A Randomized Controlled Trial of Caries Prevention in Dental Practice

Abstract

Abstract:Background: We conducted a parallel group randomised controlled trial of children initially aged 2-3 years who were caries free, to prevent the children becoming caries active over the subsequent 36 months.Methods: The setting was 22 dental practices in Northern Ireland and children were randomly assigned by a Clinical Trials Unit (using computer generated random numbers, with allocation concealed from the dental practice until child was recruited) to the intervention (22,600 ppm fluoride varnish, toothbrush, 50 ml tube of 1,450 ppm fluoride toothpaste and standardised, evidence-based prevention advice), or advice-only control, at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were dmfs in caries active children, number of episodes of pain, number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 years. Results: 1248 children (624 randomised to each group) were recruited and 1,096 (549 intervention, 547 control) were included in the final analyses. 87% of intervention and 86% of control children attended every 6-month visit (P=0.77). 187 (34%) of intervention group converted to caries-active compared to 213 (39%) in control (OR 0.81, 95%CI 0.64 to 1.04; P=0.11). Mean dmfs of those with caries in intervention group was 7.2 compared to 9.6 in control group (P=0.007). There was no significant difference in the number of episodes of pain between groups, (P=0.81) or in the number of teeth extracted in caries-active children (P=0.95). Ten children in the intervention group had adverse reactions of a minor nature.Conclusion: This well conducted trial failed to demonstrate that the intervention kept children caries free, however there was evidence that once children get caries it slowed down its progression. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Methods: The setting was 22 dental practices in Northern Ireland and children were randomly assigned by a Clinical Trials Unit (using computer generated random numbers, with allocation concealed from the dental practice until child was recruited)to the intervention (22,600 ppm fluoride varnish, toothbrush, 50 ml tube of 1,450 ppm fluoride toothpaste and standardised, evidence-based prevention advice), or adviceonly control, at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were dmfs in caries active children, number of episodes of pain, number of extracted teeth.Adv...

Identification of caries risk in 2‐year‐olds

“…The findings showed that the preventive care delivered failed to prevent increment in caries experience in the studied children. The findings are in line with a newly published study from Ireland showing that biannual application of fluoride varnish did not keep children caries free during preschool age …”

Oral health behaviours of parents and young children in a practice‐based caries prevention trial in Northern Ireland

“…When considering caries prevention strategies, the NICPIP trial demonstrated that fluoride interventions delivered in dental practice, to children with high levels of attendance and adherence (86.7% of children attended every 6 months for 3 years in the test group and 84.5% in the control group), produce statistically significant benefits but the effect size was small and, due to the high costs of the dental workforce, of questionable cost‐effectiveness . This study suggests that, in this population, behaviour relating to restricting sugar consumption is a greater problem than promoting toothbrushing and attendant fluoride toothpaste use.…”

“…The Northern Ireland Caries Prevention in Practice (NICPIP) trial measured the effects and costs of a compound fluoride intervention delivered in dental practice which was designed to prevent caries in pre‐school children. The clinical findings of the NICPIP trial have been published elsewhere . A key finding was that, even with an 87% adherence to the preventive intervention, 34% of children developed caries.…”

Wirkungsweise von Fluoriden: Allgemeine Aspekte – Festsitzende KFO-Apparaturen: Karies und Prophylaxe

“…Deshalb sollte die Durchführung der professionellen Lackapplikation routinemäßig bei den kieferorthopädischen Kontrollterminen erfolgen [24]. Hochkonzentrierte Fluoridlacke sind eine effiziente Maßnahme mit sehr guter Evidenz in der Prophylaxe der Karies [25]. Wichtig ist dabei, dass man den Lack nur an betroffenen bzw.…”