Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)

BMC Oral Health volume 20, Article number: 45 (2020) 

Abstract

Background

A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA).

Methods

Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%.

Results

A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P.

Conclusions

The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%.

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Should root canal treatment be performed in one dental visit or over several visits?

Root canal treatment is a common procedure in dentistry, and requires one or more visits to the dentist. In an updated review in December 2016, the Cochrane authors have brought together the trials that compared different numbers of visits and we asked the lead author, Maddalena Manfredi from the University of Parma in Italy to tell us what they found.

 Listen to the short podcast:
https://www.cochrane.org/sites/default/files/public/podcasts/mp3/issue16-12-cd005296-single-versus-multiple-visits-for-endodontic-treatment-of-permanent-teeth.mp3

Single versus multiple visits for endodontic treatment of permanent teeth

Cochrane Systematic Review – Intervention Version published: 01 December 2016 see what’s new

 

Abstract

Background

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007.

Objectives

To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.

Search methods

We searched the following electronic databases: Cochrane Oral Health’s Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases.

Selection criteria

We included randomised controlled trials (RCTs) and quasi‐RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare‐up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event).

Data collection and analysis

We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta‐analysis of the data using the random‐effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth.

Main results

We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.
Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single‐visit participants lost a tooth versus 2/103 multiple‐visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low‐quality evidence).
We found no evidence of a difference between single‐visit and multiple‐visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I2 = 18%; low‐quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I2 = 33%; moderate‐quality evidence); swelling or flare‐up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I2 = 0%; low‐quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I2 = 0%; low‐quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I2 = 18%; moderate‐quality evidence).
The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I2 = 54%), though the quality of the evidence for this finding is low.
Moderate‐quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I2 = 0%).

Authors’ conclusions

There is no evidence to suggest that one treatment regimen (single‐visit or multiple‐visit root canal treatment) is better than the other. Neither can prevent all short‐ and long‐term complications. On the basis of the available evidence, it seems likely that the benefit of a single‐visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).

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At CDS 2020: Owandy Radiology Debuts 5-Year Warranty Program that Covers Complete Product Line

Mount Laurel, NJ  – February 17, 2020 – Owandy Radiology Inc., a global leader in the manufacture of dental radiology hardware and imaging software, will be introducing its new 5-year warranty program during the Chicago Midwinter Meeting in booth #4821.

According to Owandy company spokesman Boris Loyez, “We’ve extended our standard 2-year warranty to 5 years with no additional upcharge to provide our customers with additional value and peace of mind. Our 5-year warranty includes our entire product line, including the I-Max 3D Cone Beam Unit, which is now our best seller since its recent upgrades which included improved face scanning and airway imaging, which support the rapidly growing segment of dental sleep medicine.”

In addition to the I-Max 3D, the Owandy 5-Year Warranty provides optimal protection to the following products:

Owandy I-Max Digital Pan Unit 
Opteo Digital Sensors
Owandy-RX X-Ray Generator
OwandyCR Plate Scanner System
Owandy-Cam and Owandy-Cam HD Intraoral Cameras

The Owandy 5-Year Warranty will be in full effect during the Chicago Midwinter Meeting and covers Owandy parts and service. Repairs are performed by Owandy’s network of local distributors.
-more-
For more information about the Owandy 5-Year Warranty Program, and other Owandy innovations, visit www.owandy.com, call 203-745-0575 or e-mail at sales@owandyus.com. Distributor inquiries are always welcome.

About Owandy Radiology, Inc.:

Headquartered in France, and serving North America from Mount Laurel, New Jersey, Owandy Radiology is a global leader in the manufacture of dental radiology hardware and imaging software. Its products are distributed through dental dealers across the USA, and in 50 countries world-wide, on every continent.

