Fillings may not be best way to tackle child tooth decay, research suggests

Conventional fillings may not be the best way of tackling decay in children’s teeth, new research suggests.

The three-year study found no evidence to suggest that fillings are more effective than sealing decay into teeth, or using prevention techniques alone, in stopping pain and infection from tooth decay in primary teeth, also known as milk teeth.

The FiCTION study also found that 450 children who took part in the research experienced tooth decay and pain regardless of which kind of dental treatment they received.

Researchers said that the best approach is to prevent tooth decay from occurring in the first place.

Professor Nicola Innes, chairwoman of paediatric dentistry at the University of Dundee and lead author on the paper, said: “Our study shows that each way of treating decay worked to a similar level but that children who get tooth decay at a young age have a high chance of experiencing toothache and abscesses regardless of the way the dentist manages the decay.

“What is absolutely clear from our trial is that the best way to manage tooth decay is not by drilling it out or sealing it in – it’s by preventing it in the first place.”

During the study, more than 1,140 children between the ages of three and seven with visible tooth decay were recruited by dentists working in one of 72 dental clinics throughout the country.

One of three treatment approaches was then chosen randomly for each child’s dental care for the duration of the trial, which was up to three years.

The first approach avoided placing any fillings and aimed to prevent new decay by reducing sugar intake, ensuring twice daily brushing with fluoridated toothpaste, application of fluoride varnish and placing of fissure sealants on the first permanent molar (back) teeth.

The second option involved drilling out tooth decay, an option based on what has been considered the standard “drill and fill” practice for more than 50 years, together with preventive treatments.

The third treatment strategy was a minimally invasive approach where tooth decay was sealed in under a metal crown or a filling to stop it progressing together with preventive treatments.

The main trial findings, published in the Journal of Dental Research, found no evidence to suggest that any of the treatment strategies were better than another in terms of making a difference in children’s experience of pain or infection, quality of life or dental anxiety between groups.

All three different ways of treating decay were found to be acceptable to children, parents and dental professionals.

Scotland’s Chief Dental Officer Tom Ferris said: “FiCTION highlights the importance of preventing tooth decay in our youngest children.

“I believe the key to success in prevention lies within families and communities; for this reason the Scottish Government launched the Oral Health Community Challenge Fund for third sector organisations working alongside families living in our most disadvantaged areas.

“The activities from these projects complement our mainstream Childsmile work in education and health settings.”

The study was led by dentists from the universities of Dundee, Newcastle, Sheffield, Cardiff, Queen Mary University of London and Leeds.

It was funded by the Health Technology Assessment programme of the National Institute for Health Research.