Atraumatic restorative treatments improve child oral health‐related quality of life: A noninferiority randomized controlled trial

Arrow, Peter; Forrest, Helen

doi:10.1111/cdoe.12539

Cited by 12 publications

(22 citation statements)

References 32 publications

(80 reference statements)

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“…Some participants in the DGA sought other treatment options for various reasons including concern about costs and safety of DGA. A qualitative study found that parents felt troubled and found difficult to accept DGA as the treatment option for their child 21 31 …”

Section: Discussionmentioning

confidence: 99%

“…The trial investigated the provision of comprehensive care including tooth extractions and pulp treatment in a primary care setting in order to minimize the need for a DGA. The findings with respect to clinical effects, impacts on child oral health‐related quality of life (COHRQoL) and parent/carer perspectives on care provided to their child have been reported 20–22 . The specific objectives of the RCT were to: (a)estimate average probability of successfully managing the dental treatment of the child; (b)identify changes in COHRQoL; (c)determine parents' views on the care provided to their child; (d)investigate if the ART/HT offers good value‐for‐money, defined as less costly with improved effectiveness or cost neutral with improved effectiveness. …”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Tonmukayakul

Forrest²,

Arrow³

2021

Australian Dental Journal

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Background This study assessed the cost‐effectiveness of atraumatic restorative treatment and the Hall Technique approach (ART/HT) in managing dental caries in young children under the health provider perspective in order to explore a best‐buy alternative to dental general anaesthesia (DGA). Methods Sixty‐five observations from a randomized controlled trial were used to construct 20 000 microsimulations representing individual‐level clinical outcome and costs of the DGA and ART/HT. Outcome was percentage of successfully managed cases. Costs were reported in 2020 price. Three different scenarios with different assumptions of clinical success of the DGA and the ART/HT were analysed. Probabilistic sensitivity analysis was carried out. Results The ART/HT successfully managed more cases at lower cost ($557) than the DGA when the system failure of the DGA was considered. Under per protocol analysis, participants in both arms were successfully managed, but the ART/HT costed $580 less than the DGA. Probabilistic sensitivity analysis confirmed the ART/HT was a dominant intervention. Conclusions The ART/HT approach was non‐inferior in managing dental caries in young children but at lower costs than the DGA. The ART/HT could be a viable option in the provision of comprehensive dental care in locations with limited access to DGA and reduce hospital admission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Tonmukayakul

Forrest²,

Arrow³

2021

Australian Dental Journal

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“…Findings related to clinical outcomes and changes in child oral health-related quality of life have already been reported [8,9].…”

Section: Discussionmentioning

confidence: 86%

“…While acknowledging the use of other options such as pharmacological sedation and protective stabilisation in managing dental treatment of children [12], this study reports on P/C views within a randomised trial of the management of their child's dental caries under a DGA and an alternative minimally invasive approach using the Atraumatic Restorative Treatment and the Hall technique (ART/HT) after their child had been recommended a DGA. The findings with respect to clinical outcomes and impact on COHRQoL have been reported [8,9]. The aim of this study was to elicit P/C views on approach to care with the DGA within a publicly funded care system and a minimally invasive alternative approach to the DGA.…”

Section: Introductionmentioning

confidence: 99%

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

Arrow

Forrest

Piggott

2021

Front. Oral. Health

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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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“…The findings lend further support for the use of ARTs in the delivery of dental services to young children. The approach had enabled the provision of dental treatment in a primary care setting and improved the oral health-related quality of life of young children recommended for dental general anaesthesia (Arrow and Forrest 2020a, 2020b). However, there has been no evidence of its effectiveness in a remote Aboriginal Australian context.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial

Arrow

Piggott

Carter

et al. 2020

JDR Clinical & Translational Research

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Introduction: The management of early childhood caries (ECC) is challenging. Objectives: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Methods: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. Results: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. Conclusion: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. Knowledge Transfer Statement: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

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Atraumatic restorative treatments improve child oral health‐related quality of life: A noninferiority randomized controlled trial

Cited by 12 publications

References 32 publications

Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

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

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial

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