Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial.

This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

Abstract: This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Management of dental caries among children: a look at the cost-effectiveness.

INTRODUCTION: Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide. AREAS COVERED: This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children. EXPERT COMMENTARY: Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

Efficacy of conventional treatment with composite resin and atraumatic restorative treatment in posterior primary teeth: study protocol for a randomised controlled trial.

INTRODUCTION: Despite the widespread acceptance of conventional treatment using composite resin in primary teeth, there is limited evidence that this approach is the best option in paediatric clinics. Atraumatic restorative treatment (ART) using high-viscosity glass ionomer cement has gradually become more popular because it performs well in clinical studies, is easy to handle and is patient friendly. Therefore, the aim of this randomised clinical trial study is to compare the restoration longevity of conventional treatment using composite resin with that of ART in posterior primary teeth. As secondary outcomes, cost-efficacy and patient self-reported discomfort will also be tested. METHODS AND ANALYSIS: Children aged 3-6 years presenting with at least one occlusal and/or occlusal-proximal cavity will be randomly assigned to one of two groups according to the dental treatment: ART (experimental group) or composite resin restoration (control group). The dental treatment will be performed at a dental care trailer located in an educational complex in Barueri/SP, Brazil. The unit of randomisation will be the child. A sample size of 240 teeth with occlusal cavities and 188 teeth with occlusal-proximal cavities has been calculated. The primary outcome will be restoration longevity, which will be clinically assessed after 6, 12, 18 and 24 months by two examiners. The duration of the dental treatment and the cost of all materials used will be considered when estimating the cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Facial Scale of Wong-Baker. ETHICS AND DISSEMINATION: This clinical trial was approved by the local ethics committee from the Faculty of Dentistry of the University of São Paulo (registration no. 1.556.018). Participants will be included after their legal guardians have signed an informed consent form containing detailed information about the research. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov, NCT02562456; Pre-results.

Perfil de problemas orales en infantes y preescolares atendidos en el servicio de urgencias odontológicas de un centro de salud infantil de Brasil / Perfil de problemas orais em infantes e pré-escolares tratados no serviço de urgências odontológicas de um centro de saúde infantil do Brasil / Oral health problems profile in infants and preschool children attended at the dental emergency service of a children ́s health centre of Brazil

Objetivo: Determinar el perfil de los problemas orales en lactantes y preescolares atendidos en el servicio de urgencias de la Clínica de Especialidades infantil/ Clínica de Bebés de la Universidad Estatal de Londrina, Brasil. Materiales y métodos:Estudio retrospectivo donde se analizaron 776 historias clínicas de pacientes en el rango de edad de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Los datos recolectados fueron: Género, edad, lugar de residencia, ocupación y grado de escolaridad de los padres, motivo de consulta, dientes involucrados e intervenciones realizadas. Se utilizó la prueba de Chi2(χ2) y un nivel de significancia de 5% para la asociación entre variables. Resultados: Se observó una mayor proporción de pacientes de género masculino en la búsqueda del servicio (55,5%) y la mayoría de pacientes se ubicaron en el rango de edad de 0 a 24 meses (27,3%). Se verificó que el 62,9% residían en la zona urbana y la mayoría de los padres/responsables habían cursado secundaria completa (30,5% padres, 33,8% madres). Los motivos de consulta más frecuentes en la atención fueron caries dental (38,9%) siendo el dolor la queja principal (42,0%) y trauma dental (28,9%). Los dientes más afectados por caries fueron los segundos molares inferiores primarios y, por trauma los incisivos centrales superiores primarios. Dentro de las intervenciones más comunes se encontraron el tratamiento endodóntico (16,0%) y la adecuación del medio bucal (15,1%). Se encontró una asociación estadísticamente significativa entre escolaridad de la madre y motivo de consulta en el servicio de urgencias (p=0,001). Conclusión: El servicio analizado es necesario y útil, sin embargo, la resolución de problemas orales en la población infantil de Londrina, ocurrirá por medio de una reorganización de los servicios odontológicos actuales.

Objective: To determine the profile of oral problems in infants and preschool children treated at an emergency service from Clinic of Infantile Specialities / Clinical Baby of the State University of Londrina, Brazil. Materials and method: Retrospective study where 776 clinical histories of patients aged 0 to 72 months, treated between April 2007 and April 2008 were analysed. Data collection included gender, age, place of residence, parental occupation and educational level, reason for consultation, involved teeth and performed intervention. Chi-square test (χ2) and a significance level of 5% were used for variables associations. Results:A greater proportion of male patients (55.5%) attended the service and the main age group was the 0-24 months (27.3%). It was found that 62.9% lived in urban areas and most parents/caregivers had completed secondary school (30.5% parents, 33.8% mothers). The main reason for consultation was caries (38.9%) - pain as main complaint (42.0%) and dental trauma (28.9%). The most affected tooth by caries was the lower second primary molar and, regarding trauma, the upper central primary incisors were the most injured. Interventions varied from endodontic treatment (16.0%) and adequacy of oral environment (15.1%). There was a statistically significant association between mother educational level and reason for consultation (p = 0.001). Conclusion:The assessed health service was necessary and useful. However, oral health problems resolution in the paediatric population in Londrina will only occur after the implementation of reorganised dental services from the currently available.

Objetivo: Determinar o perfil dos problemas bucais em lactantes e pré-escolares atendidos no pronto socorro da Clínica de Especialidades Infantis / Bebê Clínica da Universidade Estadual de Londrina, Brasil. Materiais e métodos: Estudo retrospec-tivo onde foram analisados 776 prontuários odontológicos de pacientes na faixa etária de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Os dados coletados foram: Gênero, idade, lugar de moradia, ocupação e grau de escolaridade dos pais, motivo da consulta, dentes envolvidos e intervenções realizadas. Foi usado o teste qui-quadrado (χ2) e estabeleceu-se um nível de significância de 5% para a associação entre variáveis. Resultados: Observou-se uma maior proporção de pacientes de sexo masculino na procura do atendimento (55,5%) e a maioria dos pacientes pertenciam à faixa etária de 0 a 24 meses (27,3%). Verificou-se que, 62,9% moravam na zona urbana e a maioria dos pais/responsáveis possuíam escolaridade de segundo grau completo (30,5% pais, 33,8% mães). Os motivos mais frequentes pelo atendimento foram cárie dentária (38,9%) sendo a dor a principal queixa 42,0%, e trauma dentário (28,9%). Os dentes mais acometidos pela cárie foram os segundos molares infe-riores e por trauma, os incisivos centrais superiores decíduos. As intervenções mais comuns foram o tratamento endodôntico (16,0%) e adequação do meio bucal (15,1%). Houve associação estatisticamente significante entre escolaridade da mãe e moti-vo da consulta do pronto socorro (p=0,001). Conclusão: O serviço de urgência é necessário e útil, porém, a resolução dos pro-blemas bucais na população infantil de Londrina, ocorrerá por meio de uma reorganização dos serviços odontológicos atuais.

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial.

BACKGROUND: Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions. METHODS/DESIGN: This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction. DISCUSSION: Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01477385), Initial release: 11/16/2011: last update: 06/02/2014.