subject 유치: 파내고 충전치료하는것이 최선인가?
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date 19-12-17 15:07
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2019 Nov 26:22034519888882. doi: 10.1177/0022034519888882. [Epub ahead of print]

Child Caries Management: A Randomized Controlled Trial in Dental Practice.

Author information

1
School of Dentistry, University of Dundee, Dundee, UK.
2
Dental Health Services Research Unit, University of Dundee, Dundee, UK.
3
School of Dentistry, University of Leeds, Leeds, UK.
4
Institute of Health and Society, Newcastle University, Newcastle, UK.
5
School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
6
Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK.
7
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
8
School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
9
Institute of Dentistry, Queen Mary University of London, London, UK.

Abstract

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co-primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: -2% [-10% to 6%]) or PA (4% [-4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005). 

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