Conventional fillings are less effective than people imagine

Researchers from the Universities of Leeds, Cardiff, Sheffield, Dundee, Newcastle and Queen Mary University of London have published their findings on the three year Fillings in Children’s Teeth Indicated or Not (FiCTION) trial, in the Journal of Dental Research, and it reveals that there is no evidence to suggest that conventional fillings are any more effective than standard preventative methods or the sealing of tooth decay.

Researchers closely analysed three established methods which are currently used for the treatment of tooth decay in dentist surgeries, including the drill and fill method, the sealing of the decay method and standard preventative methods, to assess how effective the treatments were for the prevention of tooth decay in children. One-thousand-one-hundred and forty-four children between the ages of three and seven took part in the trial, all with evident tooth decay, and they were all given one of the three treatments. Treatment number one consisted of making sure the children were brushing their teeth twice a day with fluoridated toothpaste and that they cut down on their sugary intake to prevent additional caries. Also, fissure sealants were planted onto the first permanent molar teeth and a fluoride varnish was applied to avoid fillings. Treatment number two consisted of preventative methods, in addition to the drill and fill method where dentists removed the decayed tooth by drilling it out and filling the hole with sufficient material. For treatment number three, children were required to under-take the preventative methods and dentists sealed the decay under a filling or metal crown to prevent the further development of decay in the tooth.

Despite all of the methods being widely acknowledged by dentists, clinicians and parents, all three provided no evidence to support the improvement on the children’s dental anxiety, quality of life or pain. Moreover, researchers found that the best option was likely to be ‘sealing the decay’ when managing decay in children.

A co-chief investigator and chair of Preventative Dentistry at Newcastle University, Professor Anne Maguire, stated: “The FiCTION findings have focused attention again on the need to prevent dental decay before it begins but also some reassurance that if decay does develop in a child’s mouth, there are a number of treatment options available which can be tailored to the clinical and behavioural needs of an individual child.”

Lead author of the study and chair of Paediatric Dentistry, Professor Nicola Innes, stated: “Our study shows that each way of treating decay worked to a similar level but that children who get tooth decay at a young age have a high chance of experiencing toothache and abscesses regardless of the way the dentist manages the decay. What is absolutely clear from our trial is that the best way to manage tooth decay is not by drilling it or sealing it in, it’s by preventing it in the first place.”

Another study chief investigator and chair of Dental Public Health at Leeds University, Professor Gail Douglas, stated: “All of the children in our study were chosen to take part because they already had tooth decay and unfortunately even with lots of care and attention from the dentists, once children have decay there’s quite a chance that it will cause further problems. The good news, however, is that tooth decay can be prevented. Brushing your teeth with fluoride toothpaste, especially last thing before bedtime, avoiding sugary drinks and snacks between meals and seeing a dentist regularly are all small habits that can help boost the overall health of your teeth.”