Pain prediction for preventive non-operative management of dentinal caries in primary teeth in general dental practice

Abstract

Objective: To provide a pain-predictive model for the non-operative management of carious deciduous teeth from the analysis of data from a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care. Design: A clearly defined protocol was used to determine the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored from the sequential examination of the clinical records of 480 children attending at least annually. Results: The age of the children at the first visit when carious teeth were diagnosed ranged from 0.8 to 12.3 years, with the majority of children (243/480) presenting by 6 years of age. In all, 250 teeth from 162 children were extracted because of pain or became painful and were treated. The remaining 318 children did not report pain on subsequent visits. The strongest predictor of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. Data from the present study provides a model that enables a child with deciduous caries to be placed into one of six pain-predictive groups associated with a risk of pain or infection if the teeth are not restored but provided with preventive care only. Conclusion: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. A higher risk of subsequent pain or infection was associated with the development of caries in younger patients, disease extending beyond single surfaces, and disease in lower deciduous molars. The results provide evidence to aid the treatment planning of carious deciduous teeth in children receiving regular preventive dental care.