Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

Background: Our aim was to compare salivary levels of secretory immunoglobulin A (s-IgA) in children with early childhood caries (ECCG) and those who are caries-free (CFG) and verify these levels in a follow-up period after restorative treatment. Materials and methods: We selected 46 systemically healthy children in the complete primary dentition period, who were allocated into two groups: CFG (n = 23) and ECCG (dmf-s > 0; n = 23). Unstimulated whole saliva was obtained at baseline from both groups and during the follow-up period (7 days, 1, 2 and 3 months) in the ECCG group. The s-IgA was measured using an ELISA assay, and total protein was assessed using the Bradford method. We also evaluated the flow rate (mL/min), Streptococcus mutans and Lactobacillus spp. counting using selective media plaques. The data were submitted to statistical analysis using the software SPSS 20.0 (SPSS Inc, IL, USA) with a confidence interval set at 95%. Results: Salivary s-IgA levels were higher in baseline of ECCG than in CFG (p<0.05). No statistically significant differences were observed between s-IgA salivary levels at baseline and the evaluations after dental treatment in ECCG (p>0.05). However, we observed two different changes in s-IgA levels among participants: one group presented s-IgA reduction, and the other group demonstrated its maintenance. It was shown that patients from the ECCG group who presented a reduction in s-IgA levels during follow-up also showed a decrease in Streptococcus mutans and Lactobacillus spp. count (p<0.05), in contrast to patients who did not present this reduction. The flow rate and total protein were similar between groups (p>0.05). Conclusions: The present data support the idea that children with early childhood caries present higher levels of s-IgA in saliva than caries-free children. The restorative dental treatment does not have a significant influence on salivary levels of this immunoglobulin during the follow-up period.

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Disease Management of Early Childhood Caries: ECC Collaborative Project

International Journal of Dentistry ◽

10.1155/2014/327801 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Man Wai Ng ◽

Francisco Ramos-Gomez ◽

Martin Lieberman ◽

Jessica Y. Lee ◽

Richard Scoville ◽

...

Keyword(s):

Early Childhood ◽

Disease Management ◽

Health Care Providers ◽

Early Childhood Caries ◽

Standard Of Care ◽

The United States ◽

Care Providers ◽

Restorative Treatment ◽

Wide Scale ◽

Childhood Caries

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

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Minimally Invasive Dentistry: Parent/Carer Perspectives on Atraumatic Restorative Treatments and Dental General Anaesthesia to the Management of Early Childhood Caries

Frontiers in Oral Health ◽

10.3389/froh.2021.656530 ◽

2021 ◽

Vol 2 ◽

Author(s):

Peter Arrow ◽

Helen Forrest ◽

Susan Piggott

Keyword(s):

Early Childhood ◽

Minimally Invasive ◽

General Anaesthesia ◽

Early Childhood Caries ◽

Cost Of Care ◽

Atraumatic Restorative Treatment ◽

Treatment Needs ◽

Minimally Invasive Dentistry ◽

Dental General Anaesthesia ◽

Childhood Caries

Introduction: Parents of children treated under dental general anaesthesia (DGA) have reported feelings of concern and anxiety. This study elicited the views of parents/carers (P/C) of children with early childhood caries (ECC) who participated in a randomised trial (core study) which tested the effectiveness of care under DGA or care using alternative minimally invasive Atraumatic Restorative Treatment and the Hall Technique approaches (ART/HT).Methods: P/C of children treated using the ART/HT (test) approach or care under a DGA (control) were interviewed. Focus group semi-structured interviews with P/C were undertaken in community facilities. The transcripts were read and inductively coded into domains to identify emergent themes. The codes were entered into NVivo software to assist data management and were further refined into broad themes.Results: Seven grouped interviews with 14 participants were conducted and one test participant provided a written response. Four groups with eight test participants; two groups with four control participants; and one combined group with one test and one control participant were interviewed. Five broad themes emerged after thematic analysis: (1) Impacts on the child and the family; (2) Child-/family-centred care; (3) Timeliness of care; (4) Affordable care; (5) Accessible care. Impacts were related to that of the effects of the disease, and of the care for the disease. Child-centred/family-centred care (CCC) was a source of appreciation by P/C of both groups when it was experienced. Frustration at the lack of timely care of their child's treatment needs, coupled with the perceived expensiveness of care and difficulties in physically getting to the location for a specialist consultation was expressed by P/Cs in the study.Discussion: The use of the ART/HT enabled the establishment of a relationship between the clinical team and the child and P/C which was central to the delivery of CCC. P/Cs in the DGA arm of the study expressed dissatisfaction more often with the issues of timely care, cost of care and accessibility of care. P/C of both groups were equally satisfied with the treatment, where treatment had been received in a timely, child-centred manner.Conclusion: The findings suggest that minimally invasive approaches which facilitated CCC are acceptable alternative options to the DGA and should be considered for the management of ECC.Australian New Zealand Clinical Trials Registry: ACTRN12616001124426.

