The fate of 1,587 unrestored carious deciduous teeth: a retrospective general dental practice based study from northern England

Abstract

Objective: To investigate the outcome of non-restoration of carious deciduous teeth by means of a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care.

Design: Using a carefully defined protocol the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored was determined from the sequential examination of the clinical records of 481 children attending at least annually.

Results: The age at initial diagnosis of carious teeth ranged from 1-12 years with the majority of cavities (1,005) presenting by 6 years of age. In all, 1,587 teeth were followed until loss from the mouth. Of these, 190 (12%) were extracted because of pain and a further 60 (4%) became painful and were treated, leaving 1,337 (84%) that remained symptomless until being lost. Of the 1,337 symptomless teeth, 178 were extracted under general anaesthesia at the same time as painful ones. The final group of 1,159 (74%) teeth were exfoliated without causing pain after a mean survival time of 1,332 days. Excluding from the analysis the 178 extracted, but symptomless teeth, leaves a total of 1,409 teeth of which 18% gave pain and were extracted or treated and the remaining 82% exfoliated. The strongest determinant of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. The carious teeth most likely to cause symptoms were found to be molars that developed cavities with pulpal involvement by the age of 3 years, 34% of which caused pain. In contrast, those least likely to cause pain were carious molar teeth presenting without pulpal involvement after 8 years, only 6% of which produced symptoms.

Conclusion: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. The results provide evidence to aid the treatment planning of carious deciduous teeth in children regularly receiving regular preventive dental care.