Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

  1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
  2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
  3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy. Continue reading

Slowly does it: no evidence that slow-release fluoride devices are effective

Tooth decay is not distributed evenly among the population, with certain groups being at greater risk of developing tooth decay than others. For example, research in Scotland has shown that 50% of tooth decay occurs in 11% of 5-year-old children and only 6% of 14-year-old children. In light of this uneven distribution, it is often suggested that these small percentages of children may be offered targeted-caries preventive measures to great potential effect, in a cost effective manner. One such preventive measure is the use of slow-release fluoride devices (e.g. slow-dissolving fluoride-releasing glass beads). Continue reading

No evidence that fluoride supplements taken by pregnant women prevent tooth decay in their babies

Tooth decay is one of the most common health problems among children. If fluoride supplements taken by pregnant women can prevent tooth decay in their children, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Fluoride tablets, drops, lozenges or chewing gums are sucked or chewed to provide topical fluoride and ingested to provide systemic fluoride. Continue reading

Children who have sealants applied to their back teeth are less likely to have tooth decay

Although children and adolescents have healthier teeth than in the past, tooth decay (also known as caries) is a problem in some people and places. Most tooth decay in young people occurs on the biting surfaces of back teeth. Tooth decay prevention includes brushing, fluoride supplements (such as tablets), fluoride directly applied to the teeth and dental sealants. Dental sealants aim to prevent bacteria growth that promote tooth decay in grooves of back teeth. Sealants are applied by dentists or dental care team members. The main types used are resin-based sealants and glass ionomer cements. Continue reading

Supervised use of fluoride mouthrinse results in large reductions in decay in children’s permanent teeth

Tooth decay is a health problem worldwide, affecting the vast majority of adults and children. Levels of tooth decay vary between and within countries, but children in lower socioeconomic groups (measured by income, education and employment) tend to have more tooth decay. Untreated tooth decay can cause progressive destruction of the tops of teeth (crowns), often accompanied by severe pain. Repair and replacement of decayed teeth is costly in terms of time and money and is a major drain on the resources of healthcare systems.

Preventing tooth decay in children and adolescents is regarded as a priority for dental services and is considered more cost-effective than treatment. Use of fluoride, a mineral that prevents tooth decay, is widespread. As well as occurring naturally, fluoride is added to the water supply in some areas, and is used in most toothpastes and in other products that are available to varying degrees worldwide. As an extra preventive measure, fluoride can be applied directly to teeth as mouthrinses, lozenges, varnishes and gels.

Fluoride mouthrinse has frequently been used under supervision in school-based programmes to prevent tooth decay. Supervised (depending on the age of the child) or unsupervised fluoride mouthrinse needs to be used regularly to have an effect. Recommended procedure involves rinsing the mouth one to two minutes per day with a less concentrated solution containing fluoride, or once a week or once every two weeks with a more concentrated solution. Because of the risk of swallowing too much fluoride, fluoride mouthrinses are not recommended for children younger than six years of age.

This review updates the Cochrane review of fluoride mouthrinses for preventing tooth decay in children and adolescents that was first published in 2003. Continue reading

Sealants versus fluoride varnish – which is better for preventing decay in children’s teeth?

ChildAlthough children and adolescents have healthier teeth today than in the past, tooth decay is still a problem among some individuals and populations, and it affects a large number of people around the world. Most decay in children and adolescents is concentrated on the biting surfaces of permanent back teeth. Preventive treatment options for tooth decay include tooth brushing with a fluoride toothpaste, use of fluoride supplements (e.g. fluoride tablets) and application of dental sealants and topical fluorides at dental clinics. Dental sealants are applied to form a physical barrier that prevents growth of bacteria and accumulation of food particles in the grooves of back teeth. Several sealant materials are available: The main types in use are resin-based sealants and glass ionomer cements. Fluoride varnishes are sticky pastes that are professionally applied to the teeth two to four times a year. Continue reading

Micro-invasive treatments for managing dental decay on adjacent tooth surfaces in children’s and adults’ teeth

dentist

Photo copyright Conor Lawless, via Creative Commons Licence

Decay on tooth surfaces that are next to each other (proximal surfaces) is common. Usually it has not progressed into late stages of decay and the tooth surface does not yet have a cavity. Different methods are used to manage proximal dental decay. A common method is drilling the affected tooth tissue and inserting a plastic or metal filling. However, a lot of sound tissue can be removed in the process and this method is regarded as invasive). Another non-invasive methods in use include dental practitioners applying fluoride varnish or advising people to floss regularly. These non-invasive methods do not require removing any tooth tissue. More recent approaches (micro-invasive treatments) involve preparing (conditioning) the tooth surface with an acid and then either placing a sealing (cover) on top of the surface or ‘infiltrating’ the softer demineralised tissue with resins. These newer methods work by installing a barrier either on the tooth surface or within the demineralised tissue to protect it against acids and avoid the further loss of minerals from within the tooth. This, in theory, should stop the decay. This approach can be performed by a dentist or other dental practitioner and involves the loss of a few micrometers of tooth tissue because of the need to condition the tooth surface with acid. There is still uncertainty as to how effective micro-invasive treatments are for managing proximal decay. It is also unclear which if any of these techniques are better than others. For example, a stronger acid is needed to infiltrated porous tissue with resin than when the tooth surface is simply sealed or covered. While infiltration might be a more effective method of protecting the tissue than sealing it, the use of a stronger acid also means losing more tissue. The aim of this review was to investigate the best approach for managing such decay in adults and children. Continue reading