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Carestream Dental and Burkhart Dental Supply Partner to Deliver Digital Technology to More Doctors

ATLANTA—Doctors will soon have greater access to Carestream Dental’s innovative technology thanks to a new partnership with Burkhart Dental Supply. As an authorized dealer, Burkhart will be able to market, sell, install and service nearly all of Carestream Dental’s equipment, accessories and imaging software.
No matter where a doctor is on their digital journey, this new partnership makes it easy for the Burkhart team to guide and support them along the way with access to Carestream Dental technology. For example, the CS 8100 3D extraoral imaging system can capture high-resolution 3D images for a more confident diagnosis and the new award-winning CS 9600 CBCT system, a highly intuitive system with smart features, can make getting the right image on the first try easier than ever. The CS 3600 intraoral scanner, known for its high speed and precision, makes taking digital impressions faster and more comfortable for the patient, while the new CS 3700 intraoral scanner offers Smart-shade matching and unlimited workflow capacity from a single scan.
“Carestream Dental is excited to support the Burkhart team through sales activities, training, customer demos and event support,” Jeremy Thomas, general manager for the Americas Region, Carestream Dental, said. “The two companies share many of the same values, such as their focus on providing cutting-edge technology and ensuring doctors have the training and education to get the most out of their systems, which makes this the perfect partnership.”
“At Burkhart we believe in putting the needs of our clients first,” Jeff Reece, vice president. Sales and Marketing, Burkhart Dental Supply, said. “Collaborating with partners such as Carestream Dental, a Best of Class Award recipient, enables us to do just that. Their expertise in technology aligns with our desire to provide our clients with innovative digital solutions.”
To learn more about Burkhart Dental Supply, visit BurkhartDental.com. For more information on Carestream Dental’s innovative solutions visit carestreamdental.com.
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About Burkhart Dental Supply
Founded in Tacoma, Washington, in 1888, Burkhart Dental Supply has ten regional divisions in eighteen locations, and three distribution centers. The company provides over $200 million a year in dental equipment and technology, equipment service and repair, supplies and consulting services.
  
About Carestream Dental
Carestream Dental is transforming dentistry, simplifying technology and changing lives around the world with its innovative digital product line of systems, solutions and support. From intraoral and extraoral imaging equipment to CAD/CAM solutions, imaging analysis software to practice management systems, Carestream Dental technology captures two billion images annually and aids in more precise diagnoses, improved workflows and superior patient care.
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Carestream Dental Introduces Digital Dentistry Difference Education Campaign

Initiative will transform public understanding and conversation about dental tech; updated Carestream Dental branding reinforces digital focus
CHICAGO—Carestream Dental, an industry-leading provider of integrated digital dental solutions, introduced its Digital Dentistry Difference public education campaign today at the Chicago Dental Society Midwinter Meeting. Through this campaign, the company will directly educate consumers about the benefits of digital dentistry and will arm doctors with resources to prompt conversation with their patients, solving a significant awareness gap that research suggests is harming patient perception of doctors and the oral healthcare industry overall. 
According to the first Global Digital Dentistry survey—commissioned by Carestream Dental in November 2019 to measure public attitudes, perceptions and behaviors related to dental technology—patients across the globe believe that the oral healthcare industry lags behind both optical and orthopedic in terms of the technology used. Even more surprising, less than half of patients even believe their doctor uses very advanced technology.
“It is a missed opportunity when you consider that doctors are investing in digital dentistry to improve patient care, yet many patients do not understand the level of advanced digital technology the industry offers, or how it can change their lives,” Ed Shellard, D.M.D., chief dental officer, Carestream Dental. “The Digital Dentistry Difference campaign will change that by speaking directly to consumers about why they should be asking about the technology used by their doctor, and at the same time, arming doctors with the tools they need to easily educate. We’re proud to be leading the charge with this campaign and look forward to the industry working together to create more smiles all around.”
As part of the Digital Dentistry Difference campaign, Carestream Dental will be directly reaching patients through a large-scale public relations initiative, by connecting digital dentistry experts with national and regional news media to share information on how the technology truly makes a difference. As part of these ongoing efforts, Carestream Dental will create a groundswell of conversation about digital technology ahead of Oral Health Month. The company is partnering with Dr. Miguel Stanley to conduct a broadcast media tour in late May, with plans to reach regional markets throughout the U.S. and encourage viewers to talk to their doctors about the digital technology used in their care.
Not only will public education about digital dentistry increase patient awareness, it is also likely to benefit doctors, according to Carestream Dental’s survey results. The survey revealed that that education is likely to help: 
  • Increase patient retention: Two out of three patients would consider changing to a dentist who uses more advanced technology. 
  • Bring in new patients: Approximately two in five patients who haven’t been to the dentist in two or more years say they would be motivated to go with education about how technology would improve their care.
  • Enhance patient perception of care: 95 percent of patients who experienced advanced technology agree they get better care.
The Digital Dentistry Difference: Global Consumer Survey results have been published in a white paper, which can be found at DigitalDentistryDifference.org, along with a suite of complimentary educational resources doctors can download and use in their own patient education efforts. The tools available include the Digital Dentistry Difference video, a series of infographics and patient education materials, which can be shared through online and social channels, shared in a doctor’s waiting room or referenced during patient consultations.
Bringing Digital Dentistry to Life
Carestream Dental’s commitment to digital is engrained in the business’ core. In addition to its new education campaign, the company has also launched a refreshed brand look to further demonstrate its dedication to digital.  
“We’re already walking the walk with our product offerings, and now it’s time to talk the talk in the way we communicate about them,” Greg Marko, chief marketing officer, Carestream Dental, said. “This brand refresh fully embraces the spirit of Carestream Dental—who we are today and where we, and the industry as a whole, are headed. Digital is at the heart of everything we do, and our refreshed brand now reinforces that even more clearly.” 
The new Carestream Dental branding can be experienced firsthand in booth #3602 during the Midwinter Meeting exhibition, Feb. 20-22. 
For more information on Carestream Dental and its products, visit carestreamdental.com.
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About Carestream Dental
Carestream Dental is committed to transforming dentistry, simplifying technology and changing lives. In this pursuit, we focus on providing the latest in high-quality scanning technology, the smartest chairside systems, the most intuitive practice management software, incredibly accurate imaging software and the data intelligence that helps continually refine patient outcomes. And we offer these solutions for the full range of dental and oral health professionals. For more information please visit carestreamdental.com.
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MouthWatch Debuts Significant Upgrades to TeleDent™ its Provider-Focused Teledentistry Platform During CDS 2020

