Optimising the treatment of caries in children

Objective: To determine an optimal treatment strategy for carious deciduous teeth

Methods: The likelihoods of each of the sequelae of caries in deciduous teeth were determined from the literature. The utility of the outcomes from non-treatment and treatment was then measured in 100 parents of children with caries, using a visual analogue scale. Decision analysis was performed which weighted the value of each potential outcome by the probability of its occurrence. A decision tree ‘fold-back' and sensitivity analysis then determined which treatment strategies, under which circumstances, offered the maximum expected utilities.

Results: The decision to leave a carious deciduous tooth unrestored attracted the maximum expected utility (77.6). The overall expected utility for the decision ‘restore' was 75.1. Non-restoration of carious deciduous teeth was therefore the optimal strategy for an average patient. The result was highly sensitive to the utility value assigned to the advent of pain by the patient.

Conclusions: Unless there is a greater than 73% probability that a restored tooth will remain pain free until exfoliation, in an average patient, a carious deciduous tooth should be left unrestored.

In depth communication, between practitioner and patient , regarding potential benefits and costs of treatment decisions is essential.