DOI: 10.1111/ipd.

12097

Acceptability of different caries management methods for

primary molars in a RCT

RUTH M. SANTAMARIA1, NICOLA P.T. INNES2, VITA MACHIULSKIENE3, DAFYDD J.P.

EVANS2, MOHAMMAD ALKILZY1 & CHRISTIAN H. SPLIETH1
1
Department of Preventive and Pediatric Dentistry, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany,
2
Unit of Dental and Oral Health, School of Dentistry, University of Dundee, Dundee, UK, and 3Clinic of Dental and Oral
Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania

International Journal of Paediatric Dentistry 2015; 25: 9–17 and parents’ and dentists’ treatment opinions
(5-point Likert scales).
Background. More conservative techniques for Results. Children showed more negative behav-
managing dental caries including ‘partial’ and ‘no iour in the CR group (37%) compared to NRCT
caries removal’ have been increasingly of interest. (21%) and HT (13%) (P = 0.047, CI = 0.41 to
Aim. To compare children’s behaviour and pain 0.52). Pain intensity was rated ‘very low’ or ‘low’
perception, also technique acceptability (parents in 88% NRCT, 81% HT, and 72% CR (P = 0.11,
and dentists), when approximal dentinal lesions CI = 0.10 to 0.12). NRCT and HT were ‘very easy’
(ICDAS 3–5) in primary molars (3–8-year-olds) or ‘easy’ to perform for >77% of dentists, com-
were managed with three treatment strategies; pared to 50% in CR group (P < 0.000). There
conventional restorations (CR), hall technique were no statistically significant differences in par-
(HT), and non-restorative caries treatment (NRCT). ents’ rating of their child’s level of comfort
Design. Secondary care-based, three-arm parallel- (P = 0.46, CI = 0.45 to 0.48).
group, randomised controlled trial, with 169 Conclusions. Dentists reported more negative
participants treated by 12 dentists. Outcome behaviour in CR group. For all techniques, chil-
measures: child’s pain perception (Visual Ana- dren’s pain perception and dentist/parent accept-
logue Scale of Faces); behaviour (Frankl scale); ability were similar.

ing that the treated tooth remains symptom-

Introduction less until it sheds naturally. Over the last
In paediatric dentistry, the common challenge decade, there has been a move away from
for clinicians and parents is to allow children the conventional restorative (CR) approach to
to experience dental treatment in an atmo- more conservative techniques, which
sphere created to empower the child and embrace changing the carious lesion environ-
maximise their ability to cooperate with, and ment to no longer favour cariogenic biofilm
accept treatment. Although the behaviour of development5. Specific to primary teeth, two
dentists and dental staff plays an important of these treatment approaches, which are
role in behaviour management of paediat- becoming increasingly widely used, are the
ric patients, there is evidence that different hall technique (HT)6, involving no caries
types of treatment might influence chil- removal and sealing, and non-restorative car-
dren’s behaviour and perceptions of dental ies treatment (NRCT)7. Although there is
treatment1–4. growing interest in NRCT, there is limited
For carious primary teeth, the ideal ‘child- investigative work to support its use8–10. Nev-
friendly’ therapy would be to manage the car- ertheless, current guidelines in the UK11 and
ies lesion without causing the child any USA12 still recommend complete caries
stress, preserving pulp vitality, and guarantee- removal and placement of a restoration for
carious primary teeth.
The need for outcomes to ‘portray the per-
Correspondence to: spectives of patients…’ and therefore consider
Ruth M. Santamaria, Department of Preventive and
Pediatric Dentistry, Ernst-Moritz-Arndt University of
their perceptions of treatment has been
Greifswald, Rotgerberstr. 8, 17487 Greifswald, Germany. discussed in the literature13. Caries manage-
E-mail: ruth.santamaria@uni-greifswald.de ment and restorative-related studies in chil-

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 9
10 R. M. Santamaria et al.

