Title Papacarie is More Effective in Removing Caries in the Primary Dentition and Results in Less Pain Perception by the Patient
Clinical Question In children with primary dental caries, is the use of Papacarie, as compared to traditional methods, more effective in caries removal with less anxiety during treatment?
Clinical Bottom Line In children with primary dentition carious lesions, Papacarie use for caries removal has shown a reduction in bacteria in infected dentine, and less pain perception. However, it took more time for application. This is supported by a systematic review and meta-analysis, as well as a Randomized clinical study.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29682851Deng/201815 articles for qualitative synthesis; 10 articles for quantitative synthesis (6 RCTs and 4 CCTs)Systematic Review & Meta-Analysis
Key resultsThe authors looked at the effectiveness and efficiency of Papacarie compared to conventional methods of caries removal in deciduous teeth among children, focusing on the following outcome variables: bacterial reduction, pain score, treatment time, and acceptance of the treatment method by children. Twenty-five articles were included in the review; 15 involved qualitative analysis and 10 (6 RCTs and 4 controlled clinical trials) involved quantitative analysis. Two studies demonstrated that the bacteria in caries dentine was significantly decreased using the Papacarie treatment (mean difference [MD] = 0.57, 95% CI 0.04 to 1.09, P = 0.03), compared with the conventional drilling method, with low heterogeneity detected among studies (v2 = 2.00, P = 0.37, I2 = 0%, 95% CI 0%–98%). Three studies for meta-analysis observed that the anxiety feeling declined more in the Papacarie group (MD = 1.01, 95% CI 1.72 to 0.30, P < 0.005). Only 7 studies showed that Papacarie required greater time for caries removal (MD = 200.79, 95% CI 152.50 to 249.09, P < 0.00001). In regard to the patient acceptability of various caries removal measures, 3 studies showed that more patients preferred the Papacarie method. This study concluded that Papacarie is effective and efficient in caries removal. Papacarie showed benefits in decreasing the bacteria in infected dentine and reducing the pain recognition during caries removal in primary teeth. However, Papacarie had a longer treatment time compared to the traditional method.
28422591Abdul Khalek/201750 healthy children aged 4-8 years with an open dentinal occlusal carious lesion and no pulp involvementRandomized Controlled Trial
Key resultsIn this study 50 healthy children aged 4-8 years were divided into two groups: one group treated with Papacarie, and one group with the Atraumatic Restorative Treatment (ART) method. Both groups were evaluated for pain and discomfort during caries removal procedures. Regression analysis was used to show the effect of the two measures of excavation on the mean Sound, Eye and Motor (SEM) score. The regression model demonstrated 45% of the variation in SEM score (adjusted R2= 0.45). After adjusting for the effect of various factors, the mean (95% confidence interval) SEM scores in the Papacarie and ART groups were 3.6 (1.9, 5.2) and 7.8 (6.6, 9.1). The median score was significantly lower in the Papacarie group than in the ART group for all three components (sound, eye, and motor): sound (S), 1 compared to 3 (P< 0.0001); eye (E), 1 compared to 2 (P= 0.003); and motor (M), 1 compared to 3 (P= 0.001) respectively. The study also showed that treatment with Papacarie took 1 minute longer in average than ART; however, it created significantly less pain and discomfort.
Evidence Search "Papacarie"[Supplementary Concept] OR "Papacarie"[All Fields] OR "papacarie"[All Fields]
Comments on
The Evidence
Validity: Deng (2018) is the only systematic review with meta-analysis located during a literature search that evaluated the effectiveness and efficiency of Papacarie in caries removal in primary teeth. Since this study is a meta-analysis, it provides the highest level of evidence on this topic. Several outcomes have been examined in this study, which is a point of strength. However, the review was limited to studies performed in India, Egypt, and Brazil, which limits the generalizability of the results. In addition, the type and location of caries was not specified in the studies, so the efficacy of caries removal in different teeth or surfaces was not evaluated. The Abdul Khalek (2017) study was a randomized, controlled, blinded, two parallel-arms clinical trial. Sample randomization was achieved using random allocation software. Random distribution sequence was made by one of the researchers. Subject recruitment, caries removal, and cavity restoration was completed by another investigator, and assessment was done by two independent assessors blinded to the nature of intervention and the identity of the child. Their intra-examiner and inter-examiner reliability were assessed using the Kappa statistic, which revealed intra-reliability of 0.9, 1 and 0.78 for first assessor and 0.9, 0.78 and 0.7 for the second assessor, with inter-examiner reliability of 1, 0.78 and 0.85. Generally, the measurements and criteria used in this study to attain the results were valid. Perspective: Deng: Based on this meta-analysis, it is reasonable to conclude that Papacarie is effective and efficient in caries removal in the primary dentition. Abdul Khalek: Based on the randomized clinical trial, it is reasonable to determine that Papacarie produces less pain and discomfort, but is lacking in strength. Further research is indicated to enhance the strength of evidence.
Applicability Papacarie use for caries removal has shown a reduction of bacteria in infected dentin; less pain perception was also noted, which decreased or eliminated need of local anesthesia. However, Papacarie needs repeated applications during the procedure in order to reach its desirable effect. Therefore, this might cause Papacarie to take a slightly longer time than other treatment methods, which might affect the patient's cooperation, since time is an important factor in treating children to manage their behavior during dental treatment.
Specialty (General Dentistry) (Pediatric Dentistry)
Keywords Papacarie, caries, anxiety, minimally invasive dentistry
ID# 3323
Date of submission 08/22/2018
E-mail aljameel@livemail.uthscsa.edu
Author Alaa Al Jameel, BDS
Co-author(s) e-mail
Faculty mentor Dr. Kevin Donly, DDS, MS
Faculty mentor e-mail DONLY@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available