Discussion
carious lesions, Pain, carious primary molars, caries, pain, hand excavation
DECAY, CAVITY, CARIES
The present randomized controlled clinical study aimed to evaluate the efficiency of Carie-Care™ as a chemo-mechanical caries removal agent and compare it with that of ART. To the best of authors’ knowledge, the present study is the first in Egypt and the Easternmediteranean/North African region to evaluate the effectiveness of Carie-Care™ CMCR agent versus ART in pediatric patients in terms of time taken and efficacy for caries removal, together with child pain perception and behavior. To fulfill the aims of this study, fifty children of both genders aged 5–8 years who fulfilled the inclusion criteria were selected from the outpatient clinic. Fifty open carious primary molars were randomly assigned to two equal groups according to the caries removal method. In this study the split mouth technique was not used because of the difficulty to find carious lesions symmetrically distributed in the mouth of children. Based on the findings of the current study, the null hypothesis was rejected. A significant difference was detected between the two procedures in terms of the time required, efficacy of caries removal, pain assessment, and child behavior.The results of the present study revealed that the mean time taken to completely remove caries in the Carie-Care™ treatment group was significantly longer than that in the ART treatment group. This finding could be due to the repeated application of the gel to completely remove caries [There is continuous debate over the most effective strategy for treating caries in primary teeth, especially for multisurface lesions. In the present study, although Carie-Care™ was time consuming, it was significantly more efficient in caries removal than ART. This finding is in agreement with Kumar et al. [On the other hand, Banerjee et al. [Pain assessment in the present study showed significant comfort during the use of Carie-Care™ compared with the ART technique in caries removal. The CMCR gel is effective only on the denuded fibers in demineralized dentine, thus preventing painful removal and damage to healthy dentine. Moreover, the gel itself has a heat-insulating function as it covers the cavity during the procedure, and thus reduces pulpal stimulation. In addition, during ART caries removal, the unpleasant feeling of scraping the decay with hand excavation makes the procedure more stressful than the chemomechanical caries removal method [In agreement with the results of the present study, Soni et al. [Child behavior was evaluated in the current study immediately upon completion of the procedure, showing that children in the Carie-Care™ group were significantly more cooperative and enjoyed the procedure than those in the ART group. The absence of pain in the CMCR treatment group was the cause of the child cooperative behavior. In agreement with the results of Kumar et al. [The results of the current study showed no significant difference between boys and girls regarding assessment parameters (time taken for caries removal, efficacy of caries removal, and child behavior) during the procedure. On the contrary other studies found that dental procedures were affected by the child gender where boys were less dentally anxious than girls which goes with the nature of boys who prefer to seem strong. [Studying the influence of previous dental visit experience on assessment parameters, children in the Carie-Care™ treatment group who did not experience a previous dental visit had a significantly better behavior rating score and efficacy of caries removal score than those who had a previous dental visit, which could be related to a history of dental pain from invasive procedures performed in previous dental visits. This is consistent with previous studies [Within the limitations of the present study and based on the results, the Carie-Care™ CMCR agent can be recommended as an alternative to ART in pediatric patients, considering its effectiveness in caries removal, patient comfort, and relatively low price, which could be of great benefit, especially for low-income developing countries in Africa. However, future large-scale multicenter trials are recommended to verify the findings of the present study.