FiCTION trial discovers trust to be essential for child oral health and caries management
Delegates at BSPD’s annual conference in September were presented with the long-awaited results of the FiCTION trial which was set up to test three different approaches to the management of tooth decay (dental caries) in children.
The trial team are currently awaiting feedback from their funders – the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme – which must endorse their interpretation of the results. Only when they have the approval of the funders can the results be made public.
However, delegates to the conference heard about the trial in detail and learned of a key finding – that trust engendered by the dentist providing the care and delivering preventive advice is critical to any outcome. They also learned that once a child has developed caries, they are likely to experience pain and/or infection. Intensive prevention should be targeted to the child and its parents.
Professor Jan Clarkson, Chair of the conference organising committee and a lead investigator for the FiCTION trial, explained: “Our findings will now feed through into advice for the dental profession. We are working to ensure it is included in updates of the Scottish Dental Clinical Effectiveness Programme (SCDEP) and Delivering Better Oral Health.”
FiCTION (Filling Children’s Teeth: indicated or not?) began ten years ago in Dundee. This important multi-centre randomised controlled trial involved seven locations – Cardiff, Glasgow, Leeds, Newcastle, Sheffield, London and Dundee – and 1144 children aged 3-7 years. The first of its kind, the trial recruited more than 70 general dentists across the UK who tested out each of three approaches, which were:
• Conventional (drill and fill) with prevention
• Biological management (sealing in) with prevention
• Best practice prevention alone
Public health dentist, Zoe Marshman, was one of the core team and led on the patient and parent perspectives. A Professor and Honorary Consultant in Sheffield, improving children’s experience of treatment is her research interest.
Although children were initially allocated to one of the three interventions to have all their treatment carried out that way for three years, child patients were moved to a different arm for treatment when this was felt to be in the child’s best interests.
Professor Marshman said of the findings: “As well as looking at the clinical perspective, we also focused on pain, infection, anxiety, quality of life and health economics. We interviewed children, parents and dental professionals about their views on the acceptability of treatment and found that, with the child-centred patient management, all treatments were considered acceptable.”
Re-evaluating the child's caries risk status
Professor Nicola Innes, also Dundee-based and a lead investigator along with Professors Anne Maguire and Gail Douglas and Jan Clarkson, commented: “Successfully delivering this complex research is a testament to collaboration across the paediatric dental community and the willingness of general practitioners to participate in research and contribute to improving patient care.”
Professor Anne Maguire from the Centre for Oral Health Research, School of Dental Sciences, Newcastle University, is a Paediatric Dentist and Clinical Lead for north-east England. She commented: “FiCTION was conceived back in 2007 so it has been a long but interesting journey for everyone involved at each stage. We thank all the “FiCTIONEERS” who took part; the children, their families, the general dental practice teams and the researchers.”
Claire Stevens, BSPD spokeswoman said: “One of the key messages of this trial is the importance of evidence-based prevention which must underpin any approach to caries.”
She added: “As soon as early caries is identified, clinicians need to be re-evaluating the child's caries risk status and providing enhanced prevention in line with Delivering Better Oral Health and SDCEP guidance.
“This might include increasing the fluoride in the toothpaste and placing topical fluoride varnish four times rather than two times per year. Recall interval should also be reduced so that the child and their family receive close support to minimise the risk of further caries developing.”
The preventive approach was amplified by another of the lead investigators in the trial, Professor Gail Douglas, a Professor and Honorary Consultant in Dental Public Health based at the University of Leeds whose research interests include caries detection and prevention.
“It’s saddening that caries is such a common disease in children. There is much that the dental team can do to help but prevention at home from the first tooth erupting is key. Avoiding sugary drinks and snacks helps – and toothbrushing with fluoride toothpaste is vital, especially last thing at night.
“An important thing many people may not know is that the fluoride from toothpaste keeps working long after the teeth have been brushed so it’s best to avoid rinsing with water after brushing.”
For more information on the FiCTION trial visit https://dentistry.dundee.ac.uk/nihr-hta-fiction-trial