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ECC: quality care or supervised neglect?

In this issue of the EAPD we publish a number of very interesting papers including two reviews. One concerns an assessment of intervention studies on early childhood caries (ECC) and the second the evidence for the use of MTA for pulpotomies. Interestingly recent worrying developments make the juxtaposition of these two papers very relevant.

ECC continues to be a serious problem for paediatric dentistry as the prevalence of the condition does not seem to change and in some sub-populations may even be increasing. Attempts to prevent the condition have been many and varied with moderate to good degrees of success. Nevertheless, there has not been the degree of implementation of preventive measures for ECC that we would have liked. In these days of evidence based dentistry those public bodies that fund the necessary dental care require sufficient evidence of cost-effectiveness of an intervention. However, the study designs of these prevention studies on ECC do not meet the latest concepts of conducting intervention trials. There is a1 pressing need for more studies as Professor Twetman discusses in his important review paper in this issue.

The dental treatment of infants and toddlers with ECC, in very many cases, requires extensive restorative treatment. The use of pulpotomies and preformed metal crowns has revolutionised the dental approach to this condition and ensures that primary teeth are retained. This is in contrast to the old fashioned, Victorian, approach of extractions. As the newer pulpotomy medicaments come available, such as MTA, as reviewed here by Dr Ng and Professor Messer, our success in retaining functional primary teeth increases. This is all very promising as long as we can have the resources to care for infants with ECC.

However, these small children will often require treatment using a general anaesthetic under hospital conditions. But recently I have been receiving reports and comments, from within Europe but also in other countries around the world, of the agencies that pay for such dental care, whether they are government health departments, insurance companies etc, withdrawing funding and support. Because in many cases the infants affected by ECC tend to be from low socio-economic backgrounds their parents are not able to pay for this care and rely on public funds. This antipathy to quality care for infants is, as we all know, very short-sighted. The restoration of the primary dentition has implications extending well beyond childhood.

It is saddening that after many years of research and clinical practice developments, that the work of many paediatric dentists should now be under threat. We must all become more active politically to resist this attempt to drive the dental care of infants back to the dental dark ages.
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Article Details
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Title Annotation:early childhood caries; mineral trioxide aggregate
Author:Curzon, Martin
Publication:European Archives of Paediatric Dentistry
Article Type:Editorial
Geographic Code:4E
Date:Mar 1, 2008
Previous Article:Calendar of future events.
Next Article:Mineral trioxide aggregate as a pulpotomy medicament: A narrative review.

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