An Alternative To Drill-And-Fill

Award winning child friendly dentistry

Award winning clinical researchers at Dundee’s School of Dentistry are at the vanguard in developing and promoting techniques to tackle one of the world’s most common childhood diseases: dental caries, or tooth decay.

For over a hundred years, children with cavities in their baby teeth have undergone ‘drilling and filling’ or extractions, which remains the most common reason for a child requiring an outpatient general anaesthetic.

Dundee’s Paediatric Dentistry team, however, are perfecting more inexpensive, practical, quick and child friendly methods of tackling caries: the Hall Technique is one of these.

“It’s a very simple way of managing decay in baby teeth which avoids having to use dental injections or drills,” explains Dr. Dafydd Evans, Senior Clinical Lecturer in Paediatric Dentistry and Head of the Children’s Department . “The decay is simply sealed into the tooth using a preformed metal cap, which is checked for size then cemented onto the tooth to give a tight fit and a good seal.”

In effect, any decay is sealed in. As long as the decay is not too advanced, and has not reached the nerve of the tooth, then the Hall Technique is highly effective. Once capped, the environment in the decayed tissue changes – sugar, and oxygen cannot reach the tooth and dental plaque in the same way, so the bacteria can’t survive.

Dundee’s sterling work was recognized by the International Association for Dental Research, which awarded the paediatric team of Dr. Nicola Innes and Dr. Evans the Senior Clinical Research Prize in 2011 for their randomized controlled trial of the Hall Technique.

Carried out in general dental practices in Tayside, 132 children with matched decay in baby teeth on both sides of their mouths were involved: the decayed tooth on one side received the usual filling; the one on the other side was fitted with a Hall crown.  After five years, 70 children were followed-up and the study revealed that 5% of Hall crowns had failed against a 42% failure rate for fillings.

Dundee’s School of Dentistry is recognized nationally and internationally as one of the foremost centres for the study of clinical cariology.

Dafydd Evans and Nicola Innes have lectured on the Hall Technique in the Netherlands, Germany, Lithuania, the US and Australia - and in 2011, toured New Zealand speaking to the majority of Dental Therapists who provide 90% of the country’s child dental care.

In collaboration with colleagues in Dundee, Cardiff, and London, they are now investigating a package of more child friendly approaches to dentistry. They are also involved in another randomized control trial – named FiCTION - of 1490 children in dental practices in Scotland, England and Wales that is focusing on comparing 3 different ways of managing decay: “drill and fill” techniques, alternative methods of biological management, including the Hall Technique and using preventive methods alone.

The School of Dentistry is also collaborating on broader dental health projects. “We are working with the University of Dundee’s School of Nursing in a study to identify dental neglect in children as a marker for general child neglect,” says Dr. Nicola Innes, Senior Clinical Lecturer in Paediatric Dentistry. “It is very difficult to recognize hard markers for child neglect early and intervene. We know that children carry the burden of neglect with them for the rest of their lives so early intervention is important.”

The upside to this story is that in Scotland, largely due to significant Scottish Government investment in a well planned community-based oral health promotion programme called the Childsmile programme, the proportion of Scottish five year olds with visible decay in their teeth has fallen from two-thirds to one-third of children over the last 10 years.

Dr Evans said ‘It’s important that we work with parents and children to prevent and find ways of managing decay for children that they can cope with, as adult dental diseases begin in childhood”.

More information on the Hall Technique in the form of a fully illustrated manual which has been produced by Dr Evans and Dr Innes and is freely available.