Shaun Sellars continues this exciting and essential series on ethical dilemmas in dentistry which appears in every second issue of the BDJ.

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The results of the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial have recently been published.1 If you've missed out on this piece of research, the three year, multi-centre, primary care study looked at how best to treat caries in high caries risk children of 3-7 years of age. Children were either solely given best practice preventative advice, or prevention combined with either conventional restorations or the use of stainless steel crowns using the Hall technique.

FiCTION was a vast piece of research. There is no comparable study in regards to the number of children studied over such a time. It was well designed, and despite some apparent ups and downs throughout the trial, has produced a multitude of data.

So what are the results? That's the most intriguing part of the research. The study showed that, in high caries risk children with previous caries experience, when looking at the incidence of pain and/or infection, there was no significant difference between each arm.

This result came as quite a surprise to me, and possibly to the researchers. As a rule, we like to think that the treatment we carry out makes a difference to patients. To find out that in some, for the most vulnerable people we work with, that looks unlikely to be true hits at the very core of what we do.

Does this mean that the research wasn't worthwhile in carrying out? Absolutely not. While the statistics may show no difference in treatment arms, there are many ways in which we could interpret the results.

First and foremost, this highlights the need to prevent caries in the first place. Once the decay is there, it's too late. Unsurprisingly this has been the focus of the press coverage following the trial. It's an easy to grasp concept that we can all get on board with.

Secondly, the results reinforce the idea that any treatment we carry out is only ever going to be of limited benefit. What is best for teeth is teeth. Nothing we do to try and replace what's gone will last forever.

This is an issue. Most of us make our income based on the treatment we carry out, not for trying to prevent those issues arising. While most recent contract reforms have paid lip service to preventative measures, there is still some way to go.

What this trial highlights is that the results of research go much further than the numbers produced. These statistics require careful interpretation to understand what they truly mean, and the story behind the numbers is what counts.

While on first inspection, this piece of research has come up with a negative result, this is valuable information. Without this kind of research, we will keep carrying out ineffective treatments while assuming that we're doing the best for our patients.

There are still a multitude of unknown unknowns in dentistry. The FiCTION trial expands a little on our knowledge of what doesn't work, and knowing what doesn't work is just as important as knowing what does.