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44 I I feature _ interview arenotmuchdifferenttothatforpermanentteeth; in both cases, diseased portions of the dental pulp are removed in an effort to preserve the hard struc- ture of the tooth for functional or cosmetic pur- poses. Anatomical and physiological differences be- tween primary and permanent teeth make a dif- ference to the principle of root-canal treatment. A permanent tooth requires an inert, solid, non- resorbable material that can last a lifetime, and gutta-perchafitsthatbill.Theidealroot-canalfilling materialforprimaryteethshouldresorbatasimilar rate to the primary root in order to permit normal eruption of the successor tooth; not be harmful to the underlying tissues or to the permanent tooth germ; fill the root canals easily; adhere to the walls and not shrink; be easily removed, if necessary; be radiopaque; be antiseptic; and not cause discol- ouration of the tooth. There is currently no material thatmeetsallthesecriteria,butthefillingmaterials most commonly used for primary pulp canals are non-reinforced zinc-oxide-eugenol paste, iodo- form-based paste (KRI), and iodoform and calcium hydroxide (Vitapex). _A study in the Netherlands has found that prevention involving the counselling of parents on caries-promoting feeding behaviour is often inef- fective in the long term. Is there a lack of quality interventionstrategies? DrHerman:Ifwe(ortheWHO)couldanswerthis question, we’d have found the key to unlocking the mysteryofimprovingorenhancinghumanmotiva- tion. It is probably true that without continual and periodic follow-up, counselling will wear off even amongsthighlymotivatedindividuals.Wethinkthe key lies with education that begins early and pro- motes a sound nutritional and sustainable oral- hygiene model for parent and child alike. As you mightimagine,thisisatasknotwellsuitedtothetra- ditionaldental-caredeliverymodel,andwillrequire some serious paradigm changes to permit effective implementation. _What preventative measures do you recom- mendbasedonyourclinicalexperienceinNewYork? Dr Herman:Preventivemeasuresandconserva- tivetherapiesthatconfrontthecauseofthedisease, ratherthantreatthesymptoms,arethemosteffec- tive and work the best. Fluoride varnish has proven to be a godsend, although most of the evidence to date is empirical and anecdotal. Good long-term longitudinal studies are needed to prove conclu- sively what we already know as clinicians—an intensive regimen of fluoride varnish, along with adjunctive measures, can control and often reverse dental decay, as well as prevent it. Dr Lim: Starting in infancy, children at-risk for dental decay should be receiving twice-yearly ap- plications of fluoride varnish, whether by a dentist or dental professional, or as part of their well-baby care from their paediatricians. More than 40 states intheUShaveimplementedsuchprogrammes,and the outcomes are impressive—as much as 40 per cent fewer children with early signs of ECC. Prof Fernandez: Collaboration between other healthprovidersandthedentalprofessionsiskeyto combating the incidence of ECC._ Editorialnote:Theinterviewquestionswerekindlyprovided byDanielZimmermann,DTI. roots3_2010 Dr Lily Lim (middle) with colleagues bringing smiles to a child after treatment. Dr Neal Herman.