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Intervention Review

Pulp treatment for extensive decay in primary teeth

  1. Gill Nadin1,*,
  2. Beena Rani Goel2,
  3. Albert Yeung3,
  4. Anne-Marie Glenny4

Editorial Group: Cochrane Oral Health Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 1 NOV 2002

DOI: 10.1002/14651858.CD003220


How to Cite

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

Author Information

  1. 1

    Shetland NHS Board, Lerwick, Shetland, UK

  2. 2

    International Academy for Rotary Endodontics, India Office, Belgaum, India

  3. 3

    Lanarkshire NHS Board, Public Health Department, Hamilton, UK

  4. 4

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, Manchester, UK

*Gill Nadin, Shetland NHS Board, Montfield Dental Clinic, Burgh Road, Lerwick, Shetland, ZE1 OLA, UK. g.nadin@nhs.net.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pulp treatment for extensive decay in primary teeth

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

乳牙廣泛性齲齒之牙髓治療

乳牙齲齒仍然是相當重要的健康問題.當齲齒侵犯到牙髓,無論症狀的有無,通常使用牙髓治療技術去處理.

目標

去評估以下項目的相對有效性: 1. 各種牙髓治療技術對於齲齒侵犯到牙髓的乳牙大臼齒之效果,觀察期至少12個月2. 牙髓治療技術與拔牙對於避免長期副作用的情形

搜尋策略

我們搜尋考科藍口腔衛生團體之臨床試驗註冊資料庫(Cochrane Oral Health Group's Trials Register)(2002年八月);考科藍隨機對照試驗中央註冊資料庫(Cochrane Central Register of Controlled Trials)(The Cochrane Library Issue 3, 2002);MEDLINE(1966年一月至2002年八月);EMBASE(1980至2002年八月);科學引文資料庫(Science Citation Index Expanded)(1981年至2002年八月);社會科學引文資料庫(Social Science Citation Index)(1981年至2002年八月);Index to Scientific and Technical Proceedings(1982年至2002年八月);System for Information on Grey Literature in Europe(2002年八月).關鍵期刊為人工查詢.對於發表的語言沒有限制.

選擇標準

對於乳臼齒廣泛性蛀牙做隨機或半隨機對照試驗(RCTs),比較不同牙髓治療技術(彼此之間,與拔除或與無治療作比較).主要評估的項目為牙髓治療後的拔牙及長期的後遺症.

資料收集與分析

資料擷取與品質評估分別進行並複製.必要時與作者接觸以獲得額外資訊.

主要結論

辨識出82篇研究但只有3篇是符合納入條件.9篇研究符合納入條件但具有不適當的研究設計或分析.包含試驗調查以蟻醛甲酚合劑(formocresol)冠髓切除術,硫酸鐵(ferric sulphate)冠髓切除術,電刀冠髓切除術或氧化鋅丁香油酚(zinc oxide eugenol)牙髓切除術處理無症狀但因齲齒暴露的牙齒.對於長期後遺症並無敘述.3篇研究皆有於牙髓治療後拔除牙齒的資料,2篇研究顯示在各項治療中彼此並無統計上顯著差異.另外一篇研究顯示,以硫酸鐵冠髓切除術處理的牙齒,後來被拔除的數目比以氧化鋅丁香油酚牙髓切除術處理者為多,但這個結果仍須謹慎檢視

作者結論

根據蒐集到的隨機對照試驗(RCTs),並無可靠的證據支持任何一種對於牙髓侵犯的乳臼齒治療的優越性.對於牙髓侵犯的乳臼齒,因為缺乏可靠科學研究,因此無法對於其最適當治療或技術定下結論.高品質的隨機對照試驗(RCTs),適當的隨機群組單位伴隨分析都是必須的.

翻譯人

本摘要由臺灣大學附設醫院郭玟伶翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針對兒童牙神經侵犯的齲齒,並無足夠證據顯示牙髓治療的有效性.當蛀牙深及牙髓,可能會造成疼痛與腫脹.若發生在兒童乳牙,牙齒通常被拔除.拔除乳牙會產生發展中齒列問題而且需要全身麻醉.可嘗試各項牙髓治療作為替代方案,使用藥物或技術去治療或移除牙髓,或是刺激牙齒修復.從試驗中並無足夠證據顯示何種牙髓治療可以幫助有深及神經蛀牙的兒童.