Non-surgical treatment of dentin caries in preschool children – systematic reviewby Duangporn Duangthip, Ming Jiang, Chun Hung Chu, Edward CM Lo

BMC Oral Health


Dentistry (all)


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E co an ua the management of early childhood caries (ECC) [2]. and troublesome. Despite clear guidelines that restorations

Duangthip et al. BMC Oral Health (2015) 15:44

DOI 10.1186/s12903-015-0033-7Faculty of Dentistry, University of Hong Kong, 3/F, Prince Philip Dental

Hospital, 34 Hospital Road, Hong Kong, SAR, ChinaHowever, this procedure requires sophisticated equipment and well trained dental personnel, especially when treating apprehensive young children. Studies have found

ECC being more prevalent among children coming from lower socio-economic groups and high proportions of the should be provided, the feasibility of asking general dental practitioners to restore all the decayed primary teeth has been questioned [6]. Fortunately, the requirements for management of caries in the primary dentition can be different from those in the permanent dentition as the lifespan of primary teeth before tooth shedding is usually about 6–8 years [7]. * Correspondence: edward-lo@hku.hkor restorations have been used as a treatment option forin arresting or slowing down the progression of active dentin caries in primary teeth in preschool children.

Methods: A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947–2014. Keywords and MeSH terms used in the search were “dental caries”, “primary dentition” and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus.

Quality of the included studies was assessed and data were extracted for analysis.

Results: The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children.

Conclusions: There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.

Keywords: Dental caries, Primary teeth, Preschool children, Fluoride, Treatment, Review


Dental caries remains one of the most common childhood diseases worldwide. Beneficial effects of dental rehabilitation on dental and general health of children with dental caries have been reported [1]. Dental fillings cavitated carious primary teeth in preschool children are left untreated [3]. The dental profession is currently faced with an enormous task of how to manage the huge burden of consequences of the caries process amongst the world population [4]. Dentists have barriers to the treatment of

ECC [5]. Providing care for young children can be stressfulNon-surgical treatment o preschool children – syst

Duangporn Duangthip, Ming Jiang, Chun Hung Chu and


Background: Untreated dentin caries in primary teeth is

Recently, the use of simple non-surgical approaches to m

The aim of the study was to systematically review and eval© 2015 Duangthip et al.; licensee BioMed Cen

Commons Attribution License (http://creativec reproduction in any medium, provided the or

Dedication waiver (http://creativecommons.or unless otherwise stated.dentin caries in matic review dward CM Lo* mmonly found in preschool children worldwide. age the situation has been advocated. te the literature on effectiveness of non-surgical methodstral. This is an Open Access article distributed under the terms of the Creative, which permits unrestricted use, distribution, and iginal work is properly credited. The Creative Commons Public Domain g/publicdomain/zero/1.0/) applies to the data made available in this article,

Duangthip et al. BMC Oral Health (2015) 15:44 Page 2 of 10Currently, there is growing evidence that minimally invasive approaches can arrest caries progression such that the involved primary tooth can remain in the mouth till exfoliation without causing the child pain and infection.

Caries arrest treatment with fluorides in various vehicles (toothpaste, gel, varnish, soluation, mouthrinse) has been shown to be a viable alternative to the traditional restorative approach. Studies showed that daily toothbrushing using fluoridated toothpaste (1000 ppm F) could arrest non-cavitated lesions [8] as well as dentin caries lesions [9]. Toothpaste containing higher fluoride concentration, e.g. 5000 ppm, has better results in remineralizing carious lesions compared to those containing 1000 ppm [10]. A number of studies in children have shown that silver diammine fluoride (SDF) solution is effective in preventing dental caries [11,12] and in arresting dental caries [13-15]. Although SDF has been used for more than four decades with no reported complications, adoption by clinicians is still limited, probably due to the black staining associated with the arrested caries lesions [16].

Different modalities for treating caries lesions have been proposed. These include pit and fissure sealants, resin infiltration, xylitol, chlorhexidine, casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) and ozone therapy. The use of fissure sealant over carious lesion as a therapeutic intervention was suggested in the 1970s [17]. Despite the possibility of clinical success in caries arrest, the use of sealant as a therapeutic treatment for caries into dentin is still controversial [18]. An innovative approach to arrest progression of caries in enamel is recently introduced, in which a low-viscosity resin (infiltrant) is used to infiltrate and seal noncavitated interproximal surface carious lesions in permanent teeth [19]. CPP-ACP is suggested as a promising remineralizing agent with a significant effect which has been demonstrated in both in vivo and in vitro studies [20] but the advantage of using CPP-ACP as a supplement to fluoride-containing products is still unclear. Xylitol is non-cariogenic and has a dose-frequency-dependent antimicrobial effect on mutans streptococci [21]. Studies on the caries-preventive effect of xylitol in children have been published [22,23]. In summary, a number of novel nonsurgical treatment options are being developed and debated for the management of caries in permanent teeth.