Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BACKGROUND

Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth.

METHOD

This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes.

DISCUSSION

SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN.

TRIAL REGISTRATION NUMBER

ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search .

Trophic ecology drives trace element concentrations in the Antarctic octopod community

Despite the Antarctic Ocean being considered a pristine environment, elevated trace element concentrations have been reported in many marine organisms. The Antarctic Ocean is particularly vulnerable to climate change, which can also affect the bioaccumulation of trace element concentrations in biota. While Antarctic octopods are key components of the regional food webs as prey for a variety of predators (e.g., seals, fish, and seabirds), their contamination state by trace elements remains largely unknown. This study investigated the trace element concentrations in relation to the trophic ecology in Antarctic octopods. Stable isotope values (δ¹³C and δ¹⁵N) and trace element concentrations (Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, V, and Zn) were measured in eight different species (Adelieledone polymorpha, Pareledone aequipapillae, P. albimaculata, P. aurata, P. charcoti, P. cornuta, P. felix, and P. turqueti) sampled near Elephant Island, close to the Antarctic Peninsula. Stable isotopes of δ¹⁵N varied among species, with significant differences between A. polymorpha and P. aurata suggesting potential niche segregation. Trace element concentrations also differed among species and with sampling depth, which likely reflects their trophic ecology. The data presented in this study provides the first insight into the trace element concentrations for these endemic octopods in this vulnerable habitat and their stable isotope values.

Influence of sexual dimorphism on stable isotopes and trace element concentrations in the greater hooked squid Moroteuthopsis ingens from New Zealand waters

The Chatham Rise, one of the highest offshore-primary production regions in New Zealand waters, hosts a great abundance and diversity of deep-sea cephalopods including the greater hooked squid, Moroteuthopsis ingens. Stable isotope ratios of carbon (δ¹³C) and nitrogen (δ¹⁵N) and trace element concentrations (Ag, As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Pb, Se, V, and Zn) were assessed in female and male specimens of different size classes (89-563 mm mantle length). Values of δ¹³C and δ¹⁵N were overall higher in females and δ¹³C was further influenced by size and sex. Both muscular mantle (the largest fraction of the total body mass) and digestive gland (the known main storage organ for Ag, Cd, Cu and Zn in many cephalopods) tissues were analysed. Higher levels of Cd were observed in males than in females. A positive effect was found between size and Hg concentrations, which could be related to the ontogenetic descent of larger specimens into deeper waters, where they are exposed to higher Hg concentrations, and/or dietary shifts toward Hg-enriched prey with increasing size. This study provides trace element data for this abundant and ecologically important species, and further reveals higher trace element concentrations (especially Hg) in M. ingens from the Chatham Rise, compared to specimens from the sub-Antarctic zone.

INTERVAL (investigation of NICE technologies for enabling risk-variable-adjusted-length) dental recalls trial: a multicentre randomised controlled trial investigating the best dental recall interval for optimum, cost-effective maintenance of oral health in dentate adults attending dental primary care

Background

Traditionally, patients at low risk and high risk of developing dental disease have been encouraged to attend dental recall appointments at regular intervals of six months between appointments. The lack of evidence for the effect that different recall intervals between dental check-ups have on patient outcomes, provider workload and healthcare costs is causing considerable uncertainty for the profession and patients, despite the publication of the NICE Guideline on dental recall. The need for primary research has been highlighted in the Health Technology Assessment Group’s systematic review of routine dental check-ups, which found little evidence to support or refute the practice of encouraging 6-monthly dental check-ups in adults. The more recent Cochrane review on recall interval concluded there was insufficient evidence to draw any conclusions regarding the potential beneficial or harmful effects of altering the recall interval between dental check-ups. There is therefore an urgent need to assess the relative effectiveness and cost-benefit of different dental recall intervals in a robust, sufficiently powered randomised control trial (RCT) in primary dental care.

Methods

This is a four year multi-centre, parallel-group, randomised controlled trial with blinded outcome assessment based in dental primary care in the UK. Practitioners will recruit 2372 dentate adult patients. Patient participants will be randomised to one of three groups: fixed-period six month recall, risk-based recall, or fixed-period twenty-four month recall. Outcome data will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcomes measure gingival inflammation/bleeding on probing and oral health-related quality of life.

Discussion

INTERVAL will provide evidence for the most clinically-effective and cost-beneficial recall interval for maintaining optimum oral health in dentate adults attending general dental practice.

Trial registration

ISRCTN95933794 (Date assigned 20/08/2008).