Volume 7 • 2020 • Issue 7

T he study was conducted by researchers at the Universities of Dundee, Newcastle, Sheffield, Queen Mary University, London and Leeds, and the findings were published in the Journal of Dental Research . CDA Essentials spoke with lead researcher, Dr. Nicola Innes, who is chair of Paediatric Dentistry at the University of Dundee. Q What surprised you most about the trial? Dr. Nicola Innes (NI): The results. We thought there would be more difference between the arms. Usually studies look at the success or failure of treatment of caries in a single tooth. However, we were interested in looking at the whole child and their mouth, 20 primary teeth, and the cumulative effect of three years of treatment. Each child was treated within their randomized arm for 3 years. There are no other child-level studies of restorative interventions for children, followed up for this length of time. We wondered if the group who only got preventative care might take it more seriously and be more rigorous and focused than the groups who received other treatments in addition to preventive care. We wondered if the group treated with the biological treatment approach, the sealing-in of dental caries, might see better results than conventional care—based on studies comparing just one tooth with another—but, in the end, we found no difference in outcomes. Q If there weren’t significant differences between the treatment outcomes, how should dentists treat children with dental caries? NI: We found that some dentists were more comfortable with the conventional approach to managing caries and felt more confident providing fillings whereas others preferred sealing in and some felt that the prevention alone approach was most appropriate for children. However, the dentists did tailor their approach to individual children within the arms. It seems that it is best for patients when dentists have the skills and knowledge to offer all the different treatment options depending on the specific needs and expectations of their patients. It’s good for patients when dentists are willing and able to perform different kinds of treatment, including biological treatment. Less invasive treatments are often better, especially for children. In dentistry, we have been moving toward less invasive treatments, be they biological or restorative, that have proved to be just as effective as conventional treatments. There has been a lot of research that backs this up. We’ve learned a lot in the past 20 years about the biofilm as the basis of dental caries. In the 1970s, there was evidence that we could seal-in dental caries, but then it took a lot of research to understand dental plaque as biofilm-based disease rather than, as used to be thought, an infectious disease. There are a lot of different organisms in a biofilm and you can disrupt it by changing the environment, sealing it in, removing it repeatedly. If you disrupt it, the biofilm doesn’t get a chance to cause disease. An apt metaphor for a biofilm is a city. It’s a community. A city is made up of different people who have different needs. If a neighborhood needs grocery stores, schools or hospitals to meet its specific needs, the different bacteria in biofilms need different levels of oxygen, food, or acidity. If you put a giant dome over a city and nothing can get in or out, that completely disrupts the city. This is what happens when sealing-in a biofilm. Q The trial emphasized the importance of preventing dental caries in the first place, because once it’s present, half the children had problems even after treatment. Why are there so many children with dental caries in their primary teeth? NI: To be part of this trial a child needed to already have dental caries, so we didn’t get a chance to prevent it completely. However, in Scotland, we have a national program called Childsmile designed to improve the oral health of children. It provides supervised tooth brushing programs in kindergarten and school where they also get fluoride varnish applied. Dental caries rates have dropped dramatically in Scotland as a result. But that said, it is still linked to socio-economic factors, and diet as well as plaque control and fluoride both play a part. Q Did this trial bring up new questions for you? NI: I would like to look more at how the individual restorative treatments performed to find the most successful ones and also to combine some with using silver diamine fluoride to enhance the sealing-in and caries arrest process. Reference 1. Innes NP, Clarkson JE, Douglas GVA, Ryan V, Wilson N, Homer T, et al. Child caries management: a randomized controlled trial in dental practice. J Dent Res. 2020 Jan;99(1):36-43. S upporting Y our P ractice 35 Issue 7 | 2020 |