Children benefit from more active prevention of tooth decay, suggests study 

Scientists have been studying children’s teeth and tooth decay in a three year study based across the UK. The scientists wanted to examine different ways of treating the disease, once children’s teeth showed visible signs. The FiCTION study was published in late 2019 in the Journal of Dental Research, a peer-reviewed journal. The abstract is available to read online. 

Tooth decay is largely preventable, but it is also the most common oral disease in young people and children in England. The picture of oral health is improving, but in 2017, just under a quarter of children aged 5 showed signs of tooth decay. Once a child has the disease, it is likely that 3-4 teeth could be affected. If children are at risk, it can start as early as 3 years old. There are also socio-economic links to the disease - children from areas where there is poverty have more than twice the level of decay then their peers who are not from deprived areas. Children are most likely to go to hospital for tooth extractions. Nine out of ten procedures carried out on children under 5 are preventable. Tooth extraction is also the most common reason that 6-10 year olds go to hospital. 

The disease can cause children problems, including sleeping, eating, socialising and communication. It is responsible for 26% of children missing school due to dental pain and infection. 67% of parents had reported their children being in pain due to their teeth and 38% of children had sleepless nights due to pain. 

The study involved 450 children, aged between 3-7 years, at one of 72 dental surgeries throughout the country.  The patients had visible signs of dental decay in a tooth. The children were given one of three possible treatments, chosen at random. One group did not receive any fillings, but aimed to prevent further decay by making sure the children brushed their teeth twice a day, using fluoride toothpaste. They were asked to reduce their sugar intake and also received fissure sealants on the first permanent molar teeth and an application of fluoride varnish. 

The second group received a more traditional treatment of dental caries, through drilling out the decay and filling the tooth. They were also given preventative advice. The third group received a minimal approach where the tooth decay was sealed under a filling or metal crown so that it would not progress further, as well as being offered preventative treatments. 

The different treatments for tooth decay were acceptable to both the children and their parents as well as the dentists. The study found that there was no evidence to suggest that any of the treatment procedures worked better than another. They used measures of infection in the tooth or the children’s pain to measure this. None of the strategies worked better in increasing the children’s quality of life or reducing their anxiety at seeing the dentist. The minimally invasive method of sealing the decay in the tooth was considered the best way to manage the children’s decay, but the cost was £130 per treatment, which could be too high, even to avoid an episode of infection or pain. 

The scientists suggested that the best way to treat dental decay in children was to prevent it. However, if decay does develop, then there was a choice of treatment options available, according to the needs of the individual. Good quality of care from a dentist may not prevent further tooth decay issues for children, once it has been found. The scientists in charge of the study suggest that prevention starts in the community and family. 

To look after their teeth and help prevent tooth decay, children should be encouraged to: 

- Brush their teeth twice a day with a fluoride toothpaste
- Avoid sugary drinks and snacks between meals
- Visit the dentist regularly 

Improving the oral health of children in England is a Public Health England priority. The organisation has established a Child Oral Health Improvement Programme Board (COHIPB) which has delivered an action plan, working with partners and stakeholders to improve oral health for all children in England and reduce the gap for disadvantaged children. Core principles suggest that health and care professionals should understand available interventions to help improve oral health and know which resources and services are available to help. 

Innes, N.P., et al., Child Caries Management: A Randomized Controlled Trial in Dental Practice, Journal of Dental Research, November 2019 

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