dren tend to report their results as technique/ col was explained to, and discussed with, the
material efficacy and/or longevity of the res- dentists. Training consisted of instruction in
toration. Behaviour of, and discomfort experi- carrying out the interventions in each arm
enced by, children during dental treatments is with video and ‘hands on’ training for areas
rarely considered as treatment outcomes and that each individual felt less confident in, espe-
reported on. cially the hall technique and NRCT, and cali-
This study aims to compare children’s bration on outcome measurements.
behaviour and pain perception when approxi-
mal dentinal caries lesions in primary molars
Participant screening and eligibility assessment
(in children aged 3–8 years old) were man-
aged with three treatment strategies; conven- A single researcher (RS) screened for possible
tional restorations (CR), the hall technique study participants. Children aged 3–8 years
(HT), and non-restorative caries treatment old, and their parents, were invited to partici-
(NRCT). The acceptability of the techniques pate in the study if they met the following
to parents and dentists was also investigated. inclusion criteria:
This report is part of a long-term clinical 1) at least one primary molar tooth with
trial, which aims to determine the clinical caries into dentine involving two dental
efficacy of three caries treatment approaches surfaces (diagnosed according to ICDAS,
CR, HT, and NRCT in primary teeth. Results codes 3–5);
related to the clinical outcomes and potential 2) willing to be examined.
failures will be examined after 1 year and Exclusion criteria were as follows:
2 years follow-up. 1) clinical or radiographic signs or symptoms
of pulpal or periradicular pathology
(including pain);
Materials and methods
2) patients with a systemic disease requiring
special considerations during their dental
Study design and ethical approval
treatment; and
This is a secondary care-based three-arm, 3) parents/children who declined to partici-
parallel-group, patient-randomised controlled pate in the study.
trial (RCT) conducted in the Paediatric Den- Only one tooth per child was included in
tistry Department of Greifswald University, the study. Where more than one tooth per
Germany. Ethical approval was obtained child was eligible for inclusion, the next tooth
from the Research Ethics Committee of the on the prescribed treatment plan, at the time
University of Greifswald, under the protocol of screening by one of the researchers (RS),
number BB 39/11 (Registration number was chosen for the study.
NCT01797458). The study was conducted in Parents of participants had the study dis-
accordance with the principles for medical cussed with them and gave written consent
research involving human subjects described for their children to participate. Details of
by the Helsinki Declaration. patient recruitment and follow-up are pre-
sented in the Consort diagram (Fig. 1)14.
Treating dentists
Treatment appointment
To increase generalisability, treatments were
carried out by 12 different dentists (seven pae- Following consent, participants were sequen-
diatric specialists and five post-graduate paedi- tially randomised, using a computer-generated
atric students, all of whom treat 10–20 patients random number list with allocation conceal-
per week, with an average age of three to ment, to one of three arms. Parents were
6 years old). The majority of the dentists always present when treatment was performed.
(75%) were 26–45 years old (mean = 35.1; 1) Conventional restoration (CR): Local
SD = 10.3), with 58% female and 42% male. anaesthesia was used where needed,
Before recruiting any patients, the study proto- according to child’s requirement and

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Caries treatment methods for children: Acceptability 11

Fig. 1. Study CONSORT diagram14.

operator preference. A high-speed hand- 3) Non-restorative caries treatment (NRCT):

piece was used to gain access to the approximal carious lesions were opened
lesion; peripheral caries was removed using a high-speed bur to remove the
with a slow handpiece and an excavator undermined and overhanging enamel and
to cleave away the carious dentine from make the cavity accessible for plaque
the pulpal wall. A matrix band was then removal, without the use of local anaesthe-
used (T-Bands, Pulpdent, Watertown, sia. After removal of any residual plaque
MA, USA; or porta-matrix Tofflemire with a rotary bristle brush, fluoride varnish
Retainer with Tofflemire Bands, Henry (Duraphat, GABA, Lörrach, Germany) was
Schein Inc., Melville, NY, USA) and a applied to the cavity. Tooth-brushing
wedge (Interdental Wedges, Kerr, Biog- instructions were given to the parents/chil-
glo, Switzerland), applied to tightly hold dren, both in general for the whole mouth
the band against the tooth. All the and site-specific for the treated tooth.
cavities were restored with Compomer
(Dyract, Dentsply, Konstanz, Germany).
Outcome measures
2) Hall technique (HT): following the HT
manual (http://dentistry.dundee.ac.uk/ Immediately following treatment, the child-
cariology), to place the crown, no caries rens’, parents’, and dentists’ perceptions and
removal or tooth preparation were carried opinions of the treatment at that particular
out and no local anaesthesia was placed. appointment were assessed:
Hall crowns were cemented with glass 1) Behaviour: Child’s behaviour during the
ionomer luting cement (GC Fuji TRIAGE, operative session was assessed by the
GC corporation, Tokyo, Japan). dentists using the Frankl Behavior Rating

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
12 R. M. Santamaria et al.

