Documente Academic
Documente Profesional
Documente Cultură
René JM Gruythuysen
Questioning the restorative lesions cleansable. This was first advocated to plaque control. However, deciduous teeth
approach for use in young children by GV Black in are exfoliated and perhaps non-operative
Some definitions and their 1908.2 His non-restorative approach was treatments (plaque control, fluoride, diet) are all
corresponding acronyms start this section: based on his belief in plaque control to that are required to take cavitated teeth pain-
Non-Restorative Cavity Treatment (NRCT) manage caries and his insistence that the free to exfoliation’.3
is a non-restorative method of controlling most important thing in treating children The present paper stresses the
dentine lesions. It sits alongside Non- was not to frighten them. In addition, in 1908 role of the parent/carer and the oral health
Operative Caries Treatment Programme the filling materials available were amalgam team to NRCT, a technique which makes it
(NOCTP), a method of controlling enamel and gold inlays, neither really suitable for use possible for the carer to manage caries by
lesions. Taken together, this non-restorative in primary teeth. The method is still relevant plaque control rather than relying on fillings.
management of enamel and dentine lesions today because it is a biological, child-friendly The paper will start by describing the clinical
is called Non-Restorative Cavity Control approach to reduce, and preferably stop, the aspects of NRCT, then the significance of
(NRCC).1 caries activity. supporting the carer will be addressed. It is
NRCT manages cavitated caries Some years ago Edwina Kidd this person who controls caries and effective
lesions without placing fillings by making the questioned the traditional restorative communication between the oral health
approach to treating decayed deciduous team and the carer is essential to the success
teeth: ‘Whether deciduous teeth should be of the technique. Subsequently, the attitude
restored has caused controversy for at least of both the oral health team and the carer to
150 years and the argument rages on. Dental the technique will be considered. Do either
René JM Gruythuysen, PhD, Retired caries is a controllable process. The role of consider that they can be in control of the
Dentist, Post-academic Teacher Paediatric operative dentistry and restorations, as far oral health promoting outcome? At the end
Dentistry, Tandzorg.nl, Rotterdam, The as caries control is concerned, is to make of the paper the results of clinical trials will
Netherlands. Email: r.gruyt@planet.nl cavitated, uncleansable lesions accessible be discussed.
220 DentalUpdate March 2019
PaediatricDentistry
a a
parents with regard to the current state of can have an impact on our viewpoint and the with respect to the oral behaviour of their
the oral health. That’s why, despite preventive way we interact with our environment. People patients. Other oral health providers blame
instructions, fillings will often fail due to new who base their success on their own work outside forces, such as bad co-operation of
caries (Figure 7). Non-restorative treatment and believe that they control their life have patients and public services, for the poor
methods, on the other hand, focus solely on an internal locus of control. In contrast, people oral health behaviour of their patients. They
stopping caries activity by plaque removal. who attribute their success or failure to outside have an external locus of control. Their
These methods are all about guidance of oral influences have an external locus of control. attitude is: whatever they do is doomed to
health care and transferring responsibility to There is currently interest in the failure because of forces beyond their control
where it has to be, with the carer (Figure 8). locus of control in patients.17 Regarding caries (Figure 9). Could the unfounded criticisms
This means motivating parents to re-brush prevention and the management of pre- of NRCT be a sign of an external locus of
their child’s teeth every day. Failure is very cavitated caries lesions, it is stated that: ‘Non- control?
