Treatment of Root Caries in an Older Irish Population.

Randomized Clinical Trial This study is a prospective study of older adults. It will assess the suitability of BiodentineTM as a filling material for Class V lesions and compare it's performance to that of Glass ionomer cement (GIC) and Resin-modified glass ionomer cement (RMGIC).

Patients for the study will attend Cork University Dental School and Hospital. These patients will represent a sample of the population of elderly who are generally well and able to care for themselves independently as well as adhere to a given maintenance programme. The general methods are outlined below.

Ethical Approval Ethical approval has been obtained from the Research Ethics Committee of the Cork Teaching Hospitals (CREC) for the recruitment, sampling, and treatment of elderly patients. Written informed consent will be obtained from all participants.

Inclusion Criteria

For inclusion in this research patients will:

• Be either male or female aged 65 or over
• Present a minimum of 6 teeth in one arch
• Have sufficient manual dexterity to undertake tooth-brushing
• Have sufficient cognitive ability to understand consent procedures and be able to complete a questionnaire

Exclusion Criteria

Patients will not be eligible for inclusion if:

• They are medically frail (ASA III or IV)
• They have pulpal involvement or painful symptomology other than sensitivity
• They have severe periodontal disease
• They require antibiotic prophylaxis for invasive dental treatment

Patient Recruitment (Phase 1) Prospective patients will be approached whilst attending Cork University Dental School and Hospital. General medical and dental practitioners in Cork will also be given information regarding the study to distribute to patients that may be suitable. A number of social clubs will also be approached. They will receive all the information in writing including the inclusion criteria as well as a consent form. If they indicate a willingness to participate, they will be offered an examination appointment. Insurance will be provided under the Clinical Indemnity Scheme, University College Cork.

Clinical Examination Procedure The clinical examination procedure will determine the extent of dental disease and confirm the suitability of the patient for enrolment in the study. Clinical data will be collected by a suitably trained examiner. This examiner will also provide the restorative treatment to the patients in the study.

During the course of the initial examination the following data will be collected:

• Age
• Gender
• Number of teeth
• Visually decayed, missing and filled teeth (VDMFT) index
• Visually decayed and filled root surfaces (RDFT)
• Plaque score
• Bleeding score
• Community Periodontal Index (CPI)
• Salivary flow rate
• Salivary buffer capacity (using CRT®buffer kits)
• Strep mutans count (using CRT®bacteria kits)
• Lactobacilli count (using CRT®bacteria kits)
• Denture wearing (Acrylic/Co-Cr, age of denture, abutment teeth)
• Fluoride exposure (public/private water supply, toothpaste, mouthwash)
• Medications (xerostomic potential, sucrose containing)
• Frequency of sugar intake
• Dental attendance pattern
• Alcohol consumption
• Smoking history
• Medical History
• Radiographs (where clinically indicated) The patient will be given another appointment to return if they are accepted into the trial.

Treatment Intervention (Phase 2) Each patient will be randomly assigned (using random number allocation) to be filled with one of three filling materials; Glass Ionomer Cement (GIC), Resin Modified Glass Ionomer Cement (RMGIC) and BiodentineTM. Treatment groups will be randomized and adjusted for the covariates age, gender and caries experience. Once it has been determined which filling material is to be placed in each lesion the treatment intervention stage will proceed as follows;

1. Scaling/prophylaxis to remove plaque and calculus
2. Removal of carious tissue from Class V lesions with hand or rotary instruments and restoration of the resulting cavities with the randomly assigned filling material

They will then be given review appointments for 6 months, one year, 18 months and two years. They will be sent appointment cards with the date of the next appointment by post and a phone call to confirm it.

Review Appointment (Phase 3) At each review appointment the following data will be gathered;

1. Survival and integrity of the restorations (according to USPHS Criteria)
2. Wear rates of the restorations (by means of dental impressions and contact profilometry)

Blinding A suitably trained examiner will assess the survival and integrity of the restorations placed by the principal investigator to eliminate potential bias.