None listed
Conditions
Brief summary
Dental caries (tooth decay) is the second most costly diet-related disease in Australia. Its economic impact is comparable with that of heart disease and diabetes with an increasing total expenditure for dental services from $4.4 billion per annum (6.1 % of total health expenditure) in 2001 to more than $5.3 billion per annum (10% of total health expenditure across Australia) in 2007. Research has demonstrated that placing dental fillings does nothing to manage the dental caries disease process. Minimal Intervention Dentistry (MID) is a multi-pronged approach which focuses on the management of dental caries as a diet related, transmissible, infectious disease. It comprises measures that range from prevention, early intervention, and treatment. The proposed research will be undertaken with a group of adolescent public dental patients (concession-card holders). The current direct-service delivery model does not place specific emphasis on the management of dental caries through caries risk assessment, prevention or early intervention. The overall goal of this project is to undertake a pilot study to test the impact on caries-risk status of implementing a MID clinical protocol to a group of adolescent public dental patients (aged 13-18 years) who are at high risk to dental caries.
Interventions
Arm 1 - Control Arm - Standard course of dental care
Arm 2 - Test Arm - will have all four principles of Minimal Intervention Dentistry (MID) approach for the management of dental caries implemented by the community clinic oral health practitioners, namely:
1. prevention and early intervention to control the disease. Patients’ caries risk level will be identified as outlined by Evans et al (2008) and a treatment plan based on the caries risk assessment will be developed and implemented. A dent
Arm 1 - Control Arm - Standard course of dental care Arm 2 - Test Arm - will have all four principles of Minimal Intervention Dentistry (MID) approach for the management of dental caries implemented by the community clinic oral health practitioners, namely: 1. prevention and early intervention to control the disease. Patients’ caries risk level will be identified as outlined by Evans et al (2008) and a treatment plan based on the caries risk assessment will be developed and implemented. A dental therapist will undertake motivational interviews with the patients to promote self management of dental caries including oral hygiene instruction, dietary habits, the importance of saliva, the role of fluoride and antibacterial therapies. 2. Remineralisation and ongoing monitoring of non-cavitated active lesions including preventive and re-mineralization procedures, application of fluoride varnish and bioavailable calcium phosphate agents, and application of fissure sealants. In addition, patients will be provided with oral health care products for home care as required. 3. Any carious lesion becoming cavitated or progressing into the outer third of the dentine (based on the bitewing radiographs) will be restored by the dental therapist/s employed by the community dental clinic using adhesive and biomimetic restorative materials according to the protocol for the management of carious lesions devised by Jenson et al (2008). 4. Where appropriate, failed restorations will be repaired rather than being replaced by the dental therapists/s employed by the community dental clinic with the use of minimal cavity designs and adhesive and biomimetic restorative materials. The overall duration of the intervention is 12 months with review appointments at 3 months, 6 months and 12 months.
Sponsors
Dental Health Services Victoria
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
13 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
Inclusion criteria for this study include: 1. Adolescent patients (13-18 years) who hold a concession card or are dependents of a concession card holder. 2. Adolescent patients assessed as being at high risk to developing dental caries. 3. Adolescent patients attending 12-month high-risk recall visit at the Western Region Health Centre Dental clinic.
Exclusion criteria
Exclusion criteria for this study include: 1. Methamphetamine users and drug addicted patients 2. Patients with severe salivary gland hypofunction 3. Patients with medical or physical conditions that may, in the opinion of the investigators, compromise the study outcome e.g. requiring anticoagulant therapy; diagnosed intellectual, physical or mental health disability; conditions requiring chemotherapy or radiotherapy.
Outcome results
None listed