Dental caries lesions in primary teeth without obvious cavitation: Treatment decision-making process.

BACKGROUND: Dental caries diagnosis and management have changed over time. AIM: To identify the treatment decision-making process performed by paediatric dentists, after caries detection using CAST instrument (Caries Assessment Spectrum and Treatment), for enamel (CAST 3) and non-cavitated dentin caries lesions (CAST 4) before and after analysing radiographic images. DESIGN: Seventy-four paediatric dentists were invited to participate. Twelve clinical cases were presented online, and treatment decisions before and after the analysis of bitewing radiographs were evaluated. RESULTS: Sixty-one specialists answered the questionnaire. The necessity for radiographs was significantly associated with the presence and depth of the caries lesion (P < 0.0001). CAST 3 lesions were preferentially monitored before and after the radiographic assessment. For CAST 4 lesions limited to the outer half of dentin, treatments indicated before and after radiographic analysis were sealant (33%) and restoration (40%). For the lesions in the inner half of dentin, restoration was the most cited before (45%) and after (84%) radiographs. The radiographic depth was the only significant independent variable when "change in the treatment option" was analysed by the regression model (P < 0.001). CONCLUSIONS: Enamel lesions were treated through less invasive treatments. Radiographs influenced the decision, especially for the lesions that involved the inner half of dentin.

Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols.

OBJECTIVE: To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols. MATERIALS AND METHODS: In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data. RESULTS: No treatment group effect was observed on the FIS Tx-2 score (p = 0.64). A FIS Tx-1 score (p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r = 0.30 (p < 0.0001). CONCLUSION: At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session.

Self-report of pain in children treated according to the atraumatic restorative treatment and the conventional restorative treatment--a pilot study.

OBJECTIVE: To compare the level of pain among children treated according to the Atraumatic Restorative Treatment (ART) and the Conventional Restorative Treatment (CRT). STUDY DESIGN: Forty children of both genders, 4- to 7-years old, presenting Class I cavitated dentin lesions in primary molars were randomly allocated to 2 groups. One group (CRT) received conventional restorative treatment using rotary instruments, while in the other one (ART) hand instruments were used to perform the restorations. All children were treated by the same operator A high-viscosity glass-ionomer cement (Fuji IX) was used to restore the teeth in both groups. Children's pain was measured at the end of the first restorative treatment session using the Wong-Baker FACES Pain Rating Scale (dependent variable). Age, gender, treatment time and treatment group were independent variables. ANOVA and ANCOVA tests were used to analyze the data. RESULTS: The CRT procedure took longer than the ART procedure (p < 0.001). Children from the ART group reported less pain than those from the CRT group (p = 0.0037). Four year olds reported more pain than 5- to 7-year olds (p < 0.0001) in both groups. CONCLUSIONS: Restorations placed using ART were less time consuming, children felt less pain when the ART approach was used, and younger children (4-years) reported more pain than the older ones for both restorative treatments.