Disease Management of Early Childhood Caries: ECC Collaborative Project

Abstract

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

The International Caries Classification and Management System (ICCMS™) An Example of a Caries Management Pathway

“…In addition to the scientific evidence that supports the different interventions proposed in this paper, additional evidence indicates that remineralization of caries lesions can take place in enamel and dentin [ 82 ]. An early childhood caries management approach that focuses on home care, prevention, and restorative care resulted in positive outcomes [ 83 ]. Sealants and resin infiltration have shown potential of slowing the progression or reversing non-cavitated caries lesions [ 84 - 86 ].…”

Role of saliva proteinase 3 in dental caries

“…Caries can progress rapidly if left untreated, resulting in pain and infection; thus, early diagnosis and prevention is of great importance. 1 , 2 , 3 , 4 , 5 Salivary analyses have been used to help assess the risk of caries by measuring the saliva's buffering capacity and bacterial content. 6 Recent studies have also indicated that a comprehensive compositional analysis of the complexity of oral fluid is very important in the assessment of the severity of caries.…”

Pediatric Dental-Focused Interprofessional Interventions

“…Dental personnel may also serve effectively as helping professionals in ECC counseling 4748 but would require sufficient compensation to routinely implement disease management protocols in practice 49 to offset income lost from reductions in dental repair. The high cost of dental professionals and their sophisticated clinical expertise, however, suggest that engaging them in family-level counseling is inherently inefficient while limiting their availability to function at the top of their scope of practice.…”