Scale15. This four-point scale ranges from ‘events’ carried out (52 HT, 52, NRCT and 65
definitely negative behaviour, when the CRs).
child refuses the treatment, cry, etc., to
definitely positive behaviour, when the
Baseline characteristics of participants and teeth
child is completely cooperative.
2) Pain: The VASOF16 was used to measure There were no significant differences between
pain experience. The five-point scale the three randomised groups for boy/girl distri-
includes five faces of children representing bution; d3mft values (P = 0.25, CI = 0.25 to
from very light to very intense pain. Chil- 0.27); or ICDAS categories (P = 0.35, CI = 0.35
dren were asked to select the face that rep- to 0.70) (Table 1). There was also no signifi-
resents how he/she felt during treatment. cant difference in the overall age of boys
3) Treatment perceptions and opinions: (mean = 5.61; SD = 1.49) and girls (mean =
Five-point Likert scales were used to 5.49; SD = 1.42; P > 0.05) between the groups.
assess parents’ perceptions of their child’s There were differences in the age spread for
behaviour, comfort during treatment and younger/older children (3–5/6–8 years) between
satisfaction with treatment undertaken CR group (where 37% were 3–5 years) and the
and dentists’ ease of treatment provision/ HT group (62% were 3–5 years), P = 0.008
material, patients’ discomfort and the rel- (CI = 0.01 to 0.07) independently comparing
ative time for the procedure. Parents two samples with a Bonferroni-corrected
were also asked whether they would Mann–Whitney U-test. First primary molars
choose the same treatment option again, comprised 69% (116) of the study teeth, and
and dentists were asked which treatment 31% (53) were second primary molars
option, out with the study, they would
have chosen for that tooth.
Children’s behaviour
Thirty-seven percent of children who received
Data analysis
CRs were rated by their dentist as having ‘defi-
Data analyses were performed using the SPSS soft- nitely negative’ or ‘negative’ behaviour, com-
ware for Windows (version 17.0. Chicago, IL, pared with 21% in the NRCT group and 13% in
USA: SPSS Inc.). To determine the statistical sig- the HT group [P = 0.047, confidence interval
nificance of differences in children’s behaviour (CI) 0.041 to 0.052] (Table 2). This difference
and between treatment arms, the data for chil- was also observed when the younger child age
dren’s pain perception, parents’ and dentists’ group (3–5 years) was analysed independently;
treatment opinion, differences between youn- P = 0.044 (CI 0.04–0.05); however, significant
ger/older children (3–5/6–8 years), and distribu- differences were not found between groups for
tion of ICDAS categories among the groups were the older ages (6–8 years) of children; P = 0.13
analysed using nonparametric Kruskal–Wallis (CI 0.12–0.14).
analysis of variance and Bonferroni-corrected Child behaviour was not affected by the
Mann–Whitney U-test. For parametric variables dentists’ level of experience (specialists vs.
(age, d3mft), comparisons were performed using post-graduate students); P = 0.46 (CI = 0.44–
analysis of variance (ANOVA). The level of 0.47). In the CR group, local anaesthesia was
significance was defined as P < 0.05. administrated to 52% of the patients. Within
this group, the children’s behaviour did not
differ significantly between children treated
Results
with, and those without, local anaesthesia;
From 181 eligible patients, 169 (93%) 3–8- P = 0.43 (CI = 0.41–0.44).
year-old children (96 boys and 73 girls)
joined in the study. The 12 participating den-
Pain intensity
tists recruited between one and 40 patients
over a period of 18 months (4/2011-11/ Regarding pain intensity (Table 3), it was
2012). There were, therefore, 169 treatment rated as ‘very low’ to ‘low’ in 88% NRCT,

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Caries treatment methods for children: Acceptability 13

Table 1. Children’s’ baseline characteristics according to treatment group (n = 169 children).

