child Caries Management: A Randomized Controlled Trial in Dental Practice

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