Community Dental Health

cover art

Cover Date:
June 2006
Print ISSN:
0265 539X
Vol:
23
Issue:
2

Editorial - Providing children with the quality dental care they deserve

We have some of the best data for the dental disease experience in children in the United Kingdom through a tradition of dental health surveys carried out every 10 or so years. Over the last 30 years, these surveys have provided us with figures which have been interpreted by the academics in Dental Public Health and politicians alike to convey to the world the tremendous dental health that children of the United Kingdom enjoy. But these headline statistics mask the high levels of disease borne by many children usually from deprived backgrounds. It also masks the fact that this burden of managing these high levels of disease falls upon the shoulders of the clinicians at the coal face. These clinicians face the unenviable task of dealing with a population with many social problems and a service that is woefully under funded. Given this background it is no surprise that the published Care Index for 5-year-old children (Pitts et al., 2005), reflecting the percentage of caries that is treated with restorative care, is a matter of national shame. Even for 11-year-old children, where only caries in the permanent teeth at the level of dentine was considered, the care index on average was around 41% but could be as low as 20% in some parts of the country (Pitts et al., 2006), meaning that in some areas four out of five permanent decayed teeth where caries was into dentine were not being restored. These figures should send a shiver down the spine of every dental health professional, who believes that dentistry is a caring profession. How can we condone the non treatment of a disease that carries such a high morbidity and knowingly put the child at risk of pain and suffering? The recent debate in the U.K on whether to restore decayed primary teeth at all was sparked by the publication of a paper (Tickle et al., 2002) in which the discussion, conclusions and extrapolation of the results by the authors were in many instances speculative and not always a true reflection of the methods used and of the results of the study. The most important conclusion of the study that there was no difference in the outcome measures of pain, extractions etc. between teeth that were restored or left unrestored cannot stand up to scrutiny because the quality of the restorations performed in the teeth to which the unrestored teeth were compared was unspecified. Other studies have shown that untreated caries in young children, especially preschoolers carries a high morbidity, including pain (Levine et al., 2002; Shepherd et al., 1999). A more recent study (Pine et al., 2006) clearly showed that the proportion of children with sepsis increases markedly with caries experience and this problem can be mitigated if more caries is treated. The authors, who based their findings on a sample of nearly seven thousand 5-year-old children in Scotland, concluded rightly that the findings of their study would not support a policy of non-intervention for primary teeth. It is obvious that when the presenting complaint is that of sepsis, the tooth is more likely to be extracted. Milsom et al., (2003) showed that extraction in pre-school children was highly likely to be associated with fear of dental procedures. This in my view is as strong an argument as any for good quality restorative care for carious primary teeth, with restorations that are performed to standards that do not circumvent the basic principals of restorative dentistry, as is often the case when primary teeth are restored in general dental practice. Wedging a dollop of glass ionomer cement between cavity walls after inadequate removal of caries without local analgesia is not good quality restorative dentistry, and it is no surprise that such restorations frequently fail further precipitating the myth that restorations in primary teeth don’t work as well as in the permanent. Children deserve better. Dentists need to be better trained in the diagnosis of the state of pulp in response to proximal caries in primary molars. It was shown three decades ago (Hobson, 1970) and more recently again (Duggal, 2002) that pulp inflammation sets in early especially for proximal caries, and precedes the exposure of the pulp. A high failure rate of restorations in general dental practice is a reflection that many such teeth are restored without due consideration to the pulp inflammation, longevity of restorative materials or principles of cavity design. Teeth with proximal caries are usually restored with conventional restorations when they should have been restored after pulp therapy (pulpotomy) has been carried out to remove the inflamed part of the primary dental pulp. This would certainly put an end to the myth that the restoration of primary teeth is futile. It is obvious to me that those who feel that providing good quality restorative dentistry with local analgesia in children is tantamount to “traumatic dental treatment” have never provided such care and are ignorant of the positive effects that good quality dental care has on the child’s long term dental attitudes. We all hear the people who advocate a non-interventionist approach call for evidence when challenged. There is ample evidence in the literature to show that primary teeth restored following principles of good restorative practice, preceded and followed up with a tailor made preventive programme do very well indeed and excellent success rates have been reported (Mass et al., 1999; Fuks et al., 2000). Also, in countries where emphasis is on restorative dentistry for children, fewer children are subjected to the archaic practice of extractions of teeth under a general anaesthesia as practiced rampantly across the U.K. In no other European country is the use of dental general anaesthesia for extractions of children’s teeth so prevalent and this is unlikely to change unless our care index improves in general dental practice and the dentists apply the same principles to restore primary teeth as they do permanent

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Page Start
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Articles from this issue

  • Title
  • Pg. Start
  • Pg. End

  1. Editorial - Providing children with the quality dental care they deserve
  2. 66
  3. 68

  1. The impact of fixed orthodontic appliances on daily life
  2. 67
  3. 74

  1. Service quality implications of dental undergraduate outreach teaching for Primary Care Trusts in England, UK.
  2. 75
  3. 79

  1. Prevalence of hypodontia and hyperdontia in paedodontic and orthodontic patients in Budapest
  2. 80
  3. 82

  1. Psychometric properties of the Arabic version of the Dental Cognition Questionnaire
  2. 83
  3. 90

  1. Dental caries experience in preschool children in Veneto region (Italy)
  2. 91
  3. 94

  1. Improving access to dental care in East London’s ethnic minority groups: community based, qualitative study
  2. 95
  3. 100

  1. The unequal burden related to the risk of oral cancer in the different regions of the Kingdom of Saudi Arabia
  2. 101
  3. 106

  1. Can oral health promotion help develop masticatory function and prevent dental caries?
  2. 107
  3. 115

  1. The equity of access to primary dental care for children in the North East of England
  2. 116
  3. 119

  1. Presidential Address
  2. 120
  3. 122