Gender Age Tooth of treatment

Mean in years 3–5-year 6–8-year First primary Second primary

Group Boys (%) Girls (%) (range; SD) olds (%) olds (%) molars (%) molars (%) d3mft

CR 36 (55) 29 (45) 5.77 (5; 1.32) 24* (37) 41* (63) 40 (62) 25 (38) 5.34
HT 33 (63) 19 (37) 5.25 (5; 1.56) 32* (62) 20* (38) 38 (73) 14 (27) 5.96
NRCT 27 (52) 25 (48) 5.62 (5; 1.48) 25 (48) 27 (52) 38 (73) 14 (27) 5.58

CR, conventional restorations; HT, hall technique; NRCT, non-restorative caries treatment.
Mean number of decay, missing and filled primary teeth (d3mft).
*CR-HT, P = 0.008, (CI = 0.01–0.07) Bonferroni-corrected Mann–Whitney U-test.

Table 2. Children’s behaviour during treatment (n = 169 children).

Non-restorative Conventional
Hall technique Caries Treatment Restorations
n (%) n (%) n (%) P-values

Definitely positive 26 (50) 22 (42) 23 (35)

Positive 19 (37) 19 (37) 18 (28)
Negative 7 (13) 8 (15) 22 (34) P = 0.047*
Definitely negative 0 (0) 3 (6) 2 (3) P = 0.013†
Total 52 52 65

*Kruskal–Wallis test for comparison among three groups for negative and definitely negative behaviour combined.
†Mann–Whitney U-test for comparison between NRCT and CR for negative and definitely negative behaviour combined.

Table 3. Children’s pain perception during treatment (n = 169 children)

Non-restorative Conventional
Hall technique caries treatment restorations
n (%) n (%) n (%) P-values

Very low 28 (54) 34 (65) 38 (58) P = 0.11*

Low 14 (27) 12 (23) 9 (14)
Moderate 5 (10) 4 (8) 12 (18)
Intense 3 (6) 0 (0) 2 (3)
Very intense 2 (4) 2 (4) 4 (6)
Total 52 52 65

*Kruskal–Wallis test for comparison among three groups for ‘very low’ and ‘low’ combined.

81% HT, and 72% CR, with no significant while in the CRs group, this was 50%
differences between the groups; P = 0.11 (P < 0.000). Related to procedure duration,
(CI = 0.10–0.12). Similarly, no significant dif- most of the dentists considered the NRCT
ferences were observed between treatments (89%) as a ‘very short’ or ‘short’ procedure
in younger/older children. Pain intensity was to undertake. The distribution of the data is
not significantly affected by the dentists’ level shown in Table 4. When dentists were asked
of experience. Within the CR group, the use about the treatment option, they would have
of local anaesthesia did not influence the chosen if the child/ tooth has not been in the
children’s perception of pain (P = 0.90, study, for each specific case, the majority pre-
CI = 0.89–0.91). ferred CR (72%), followed by stainless steel
crowns using the conventional technique
(17%), with few (7%) considering the NRCT
Dentists’ opinion
as an alternative treatment, 4% chose
Dentists rated each treatment event another treatment option or did not answer
(n = 169); NRCT (89%); and HT (77%) being the question, and none of the dentists chose
‘very easy’, or ‘easy’ treatments to perform, the HT as an option for treatment.

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
14 R. M. Santamaria et al.

Table 4. Dentists’ opinion about each treatment (n = 169 treatment events).

Non-restorative Conventional
Hall technique caries treatment restorations
n (%) n (%) n (%) P-values

Procedure undertaken
Very easy 26 (50) 31 (60) 16 (25) P < 0.000*
Easy 14 (27) 15 (29) 16 (25)
Manageable 8 (15) 6 (12) 32 (49)
Difficult 4 (8) 0 (0) 1 (2)
Very difficult 0 (0) 0 (0) 0 (0)
Total 52 (100) 52 (100) 65 (100)
Technique difficulty
Very easy to handle 29 (56) 36 (69) 17 (26) P < 0.000†
Easy to handle 12 (23) 13 (25) 21 (32)
Manageable 9 (17) 3 (6) 27 (42)
Difficult to handle 2 (4) 0 (0) 0 (0)
Very difficult to handle 0 (0) 0 (0) 0 (0)
Total 52 (100) 52 (100) 65 (100)
Treatment duration
Very short 24 (46) 27 (52) 10 (15) P < 0.000‡
Short 11 (21) 19 (37) 21 (32)
Time-efficient 12 (23) 5 (10) 28 (43)
Long 5 (10) 1 (2) 5 (8)
Very long 0 (0) 0 (0) 1 (2)
Total 52 (100) 52 (100) 65 (100)
Child’s level of discomfort
No apparent 21 (40) 23 (44) 21 (32) P = 0.16
Very mild 17 (33) 21 (40) 22 (34)
Mild, significant 5 (10) 6 (12) 17 (26)
Moderate 9 (17) 1 (2) 4 (6)
Significant, unacceptable 0 (0) 1 (2) 1 (2)
Total 52 (100) 52 (100) 65 (100)

