Management of dental decay in young Aboriginal children

Aboriginal communities in the Kimberley region of Western Australia will be invited to participate. Communities will be randomised to intervention or control. Children in the intervention communities will be offered care in which minimally invasive approach based on the Atraumatic Restorative Treatment approach, including the Hall crown technique, will be used to provide the necessary care. Treatment will be provided by dental therapists with at least 5-years post-graduate experience to deliver ART and the Hall crowns . The ART approach will use hand instruments to remove dental decay, without the use of local analgesia, while placement of the Hall stainless steel crown will be undertaken without any tooth preparation or use of local analgesia. Any remaining at risk tooth surfaces will also be provided with a glass-ionomer fissure sealant. Treatment will be provided using portable dental equipment within community settings. The procedures are expected to take 30 minutes on each occasions while the number of occasions of treatment will vary, depending on the level of need for care. Children will also be provided with fluoride varnish applications and oral health promotion intervention by the dental therapist to the child and their carers to reduce the incidence of dental decay. The fluoride varnish, 0.25 ml of Duraphat varnish (22,600 ppm fluoride) will be applied to at risk surfaces at each checkup visit. The oral health promotion will also be delivered by dental therapists, face-to-face at recall check-ups and in group setting within the community, using the Aboriginal-specific resource kit for early childhood caries developed by the Dental Health Services (DHS), comprising flashcards on specific topics with relevant information. Face-to face intervention will take between 5-10 minutes while group sessions will be undertaken at the baseline, six-month and 12-month visit to the communities and will take approximately 45 minutes. Interested significant community members will also be provided with training and continuing support by dental therapists to undertake community oral health promotion activities, including “yarning” sessions with parents of newborn children, again using the DHS resource kit, based on anticipatory guidance and motivational interviewing approaches. The half-day training will involve a presentation outlining the causes of early childhood dental decay and role-play in the use of traditional "yarning" as a process of delivering information and motivating mothers/carers to change behaviour. The children will have six-monthly dental check-ups for 12 months, a total of 3 checkups, one at baseline, then at 6 months and then at 12 months; and further treatment as required will be provided at the appointments. Types of treatments provided and attendance for care will be reviewed from case-notes of the participants.