Stainless steel crowns in general dental practice

Key Points

• British Society of Paediatric Dentistry (BSPD) guidelines recommend that preformed stainless steel crowns should be the restoration of choice.

• Data from the Dental Practice Board demonstrate that across England and Wales GDPs rarely provide this type of treatment.

• In this study, GDPs practising in the North West of England explain their reasons for not routinely providing preformed crowns.

Abstract

Aim

To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars.

Method

Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown.

Results

In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were that they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly.

Conclusion

The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice.

Main

General dental practitioners' views on the use of stainless steel crowns to restore primary molars A. G. Threlfall, L. Pilkington, K. M. Milsom, A. S. Blinkhorn and M. Tickle Br Dent J 2005; 199: 453–455

Comment

Within the General Dental Services the use of stainless steel (pre formed metal) crowns to restore the primary molars is limited. It is therefore timely that consideration be taken of the reasons why this is so. The British Society of Paediatric Dentistry¹ has developed guidelines regarding the restoration of the primary dentition which provide a clear rationale for their use including longevity of this type of restoration.²

This paper reports the views of 96 randomly selected GDPs practising in the north west of England in 2003 using a qualitative approach. Separate semi structured interviews were conducted around a previously agreed set of themes. The practitioners were asked to consider a scenario for treatment, to comment on 'Stainless steel crowns are widely recognised as the most effective and durable restoration for primary molars. They are the restoration of choice for primary molars with multi surface lesions, extensive caries and those where pulpal treatment has been performed' and whether they had heard of this guidance. Most of the GDPs had read the guidance¹ but very few reported using or would offer stainless steel crowns (SSC) for treatment as a matter of routine. Having said that, the main thrust of the study was to establish why the majority of the GDPs ignored the guidelines. The perception is that SSCs are an unnecessarily durable restoration for primary molars, they are not cosmetically acceptable and that young patients do not tolerate the procedure. The practitioners reported that using glass ionomer was quicker and more tolerable to their patients.

The BSPD guidelines are produced after wide consultation within the speciality but largely ignored by GDPs. Together with this and the continuing debate about delivery of dental care for children,³ it must be most unsatisfactory to those who prepared the guidelines. Part of the problem is the perception that the specialist organisation is out of touch with the realities of daily general dental practice and the guidelines do not reflect the views of GDPs. However, the overriding principle should be for safe and high quality patient care for all children seeking dental treatment. Hence the need for a continuing dialogue between the specialist organisation and general practitioners to produce guidelines which could be more suitable and practical for general use. CPD would certainly provide the means to encourage better use of SSCs; an issue to be taken up by the specialist organisation.