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Strategic Management of Early Childhood Caries in Thailand: A Critical Overview

Frontiers in Public Health ◽

10.3389/fpubh.2021.664541 ◽

2021 ◽

Vol 9 ◽

Author(s):

Thanya Sitthisettapong ◽

Parinda Tasanarong ◽

Prathip Phantumvanit

Keyword(s):

Early Childhood ◽

Oral Health ◽

Strategic Management ◽

Early Childhood Caries ◽

Community Education ◽

World Health ◽

Deciduous Teeth ◽

Atraumatic Restorative Treatment ◽

Health Coverage ◽

Childhood Caries

The aim of this report was to advocate early childhood caries (ECC) and share strategic management in Thailand, despite over two decades of free Universal Health Coverage including oral healthcare. The recent Thai national oral health survey in 2017 indicates the very high prevalence of ECC, with an average of three carious teeth affected in 53% of 3-year-old children. This is despite the efforts of the Ministry of Public Health that has launched several interventional programs ranging from an upstream policy that prohibits sugar additions in baby formula milk to downstream remediations such as advocating and encouraging toothbrushing with fluoride toothpastes. Nevertheless, ECC is strongly predicated by other key factors including the family and community commitment and participation, as embodied in the current World Health Organization guidelines. These encompass three different tiers of community-level prevention: primary, secondary, and tertiary. Accordingly, the following strategies for ECC management in Thailand should be based at primary care clusters (PCC) in sub-district health centers, with the assistance of inter-professional health teams. These include community education on the importance of deciduous teeth and effective toothbrushing with fluoride toothpaste (primary prevention), regular examination and detection of ECC lesions and early intervention (secondary prevention), insertion of non-invasive preventive restorations using cost-effective atraumatic restorative treatment (ART) or simplified and modified ART (SMART) (tertiary prevention), and, finally, effective follow-up and monitoring systems. It is anticipated that this triple tier approach to ECC management will improve not only the oral health but also the overall children's health.

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Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/10322 ◽

2018 ◽

Vol 7 (7) ◽

pp. e10322

Author(s):

Peter Arrow ◽

Rob McPhee ◽

David Atkinson ◽

Tamara Mackean ◽

Sanjeewa Kularatna ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Early Childhood ◽

Early Childhood Caries ◽

Controlled Trial ◽

Atraumatic Restorative Treatment ◽

Rural And Remote ◽

Aboriginal Communities ◽

Restorative Treatment ◽

Randomized Controlled ◽

Minimally Invasive Dentistry

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Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.10322 ◽

2018 ◽

Author(s):

Peter Arrow ◽

Rob McPhee ◽

David Atkinson ◽

Tamara MacKean ◽

Sanjeewa Kularatna ◽

...

Keyword(s):

Early Childhood ◽

Minimally Invasive ◽

Early Childhood Caries ◽

Test Group ◽

Caries Experience ◽

Control Group ◽

Atraumatic Restorative Treatment ◽

Randomized Controlled ◽

Aboriginal Children ◽

Childhood Caries

BACKGROUND The caries experience of Aboriginal children in Western Australia (WA) and elsewhere in Australia is more than twice that of non-Aboriginal children. Early childhood caries (caries among children <6 years) has a significant impact on the quality of life of children and their caregivers, and its management is demanding and commonly undertaken under general anesthesia. A randomized controlled trial using a minimally invasive dentistry approach based on Atraumatic Restorative Treatment (ART) in metropolitan Perth, WA, has demonstrated a significant reduction in the rate of referral to a dental specialist for dental care among children with early childhood caries, potentially reducing the need for treatment under general anesthesia. The tested approach was clinically successful and was without adverse effects on child dental anxiety. The model of ART-based primary care requires further testing and development if similar outcomes for Aboriginal children in remote and rural settings are to be achieved. OBJECTIVE The study aims to develop, implement, and evaluate a remote primary care model to deliver effective primary dental services, encompassing treatment and preventive services, to Aboriginal preschool children (based on minimally invasive approaches including ART). METHODS This is a two-arm parallel cluster randomized controlled study in which a test group will be provided with the intervention treatment at the start of the study and a control group will be provided with the intervention treatment 12 months after study commencement (delayed intervention). Participating communities, stratified by size of community (ie, number of children in the sample frame) and baseline caries experience, will be randomly assigned using a computer-generated block randomized list into immediate (test group) or delayed intervention (control group; provided with standard care). Informed consent will be obtained from all participants. Aboriginal research assistants will explain the study to the parents and assist the parents in completing the questionnaires. Participants in the randomized study will be examined at baseline and at 12 months follow-up by a calibrated examiner. Test group participants will subsequently be contacted and appropriate appointments coordinated for treatment. Control group participants will be provided with standard preventive care by the Aboriginal Health Workers and managed for treatment as per standard procedures. RESULTS Community consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants. CONCLUSIONS The significance of the study lies in its holistic approach to testing the model of care. Clinical evaluations as well as oral health‒related quality of life evaluations will be undertaken. Cost-effectiveness and cost-utility evaluations will assist in the development of policy options for oral health services for rural and remote communities. The elicitation of caregiver perspectives through focus group interviews will supplement the clinical, psychosocial, and cost-utility evaluations and provide a richer evaluation of the intervention. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12616001537448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371735 (Archived by WebCite at http://www.webcitation.org/70UMxndFZ) REGISTERED REPORT IDENTIFIER RR1-10.2196/10322

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