*,†Kruskal–Wallis test for comparison among three groups for ‘very easy’ and ‘easy’ combined.
‡Kruskal–Wallis test for comparison among three groups for ‘very short’ and ‘short’ combined.

ment methods: non-restorative caries treat-

Parents’ perception of child behaviour and comfort
ment (NRCT), hall technique (HT), and
None of the parental responses (treatment conventional restorations (CR) in approximal
satisfaction, children’s behaviour/comfort) carious lesions without pulp involvement in
showed statistically significant differences primary molars.
between the groups. Although, the great The main differences observed among the
majority of parents (>74%) were very satis- three treatment groups were in dentists’ per-
fied with the procedures and >98% were ception of children’s behaviour, where they
happy to have the treatment again; 75% reported that children in the HT and NRCT
rated their child as ‘very comfortable’ with groups responded more favourably compared
the HT, compared to 65% with CR and 61% to those of the CR group. When these differ-
with NRCT; however, this did not reach the ences were analysed independently in the
level of statistical significance (P = 0.46, two age groups (3–5 vs 6–8 years), significant
CI = 0.45–0.48). Children’s behaviour was differences were still observed only in the
rated as very good or good by more than younger child age group. This fits with various
80% of parents. studies reporting a positive relationship
between age and different behavioural aspects
related to dental treatment17–19. Younger
Discussion
children show more challenging behaviour
This study assessed the acceptability and pain during dental treatment compared to older chil-
perception of following three caries manage- dren; however, ability to cope improves as the

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Caries treatment methods for children: Acceptability 15

child gets older20,21. Furthermore, placing a res- they thought they should because there was
toration in a Class II cavity with resin-based a good therapeutic relationship. This was con-
materials presents a unique set of challenges for sidered a possible problem in one study
the dentist, including the anaesthetic require- where children’s pain experience with differ-
ments, moisture control and need for a matrix ent gauges of needles was investigated26. The
band, with everything leading towards longer authors stated ‘the vast majority of children
procedure duration, and increased require- rated the injection experience as positive,
ments for patient’s cooperation. Therefore, it is although there were objective signs of pain
not unexpected that the dentists’ perception of like crying’. Additionally, some studies have
children’s behaviour was more favourable with reported that the assessment of pain intensity
less technique demanding procedures like the by other sources not always correlates highly
HT or NRCT, which also took less time to carry with children’s self-assessment of pain and it
out. Similar results were reported in a rando- may possibly mirror diverse views of the pain
mised clinical trial22 that, among other things, experience27.
compared the acceptability of the HT with CR Favourable clinical results for Stainless Steel
for the general practitioners. In this study, the Crowns (SSCs) in the primary dentition have
majority of dentists rated the HT (89%) as caus- led to their wide recommendation as the res-
ing none to mild discomfort for children toration of choice for multisurface carious
compared to CR (78%; P = 0.012). primary molars28,29. Still, many dentists avoid
An unexpected but interesting finding was the use of SSCs assuming this technique is
that children’s own reports of pain perception complex and time-consuming30 or because
did not differ significantly between the three parents/children might not like the aesthetic
treatment groups, nor was it affected by the results of the crowns31. Interestingly, in our
dentists’ level of experience. All clinicians study, an overall good level of acceptance of
were either paediatric dental specialists or SSCs was observed with the HT, with 88% of
post-graduate paediatric trainees, and all trea- the parents ‘very satisfied’ and rating their
ted children on a regular and frequent basis. child as experiencing great comfort with the
In addition, trained support staff and designed technique (75%), which is in agreement with
child-friendly surgeries could have contrib- a previous study32.
uted to the children’s positive treatment In more than three-quarters (77%) of the
perception, as has also been suggested in a treatment events, the dentists rated the HT
previous study by Roberts et al.,23 and this procedures as ‘very easy’ or ‘easy’ compared
included cases where local anaesthesia was to 50% for CRs. The scores were similarly
required. A cross-sectional study24 analysed higher for each category, when they were
the management of fear and dental anxiety in asked about their opinion of the techniques
children by general dentists and specialists in (Table 4). Despite this, none of them said
paediatric dentistry. This study showed that they would choose the HT as an alternative
paediatric dentists routinely used a broader option for any treatment event. Similarly, in
range of behavioural management techniques very few cases (7%) did the dentists consider
in order to improve patients’ cooperation, NRCT as an option for treatment. The HT was
and this positively influences children’s coop- introduced to the clinic and taught to the
eration and reduces dental anxiety during clinicians as part of this trial, so they were
dental treatment. unfamiliar with it. On the other hand, NRCT
Although there is limited research on the is a relatively well-known treatment option
validity and reliability of tools to measure to many of the dentists in this study. Anec-
children’s perceptions of dental treatment, dotally, it seems that the procedure’s limited
dentists have shown to accurately rate chil- financial reimbursement by the payment
dren’s discomfort25. The differences in the systems outside of the University environ-
rating of pain or discomfort between dentists ment is a disincentive to carry out NRCT and
and children might be that children were it has not been commonly considered as a
trying to please the dentists or answering as definitive treatment itself. Interestingly, fol-

© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
16 R. M. Santamaria et al.

lowing this trial, the HT and NRCT are both compared to those treated with CR. When
routinely being performed in the paediatric children themselves were asked about com-
dentistry department at Greifswald University fort of the procedure they had undergone,
indicating an increase in the level of none of the three treatments were rated as
acceptance and use of these techniques. less comfortable than another. NRCT and HT
One of the concerns with the HT has been were rated as easier to perform, compared to
the occlusal interference33, which did not CR (P < 0.000), by dentists. The techniques
present as a problem to children in this study. compared in this study were, generally,
Although it was not possible to standardise a viewed favourably by clinicians, children, and
control appointment for the child participants their parents. Their clinical effectiveness
(mainly due to the distances the patients should be further evaluated.
have to travel to reach the clinic) to deter-
mine changes in the overbite, all parents
were advised to contact the clinic by tele- Why this clinical report is important to paediatric
phone if a problem with the treated tooth dentists
occurred. No parent called and no patient ● To our knowledge, no randomised controlled trial has
been published addressing the acceptance and percep-
returned with discomfort. tion/ opinion of non-conventional caries treatment
Non-restorative caries treatment is an alter- methods in comparison with conventional restorative
native treatment to conventional restorative techniques assessed by children, their parents, and
dentists.
techniques, which aims to arrest the carious
● This paper demonstrates the potential of non-conven-
lesion by controlling bacterial plaque7. In this tional methods for approximal carious lesions man-
study, NRCT showed an overall good level of agement for primary molars, in terms of children’s
acceptance with dentists rating it as the easi- pain perception, parents’, and dentists’ technique
acceptability.
est and most time-efficient of the three ● This paper informs clinicians’ expectations of chil-
groups. Furthermore, children’s behaviour dren’s behaviour and pain perception when non-con-
was better in the NRCT group when com- ventional caries treatment methods like the HT and
NRCT are performed.
pared to CR, but similar to the HT. In
addition, NRCT could also be seen as a child-
friendly technique that would let the dentist
desensitise especially fearful and anxious Acknowledgements
children by exposing the child progressively We thank the children, their parents, and
to the treatment, while simultaneously con- dentists who took part in this study. This
trolling caries lesions. This fits the modern study has been supported by the Paediatric
philosophy of minimal intervention simulta- Dentistry Department of Greifswald Univer-
neously empowering parents to take responsi- sity, Germany.
bility for caries control7.
For the HT, 5-year results6 have shown
Conflict of interest
favourable outcomes for pulpal health and
restoration longevity. For NRCT, however, The authors declare no conflict of interest
there is little data available from observa- with respect to the conduct, authorship and/
tional or recently a clinical study8–10. The or publication of this article.
high acceptance of alternative treatments like
the HT or NRCT offers interesting options for
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