Extent of Tooth Decay in the Mouth and Increased Need for Replacement of Dental Restorations: The New England Children’s Amalgam Trial (NECAT)

Resident: J. Hencler
Date: 12/08/2010

Article title: Extent of Tooth Decay in the Mouth and Increased Need for Replacement of Dental restorations: The New England Children’s Amalgam Trial (NECAT)

Author: Trachtenberg et al.
Journal: Pediatric Dentistry V30/No 5 Sept/Oct 08
Major topic: Factors contributing to restoration replacement

Main Purpose:
Investigate the association b/t the rate of restoration replacement and the number of dfs/dft and DFS/DFT at the time of restoration placement.

Overview of method of research:
Data was collected as part of the NECAT. Children b/w 6-10 years old were eligible if they had no existing amalgams and 2 or more posterior teeth w/ caries requiring occlusal restorations. 534 children were included in the study and randomized to receive either amalgam or composite/compomer restorations. Follow up was completed every 6 months for a five-year period. If a restoration required replacement, the reason was categorized as one of the following: 1) new caries; 2) recurrent caries; 3) fracture; 4) restoration loss; 5) other.

Findings:
Over the 5-year trial, 3,604 restorations with follow-up were placed in 489 children. Median dfs/DFS and dft/DFT were 15 and 8, respectively. Over the entire study, 212 of restorations required replacement due to new caries on adjacent tooth surfaces or recurrent caries. Of these, 69 were in primary teeth and 143 in permanent teeth.

Key points in the article discussion:
It is clear that the need for replacement increased with decay in the mouth. In terms of predicting the need for replacement, the number of dft/DFT rather than surfaces, was the better measure and found to be significantly related to replacement rates. Replacement rates were higher for increasing numbers of dft/DFT. The need for replacement also increased with age, was higher in posterior teeth compared to anterior teeth, and was significantly higher for composite and compomer restorations than amalgam. This paper presents for the first time analyses to investigate the increasing need for restoration replacement due to decay in the mouth. Although this association has been common knowledge among dental practitioners, there have been no prior studies to substantiate this consensus, nor any data to provide info to dentists and patients about the likelihood of replacement. Parents should be informed that dental restorations are susceptible to failure and that this failure may be preventable in the same way that tooth decay is preventable with modifications in OH and diet.

Summary of conclusions:
Children w/ high rates of caries are at higher risk for replacement of restorations. Patients should be informed that dental restorations are susceptible to failure due to factors related to tooth decay such as bacteria, diet, and poor OH.

Assessment of article: Good study.
It quantified what we already know; that high caries risk is related to increased restoration replacement.