Pulp treatment for extensive decay in primary teeth

Nadin G, Goel BR, Yeung A, Glenny A-M

Published Online:

October 8, 2008

Not enough evidence exists to show the effectiveness of pulp treatments for children with dental decay that has reached the tooth's nerve.
When tooth decay reaches the nerve (pulp), it can cause pain and swelling. When this happens in a child's primary (baby or milk) teeth, teeth are commonly extracted. Extraction of primary teeth can cause problems in the developing dentition and may require general anaesthetic. Various forms of pulp treatment can be tried instead, using various medications and techniques to treat and/or remove the pulp, or to stimulate tooth repair. The review found there is not enough evidence from trials to show which forms of pulp treatment may help children with decay which has reached the nerve.

Abstract (click to read)

Background:

Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth.

Objectives:

To assess the relative effectiveness of:
various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months;
pulp treatment techniques and extractions in avoiding long term sequelae.

Search strategy:

We searched the Cochrane Oral Health Group's Trials Register (August 2002); CENTRAL (The Cochrane Library 2002, Issue 3); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication.

Selection criteria:

Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects.

Data collection and analysis:

Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary.

Main results:

Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution.

Authors' conclusions:

Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

This record should be cited as:

Nadin G, Goel BR, Yeung A, Glenny A-M. Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003220. DOI: 10.1002/14651858.CD003220

Assessed as up to date:

November 1, 2002

Find the research

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Dental caries > Treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Pulp treatment for extensive decay in primary teeth

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