Metal crowns could be solution for Scotland's bad-tooth tots

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A novel method of tackling tooth decay in children by cementing metal crowns over affected baby teeth until they fall out, is about to be tested by the University of Dundee's Dental School, working in collaboration with the local primary care research network, TayRen.

Dental practitioners and families from throughout Tayside are being invited to take part in the first full-scale trial of the technique, following a successful pilot study. Known as the Hall technique (after Dr Norna Hall, a general dental practitioner in Keith, Aberdeenshire, who developed it), the practice is only suitable for children with decay in primary molars.

Dr Dafydd Evans, of the children's section at the Dental School, who is supervising the trial said: "Our first reaction when we came across this technique being used was, frankly, disbelief. It seemed to go against mainstream thinking simply to cover a decaying tooth with a metal crown. But on second thoughts, the practice seemed worth a look. The usual "drill and fill" techniques are not popular with young children, and general dental practitioners are often afraid of upsetting children by trying to fill their decayed baby teeth, so by far the majority of cavities in 5-year olds' teeth go untreated. In consequence almost half of Scottish children will have had at least one tooth extracted by the time they reach 8 years of age.

"One of the attractions of the Hall technique is that it involves no injections, caries removal or tooth preparation of any kind and, therefore, involves a minimum of pain and intrusion. As the bacteria responsible for the tooth decay are sealed in, and deprived of nutrients, the act of sealing the decaying tooth with the metal cap should prevent the decay from spreading, at least until the baby tooth is shed at around 10 years of age."

A pilot study on a group of 5-9 year olds in Tayside found that all 45 of the children for whom crowns were successfully fitted would be happy to have the technique used on them again. Of the parents, all but one were happy with the technique, the one exception being a parent who objected to the colour of the crown.

Said Dr Evans: "Having established that the technique is acceptable to patients and families we now wish to assess how effective it is in a randomised control clinical trial, involving around 10 dentists in Tayside. The trial will be co-ordinated by Dr Nicola Innes, a local general dental practitioner.

The trial, which is being jointly funded by the Chief Scientist Office, the Scottish Executive Health Department and 3M is due to begin in the spring.

If it works the technique could be in general use within two years, and it could save Scottish children from being Europe's "toothless tots".

Contact Dr Dafydd Evans 01382 635983
See www.dundee.ac.uk/tuith/Articles/rt03.htm