Effect of Treatment with Selective Caries Removal Associated to Antimicrobial Photodynamic Therapy on Children’s Oral Health-Related Quality of Life: A Non-Randomized Clinical Study

How patients perceive impact of diseases is an essential component when characterising different disease impacts, and effects of dental treatments should be perceived by the patients. This study aimed to assess the impact of conservative treatment of deep caries lesions using the selective caries removal (SCR) associated to a low laser therapy (antimicrobial photodynamic therapy–aPDT) on oral health-related quality of life (OHRQoL). Study Design: A non-randomized clinical before-and-after study was conducted on children aged 4 to 8 years. The data was obtained applying the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) to the caretakers in an interview before and after treatment. The paired T-student test considering p<0.05 and the treatment responsiveness detecting the effect size by means of standardized response mean (SRM) was evaluated. Results: The mean impact on OHRQoL on the total scale was 5.46 ± 4.54 for before and 2.42 ± 3.54 for after treatment (p<0.01). The ECOHIS demonstrated satisfatory longitudinal responsiveness except for psychological, self-image⁄ social interaction and Family function domain (SRM<0.5). Conclusion: This study demonstrated that the association of a low laser therapy (aPDT) with SCR did not influence negatively on OHRQoL. In the practice of pediatric dentistry, this conservative dental treatment improved the OHRQoL after 3 months of follow up.

Child; Caries; Photodynamic therapy; Treatment; Quality of life; Oral health

1. Díaz Jaime A., Jans Alejandra, Zaror Carlos. Efectividad de la Remoción Parcial de Caries en Molares Primarios con Lesiones de Caries Profunda. Ensayo Clínico Aleatorizado. Int. J. Odontostomat.2017;11(4):443-449.

2. Ornellas PO, Antunes LD, Fontes KB, et al. Effect of the antimicrobial photodynamic therapy on microorganism reduction in deep caries lesions: a systematic review and meta-analysis. J Biomed Opt. 2016;21(9):90901.

3. Ornellas PO, Antunes LS, Motta PC, et al. Antimicrobial Photodynamic Therapy as an Adjunct for Clinical Partial Removal of Deciduous Carious Tissue: A Minimally Invasive Approach. Photochem Photobiol. 2018;94(6):1240-1248.

4. Nassaj AE, Ghadimi S, Seraj B, Chiniforush N. Effect of photodynamic therapy on microleakage of class V composite restorations in primary teeth. Photodiagnosis Photodyn Ther. 2020;32:101964.

5. Al Deeb L, Bin-Shuwaish MS, Abrar E, et al. Efficacy of chlorhexidine, Er Cr YSGG laser and photodynamic therapy on the adhesive bond integrity of caries affected dentin. An in-vitro study. Photodiagnosis Photodyn Ther. 2020;31:101875.

6. Alrahlah A, Niaz MO, Abrar E, Vohra F, Rashid H. Treatment of caries affected dentin with different photosensitizers and its effect on adhesive bond integrity to resin composite. Photodiagnosis Photodyn Ther. 2020;31:101865.

7. Faria LV, Antunes LS, Pio LRR, Dias JC, Pinheiro LHM, Bitencourt Reis CL, Fontes KBFC, Cajazeira MRR, Antunes LAA. Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: a randomized controlled trial. Int J Paediatr Dent. 2021 Nov 16.

8. Mittal H, John MT, Sekulić S, Theis-Mahon N, Rener-Sitar K. Patient-Re-ported Outcome Measures for Adult Dental Patients: A Systematic Review. J Evid Based Dent Pract. 2019;19(1):53-70.

9. Aimée NR, Damé-Teixeira N, Alves LS, Borges GÁ, Foster Page L, Mestrinho HD, Carvalho JC. Responsiveness of Oral Health-Related Quality of Life Questionnaires to Dental Caries Interventions: Systematic Review and Meta-Analysis. Caries Res. 2019;(6):585-598.

10. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. International journal of surgery (London, England). 2010;9 (8):672-677.

11. Scarpelli AC, Oliveira BH, Tesch FC, Leão AT, Pordeus IA, Paiva SM. Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). BMC Oral Health. 2011;13;11:19.

12. Milani A.J. et al. Impact of traumatic dental injuries on oral health-re-lated quality of life of preschool children and their families attending a dental trauma care program. Portuguese Journal of Public Health. 2019; 37(1):19.

13. World Health Organization -WHO- Oral Health surveys-basic methods 5th ed. Geneva, Switzerland: World Health Organization 2013.

14. Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964;68:7-13. doi: 10.14219/jada.archive.1964.0034.

15. Andreasen J.O.; Andreasen F.M.; Anderson L. (eds.) Textbook and Color atlas of Traumatic Injuries to the teeth, 4th ed. Oxford: Blackwell; 897, 2007.

16. Massara ML, Alves JB, Brandão PR. Atraumatic restorative treatment: clinical, ultrastructural and chemical analysis. Caries Res. 2002;36(6):430-436.

17. Zou GY. Quantifying responsiveness of quality of life measures without an external criterion. Qual Life Res. 2005;14(6):1545-52. doi: 10.1007/s11136-004-0027-4.

18. Leal SC, Bronkhorst EM, Fan M, Frencken JE. Untreated cavitated dentine lesions: impact on children’s quality of life. Caries Res. 2012;46(2):102-6.

19. Antunes LA, Andrade MR, Leão AT, Maia LC, Luiz RR. Systematic review: change in the quality of life of children and adolescents younger than 14 years old after oral health interventions: a systematic review. Pediatr Dent. 2013;35(1):37-42.

20. Nora ÂD, da Silva Rodrigues C, de Oliveira Rocha R, Soares FZM, Minatel Braga M, Lenzi TL. Is Caries Associated with Negative Impact on Oral Health-Related Quality of Life of Pre-school Children? A Systematic Review and Meta-Analysis. Pediatr Dent. 2018; 40(7):403-411.

21. Perazzo MF, Serra-Negra JM, Firmino RT, Pordeus IA, Martins-JÚnior PA, Paiva SM. Patient-centered assessments: how can they be used in dental clinical trials? Braz Oral Res. 2020;34 Suppl 2:e075. doi: 10.1590/1807-3107bor-2020.vol34.0075.

22. Antunes LAA, Ornellas G, Fraga RS, Antunes LS. Oral health outcomes: the association of clinical and socio-dental indicators to evaluate dental caries in preschool children. Cien Saude Colet. 2018 Feb;23(2):491-500.

23. Foley J, Evans D, Blackwell A. Partial caries removal and cariostatic materials in carious primary molar teeth: a randomised controlled clinical trial. Br Dent J. 2004;197(11):697-701; discussion 689.

24. Maltz M, de Oliveira EF, Fontanella V, Bianchi R. A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quintessence Int. 2002;33(2):151-159.

25. Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res. 2009;43(5):354-8.

26. Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent. 2010;32(4):347-55

27. Franzon R, Opdam NJ, Guimarães LF, Demarco FF, Casagrande L, Haas AN, Araujo FB (2015) Randomized controlled clinical trial of the 24- months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth. Journal of dentistry 43 (10):1235-1241.

28. Alves LVGL, Curylofo-Zotti FA, Borsatto MC, et al. Influence of antimicrobial photodynamic therapy in carious lesion. Randomized splitmouth clinical trial in primary molars. Photodiagnosis Photodyn Ther. 2019;26:124-130.

29. Steiner-Oliveira C, Longo PL, Aranha AC, Ramalho KM, Mayer MP, de Paula Eduardo C. Randomized in vivo evaluation of photodynamic antimicrobial chemotherapy on deciduous carious dentin. J Biomed Opt. 2015;20(10):108003.