Dentistry, with historic roots in a surgical tradition, commonly approaches dental caries as an acute surgical problem requiring restoration and rehabilitation rather than as a chronic disease management process (CDM) requiring individually-tailored management of etiologic factors. CDM approach utilizes techniques such as motivational interviewing, coaching, role modeling, peer engagement, positive reinforcement, and social reward to engage parents and collaboratively solve individual impediments to action. CDM also calls for delivery system redesign, useful to facilitate reliable adoption of such techniques and evidence-based clinical protocols, as well as to evaluate patient outcomes.   As part of a protocol to achieve individualized behavioral and treatment goals, patients also receive procedures such as sealants, interim therapeutic restorations and fluoride varnish applications, in conjunction with traditional restorative treatment as required. 

Use of CDM for the care of children with Early Childhood caries has demonstrated strong potential for reductions in new cavitations, dental pain, and reduced referrals to the operating room compared to baseline rates.  Results of Phase 1 of an ECC Collaborative in two sites found that, after thirty months, children with ECC in the intervention group experienced lower rates of new cavitated lesions, pain, and referrals for restorative care in the operating room compared to baseline historical controls with ECC. Phase 2, involving five additional sites across the US, replicated these results after 18 months of intervention.  The Collaborative teams found that quality improvement strategies facilitated adoption of CDM and resulted in improved care to patients and better patient outcomes overall. The results found

 

ECC patients  treated with CDM (N=344)

Historical Controls (N=316)

Percent improvement

New caries

33%

46%

28

Pain

8%

11%

27

Referral to OR

14%

22%

36

*Adopted from Ng, Ramos-Gomez, Lieberman,et al. International Journal of Dentistry 2014

A cost effectiveness analysis of concluded that the CDM program was cost effective from the health care system, Medicaid and societal perspectives. ECC patients were found to have had significantly more preventive visits, significantly fewer restorative and surgical visits and lower overall costs compared to baseline historical controls.

Resources