 
Newest Enhancements Designed to Keep the Dentist in Teledentistry
While Delivering Improved Case Acceptance and Patient Convenience

Metuchen, NJ – February 17, 2020 – MouthWatch, LLC a leader in innovative teledentistry solutions, digital case presentation tools and intraoral imaging devices, will debut the latest upgrades to its TeleDent™ all-in-one teledentistry platform at booth #4318 during the 2020 Chicago Midwinter Meeting.

According to MouthWatch Founder and CEO Brant Herman, “Our latest upgrades firmly establish TeleDent as the clinician-focused teledentistry platform that also provides the convenience and flexibility that more and more patients expect from their health care providers.”

The three main enhancements to TeleDent include improved video conferencing, integrated provider chat and a robust patient portal.

Video Conferencing:  “We’ve expanded TeleDent’s video conferencing capabilities which now includes seamless capture of still images, videos and full-length video conferences directly into the platform’s patient record program, “ explains Herman. Other video conference upgrades include the following:

Multi-Camera Support for Intraoral Images: This allows webcam video and intraoral camera video to be streamed into the same video conference session.

Create “Freeze Frame”  Video Images: With this feature, clinicians can quickly capture still images from a video feed and save them right into the patient’s records.

Expanded Store and Forward: Now entire video conferences can be recorded, shared and replayed.

Video Conference Chat: Enables simultaneous communication during a teleconference to ask questions, share, links, etc.

Teleconference Screen Share: Similar to familiar video conference programs, the feature improves clinical collaboration and patient communication.

Provider Chat:  According to Herman, “This feature brings real-time collaboration between providers in separate locations to the next level. We predict this will become a popular feature for group practices, public health organizations and as integrated health care becomes the standard.” 

Secure & HIPAA Compliant: A necessity for all provider communications. A smart alternative to standard, unencrypted email or texting, etc.

Real Time Messaging: This function includes the ability to share audio, video and still photo attachments via encrypted messaging. This capability can be especially important in public health clinics, group dentistry and emergency room applications.

Visual Treatment Plan Sharing: There are two levels of access: Provider to Provider and Provider to Patient. In other words, patients can access only the information that  providers determine to be relevant and/or appropriate.

These new features are now available on all new TeleDent purchases. Existing TeleDent customers are currently being upgraded free of charge. Stop by booth #4318 during CDS 2020 or visit for more information, visit https://www.mouthwatch.com/teledent-software/.

       
About MouthWatch LLC
Headquartered in Metuchen, New Jersey, MouthWatch, LLC is a leader in innovative clinician-focused teledentistry solutions, digital case presentation tools and intraoral imaging devices

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