Minimal Intervention Dentistry for Children with Tooth Decay
Research type
Research Study
Full title
The MILD study: Minimal Intervention Dentistry for children with carious permanent teeth: a feasibility study
IRAS ID
270792
Contact name
Zoe Marshman
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
1 years, 8 months, 1 days
Research summary
Research Summary
Dental caries (tooth decay) is one of the most common diseases affecting childhood with surveys showing nearly a half of 15 year olds and a third of 12 year olds having obvious decay experience in their permanent teeth. Tooth decay can cause considerable pain and suffering for the child and time off school. NHS costs for treating decayed permanent teeth in 12 year olds alone are estimated at approximately £33 million per year. Traditional treatment involves treating the advanced stages of decay once it has made a cavity, using a local anaesthetic injection, drilling and placement of a filling material.Minimum Intervention dentistry (MID) is a relatively new way of managing tooth decay. It involves early detection, diagnosis, prevention, a filling when required, and review. Identifying tooth decay in its early stages, rather than waiting for a cavity to form, helps to assess the likelihood of further tooth decay, and provide early prevention and treatment. Tooth decay when detected early can be stopped with preventive MID strategies, such as sealing, without the need to drill or fill. For advanced stages where a cavity is already present , MID will aim to keep the size of the hole and subsequent filling as small, thereby preserving as much of the natural tooth as possible.
Before running a decisive trial in primary dental care to evaluating the clinical and cost effectiveness of MID, a number of uncertainties will to be addressed by this feasibility study.
This feasibility study will involve practices implementing the MID approach to children aged 6 to 16 years with decay in their permanent teeth. Data will be collected using questionnaires and interviews with dental professionals and children. These will highlight any issues such as recruitment, acceptability and implementation that may affect the running of a decisive larger trial.
Lay summary of study results
In this study, Minimal Intervention Dentistry (MID) treatment (with less or no drilling) was given to 86 children who had tooth decay in their adult teeth. Dentists and dental staff were generally supportive of doing more research like this in everyday dental clinics. They said that having support from the whole dental team, proper training, and good organisation in the clinic made it easier to take part in the study. However, some dentists said they found it hard to figure out how at-risk a child was for tooth decay. They also found it challenging to do research while keeping up with their regular NHS dental work.
Out of the 86 children who started treatment, only four didn’t finish. Interviews with children and their parents showed that most were happy to take part in the study and were supportive of the MID approach. They also said that things like informative videos would be useful to help explain the treatment.
About 95% of the paperwork for the study was returned, but there were a few issues — only 60% of the forms had a complete tooth decay risk assessment, and sometimes the correct child questionnaire was not provided for children to complete at the end of the course of treatment.
Overall, children and parents were very supportive of both the treatment and the research. They were happy with MID for treating tooth decay, and they didn’t find the paperwork to be a problem. Having videos to explain the treatment could help children and parents understand and feel more comfortable with it.
Even though the tools used to collect data worked well, dental teams could use more support in filling out the tooth decay risk assessment forms and sticking closely to the treatment process.
In summary, the MID treatment was well accepted by everyone involved, and it looks like doing a bigger trial in the future would be possible. Some improvements to the study design and the treatment process could help make sure everything runs smoothly in a full-scale trial in regular dental practices. More research is needed to find out how well MID works and whether it’s good value for money when used to treat children with cavities in their adult teeth in the NHS.
REC name
East Midlands - Nottingham 2 Research Ethics Committee
REC reference
20/EM/0018
Date of REC Opinion
5 Mar 2020
REC opinion
Further Information Favourable Opinion