Article
A common dilemma encountered by dental professionals is how to manage an early interproximal enamel carious lesion that has been diagnosed on bitewing radiographs. The systematic review evaluated the scientific evidence to support the use of resin infiltration to prevent progression of early, non-cavitated carious lesions. On the findings of the limited evidence presented, resin infiltration could be an effective intervention.
Resin infiltration is an interesting non-invasive approach, whereby a low viscosity resin is used to penetrate and replace the demineralized enamel within an early non-cavitated lesion. It is a completely different technique from the therapeutic sealing of the surface of a carious lesion with bis-GMA resin. This systematic review investigated the evidence to support the clinical use of the resin infiltration technique. Doméjean and co-authors searched the PubMed electronic database in September 2014 for studies that fulfilled the CONSORT statement for reporting of randomized controlled trials. In total, 4 papers, reporting the findings for 3 populations, met the inclusion criteria. The included studies all used a split-mouth design to assess the effect of resin infiltration on caries progression of a proximal non-cavitated lesion. One study used fluoride varnish in addition to the resin infiltration. The control lesions were treated with fluoride varnish, sealing or a placebo. One study used fluoride varnish in addition to the resin infiltration. The control lesions were treated with fluoride varnish, sealing or a placebo. One study had two control lesions (sealing and placebo). The study populations were all small, comprising between 22 and 48 participants, with either paired or grouped carious lesions (26 paired lesions, 42 paired lesions and 37 groups of 3 lesions). The mean age of participants was 7, 21 and 25 years (ie primary and permanent teeth), and the populations had different caries risk (low to high). The follow-up periods were between only 12 and 36 months. In all 4 studies the outcome was the proportion of carious lesions that progressed during the trials as determined by pairwise comparison of the depth of the lesions on bitewing radiographs. One study used digital subtraction radiography. The 4 trials all reported significant differences in caries progression between the test and fluoride varnish/placebo groups. No significant differences were found between resin infiltration and sealing. Overall, relative risk for proximal caries progression was between 0.11 and 0.46 when either fluoride varnish or a placebo was used in the control group. Therefore, the findings of the systematic review was of cautious support for the use of resin infiltration as a non-invasive approach to manage non-cavitated proximal lesions.
National Statistics published by the Department of Education (2015) show that, in March 2014, there were 48,300 children in England subject to child protection plans. Keene and co-authors found that, in Bradford, these highly vulnerable children have nearly twice the levels of untreated dental decay than children without care protection plans.
In England, if a child is considered at risk of significant harm as a consequence of child maltreatment, one option is to support a family by implementing a child protection plan (CPP). This identifies the risks to the child and specifies exactly how those risks must be reduced. If the required changes to protect a child are not met the child may then be taken into foster care. This challenging and well-conducted study by Keene and co-authors sought to compare the dental health of children subject to CPPs in Bradford, with a control group of children (young patients attending hospital outpatient surgical clinics). Over 13 months, 79 families with children subject to CPPs attended for dental assessments (representing 56% of families with CPPs under Bradford Social Care during the study period). Participants were examined using the standard British Association for the Study of Community Dentistry protocol. The mean ages of children in the study group (n=79) and control group (n=79) were both 5.9 years, and there were no significant differences between the groups in terms of gender or ethnicities. Of note, the study group was significantly more deprived (based on postcode data converted to a score for Index of Multiple Deprivation) than the control group. The key finding was that children in the study group had statistically significantly higher caries experience in their primary teeth than the control group (mean dmft=3.82 for study group, mean dmft=2.03 for control group). Moreover, study group children had nearly twice the level of untreated decay (mean dt=3.2 for study group, mean dt=1.18 for control group). Further statistical analysis using a regression model adjusting for deprivation score and gender demonstrated that being subject to a CPP was an independent predictor for dental caries in primary teeth. Therefore, this study further supports the need for all children subject to CPP and care proceedings to have a dental assessment.