Investigating the Impact of a Chronic Disease Management Protocol on Reducing the Need for Dental General Anaesthesia for Treating Early Childhood Caries in Australia.

Abstract

Background: An increasing number of children are being admitted to hospitals for dental general anaesthesia (GA). This study investigated the effects of a chronic disease management (CDM) protocol on rates of dental treatment under GA for Early Childhood Caries (ECC).

Methods: A 24-month study was conducted in New South Wales, Australia. Children aged < 72 months with ECC were managed utilising a CDM protocol. Rates of treatment completed in the chair vs. GA were compared to historical controls. The effect of silver fluoride treatment on avoiding the need for GA in the prospective group was also analysed.

Results: GA was avoided and treatment completed in the chair for 47% of the children in the prospective group (who were 9.6 times more likely to avoid a GA) compared to 15% in the retrospective control group. For participants in the prospective cohort who were initially referred for GA, silver fluoride application was associated with significantly increased odds of avoiding GA and completing treatment in the chair compared with those who did not receive silver fluoride (OR 5.51, 95% CI: 2.09-14.57).

Conclusion: The CDM protocol was effective in reducing the number of dental treatments under GA for ECC in select public dental clinics.

Clinical relevance: Implementation of a CDM protocol in public dentistry has resulted in a seismic shift in the management of caries in young children. Prospective patients referred for treatment under GA were nine times more likely to have their treatment completed in the dental chair and avoid a GA compared to historical controls. Silver fluoride played a vital role in the CDM protocol. Patients that received silver fluoride treatment were five times more likely to avoid a GA. The CDM protocol was highly effective in incorporating disease management visits within the existing appointment framework avoiding the need for additional appointments overall.