obvious to the carer on recall because the invasive therapies can also be effective to arrest Non-restorative cavity treatment
sliced tooth shows an active caries lesion. cavitated lesions but the success depends greatly may stand or fall with the locus of control of
on behavioural changes of patients to brush the oral health provider (Figure 9). Could it
Locus of control the lesions’.18 Patients’ locus of control may be be that oral health providers with an external
This section contains a suggestion relevant to whether they make the necessary locus of control focus on the weaknesses
for consideration. The suggestion is unproven behavioural changes. Do they believe that of non-restorative cavity treatment (see
and contentious!: they are in control and that their actions will criticisms above) in order to avoid its
Is an oral health provider’s attitude make a difference? However, should the locus application? Those with an internal locus
to NRCT dependent on his/her locus of control? of control of the oral health provider also be of control may see the same criticisms as
Locus of control is the framework considered? Might this also be relevant to the challenges to encourage improving the
of Rotter’s social-learning theory of outcome and to whether the NRCT approach is method. Hansen was the first researcher to
personality.16 It is the extent to which people chosen at all? And if ‘yes’, to what extent? show that self-reflection was relevant to at
believe that they can influence the events in Some oral health providers think least 33% of the failures in a 9−44 months
their lives. Is our locus of control internal or that they can improve the oral health of their prospective clinical evaluation of NRCT.19
external? Our perception of where control lies patients. They have an internal locus of control Unfortunately, there are no data of the locus
March 2019 DentalUpdate 225
PaediatricDentistry
of integral approach (Dutch). Ned Tijdschr controlled clinical trial. 2015; 25: 9−17.
Geneeskd 2015; 159: A8071. Clin Oral Investig 2014; 8: 1061−1069. 28. Santamaria RM, Innes NPT, Machiulskiene V
16. Rotter JB. Social Learning and Clinical 22. Leal SC, Bronkhorst EM, Fan M, Frencken et al. Alternative caries management options
Psychology. New York: Prentice-Hall, 1954. JE. Effect of different protocols for treating for primary molars: 2.5-year outcomes of a
17. Duijster D, de Jong-Lenters M, Verrips E, van cavities in primary molars on the quality of randomised clinical trial. Caries Res 2017; 51:
Loveren C. Establishing oral health promoting life of children in Brazil − 1 year follow-up.
605−614.
behaviours in children – parents’ views on Int Dent J 2013; 63: 329−335.
29. Nyvad B, Fejerskov O. Active root surface
barriers, facilitators and professional support: 23. Nainar SM. Is it ethical to withhold
caries converted into inactive caries as a
a qualitative study. BMC Oral Health 2015; 15: restorative dental care from a child with
157. occlusoproximal caries lesions into dentin response to oral hygiene. Scand J Dent Res
18. van Loveren C, van Palenstein Helderman of primary molars? Pediatr Dent 2015; 37: 1986; 94: 281−284.
W. EAPD interim seminar and workshop in 329−331. 30. Schwendicke F, Krois J, Splieth CH, Innes N,
Brussels May 9 2015: Non-invasive caries 24. Andropoulos DB, Greene MF. Anesthesia and Robertson M, Schmoeckel J, Santamaria RM.
treatment. Eur Arch Paediatr Dent 2016; 17: developing brains − implications of the FDA Cost-effectiveness of managing cavitated
33−44. warning. N Engl J Med 2017; 376: 905−907. primary molar caries lesions: a randomized
19. Hansen NV, Nyvad B. Non-operative control of 25. Frachella J. United States: Personal trial in Germany. J Dent 2018; 78:. 40−45.
cavitated approximal caries lesions in primary communication, 2017. 31. Vermaire JH, van Loveren C, Brouwer WB, Krol
molars: a prospective evaluation of cases. 26. Innes NPT, Ricketts D, Chong LY, Keightley
M. Value for money: economic evaluation of
J Oral Rehabil 2017; 44: 537−544. AJ, Lamont T, Santamaria RM. Preformed
two different caries prevention programmes
20. Innes NP, Manton DJ. Minimum intervention crowns for decayed primary molar teeth.
compared with standard care in a randomized
children’s dentistry − the starting point for Cochrane Database Syst Rev 2015; 12:
a lifetime of oral health. Br Dent J 2017; 223: CD005512. controlled trial. Caries Res 2014; 48: 244−253.
205−213. 27. Santamaria RM, Innes NP, Machiulskiene V, 32. van Strijp G, van Loveren C. No removal and
21. Mijan M, de Amorim RG, Leal SC et al. The 3.5- Evans DJ, Alkilzy M, Splieth CH. Acceptability inactivation of carious tissue: non-restorative
year survival rates of primary molars treated of different caries management methods for cavity control. Monogr Oral Sci 2018; 27:
according to three treatment protocols: a primary molars in a RCT. Int J Paediatr Dent 124−136.