Large scale trial stresses need for prevention for children
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- Published: Monday, 17 September 2018 07:36
- Written by News Editor
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Delegates at BSPD’s annual conference in Dundee last week were presented with the long-awaited results of the FiCTION trial which was set up to test three different approaches to the management of tooth decay (dental caries) in children. It showed that prevention and empathetic dentistry is critical in management of dental caries in children.
Despite an embargo on releasing data from the trial, delegates heard about it in detail and learned that a key finding is that it’s the trust engendered by the dentist who is providing the care and delivering preventive advice which is critical to any outcome. They also learned that once a child has developed caries, they are likely to experience pain and/ or infection. Intensive prevention should be targeted to the child and its parents.
FiCTION (Filling Children’s Teeth: indicated or not?) began ten years ago in Dundee. This important multi-centre randomised controlled trial involved seven locations - Cardiff, Glasgow, Leeds, Newcastle, Sheffield, London and Dundee - and 1144 children aged 3-7 years. The first of its kind, the trial recruited more than 70 general dentists across the UK who tested out each of three approaches, which were:
- Conventional (drill and fill) with prevention
- Biological management (sealing in) with prevention
- Best practice prevention alone
Public health dentist, Zoe Marshman, was one of the core team and led on the patient and parent perspectives. She said of the findings: “As well as looking at the clinical perspective, we also focused on pain, infection, anxiety, quality of life and health economics. We interviewed children, parents and dental professionals about their views on the acceptability of treatment and found that, with the child-centred patient management, all treatments were considered acceptable.”
Claire Stevens, BSPD spokeswoman said: “One of the key messages of this trial is the importance of evidence-based prevention which must underpin any approach to caries.” She added: “As soon as early caries is identified, clinicians need to be re-evaluating the child’s caries risk status and providing enhanced prevention in line with Delivering Better Oral Health and SDCEP guidance. This might include increasing the fluoride in the toothpaste and placing topical fluoride varnish four times rather than two times per year. Recall interval should also be reduced so that the child and their family receive close support to minimise the risk of further caries developing.”
The trial team are currently awaiting feedback from their funders - the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme - which must endorse their interpretation of the results. Only when they have the approval of the funders can the results be made public, which may not be for another 12 months.
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