1: Using only preventive techniques recommended in national guidance (better toothbrushing, less sugar in the diet, application of high fluoride varnish and fissure sealants).


2: Conventional fillings with preventive techniques.


3: Biological treatment of the decay (sealing the decay into teeth with filling materials or under crowns, generally without the need to use injections or dental drills) with preventive techniques.


He wants dentists to focus more on prevention than simply treating symptoms. Under his plans, dentists will be encouraged to identify patients at high risk of developing dental disease and spend more time giving them advice on brushing, flossing and diet. Tis will be combined with improved chairside IT systems that will help practitioners identify and manage high-risk patients. Professor Steele said: “Te existing system does need to change and we need to help dentists do what they want to do and look aſter the oral health of their patients. We are going in the right direction but there will be tough times ahead and we will need to keep our nerve to make the changes we need.” But he added: “Dentists can only do so much; parents and schools both have a role, as does wider society.” Tere are also initiatives underway in Scotland to improve child dental health. Around 150 dentists in the Lothians have signed up to the Childsmile scheme aimed at helping under-fives. Under the scheme, children will have fluoride varnish applied to their teeth every six months and will be monitored during regular check-ups. Promoting the project, NHS Lothian’s Robert Naysmith said: “Encouraging the parents of very young children to register them with a dentist will bridge the gap between birth and nursery."


Managing decay


Meanwhile, new research commissioned by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme hopes to finally uncover conclusive evidence of the best way to manage child tooth decay. Te £2.87million FiCTION study will assess three different methods. Te multi-centre trial is taking place in Cardiff, Dundee, Glasgow, Leeds, London, Newcastle and Sheffield and the methods being assessed are:


SUMMER 2011


Dr Nicola Innes, of the University of Dundee Dental School and one of the lead researchers for the trial, said: “Conventional clinical opinion is that baby teeth showing decay should be filled, yet the majority of cavities in young children are leſt unrestored. Tere is, as yet, no conclusive evidence for the most effective approach to managing decay in baby teeth. With this trial we are looking to provide that evidence.”


In the absence of such conclusive evidence, there are various pieces of clinical guidance available to dentists. One of the most recent is Prevention and Management of Dental Caries in Children published by the Scottish Dental Clinical Effectiveness Programme in April 2010.


Their list of priorities for dental teams includes: • encouraging the parent/carer to take responsibility for their child’s oral health


• focussing on prevention of caries in the permanent dentition before management of caries in the primary dentition


• if caries in the permanent dentition does occur, diagnosing it early, and managing it appropriately


• managing caries in the primary dentition using an appropriate technique that maximises the chance of the tooth exfoliating without causing pain or sepsis, while minimising the risk of treatment-induced anxiety


• identifying as early as possible those children where there is doubt about a parent/carer’s ability to comply with dental health preventive advice, support or treatment uptake, and to contact and work collaboratively with other agencies, especially the child’s named health visitor, school nurse or general medical practitioner.


The aim should be to work with families and offer support, as well as taking a rigorous approach to follow-up appointments.


For further information, read British Society of Paediatric Dentistry: a policy document on dental neglect in children at www.bspd.co.uk


n Joanne Curran is associate editor of Summons 19


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