Department of Paediatric Dentistry, School of Dentistry, International University of Catalunya, Barcelona, Spain.
Department of Epidemiology & Public Health, Institute of Epidemiology & Health, University College London, London, UK.
Community Dent Oral Epidemiol. 2024 Feb;52(1):13-23. doi: 10.1111/cdoe.12895. Epub 2023 Jul 30.
The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL).
A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%).
The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008).
Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars.
本随机临床试验旨在比较两种针对发生牙髓坏死的乳磨牙（牙髓切除术或拔牙）的治疗方案对儿童口腔健康相关生活质量（OHRQoL）的影响。
共纳入 100 名年龄在 3-5 岁、至少有一颗坏死乳磨牙的儿童，并将其随机分为两组。采用巴西版幼儿口腔健康影响量表（B-ECOHIS），由家长代理报告在基线、4 个月、8 个月和 12 个月时的情况。采用 Bootstrap 线性回归分析 B-ECOHIS 评分、Logistic 回归分析牙齿疼痛自我报告和焦虑评分的组间差异（α=5%）。
牙髓切除术组基线和 12 个月时的 B-ECOHIS 平均（SD）评分分别为 17.7（6.5）和 3.0（4.0），拔牙组分别为 18.8（7.7）和 7.9（7.7）。两种治疗方法均显著改善了 OHRQoL，但拔牙组的总 B-ECOHIS 评分（p<0.001）和各领域评分均较高，表明 OHRQoL 较低。此外，与牙髓切除术相比，拔牙组报告的焦虑水平更高（OR=2.52；p=0.008）。
与拔牙相比，牙髓切除术在 12 个月后可改善 OHRQoL 评分，应作为治疗坏死乳磨牙的首选方法。
