Acceptance of Innovative Caries Management in a Community Dental Clinic

Objectives: ‘Project Smile-Aid’ (PS-A) pilots a proactive approach to caries management in a dental public health setting. Motivational-style caregiver counselling, interim therapeutic restorations (ITRs) and topical remineralization agents are combined (‘Intervention’). The overall aims of the research are to determine ‘Intervention’ feasibility, its acceptance by immigrant parents and impact on child oral health-related quality of life.  Issues related to acceptance of the ‘Intervention’ by both parents and clinic staff will be the focus of this presentation.

Methods: Caries-active pre- and school-aged children from culturally-diverse low-income families were recruited at a community dental public health clinic in Vancouver, Canada.  Target sample size is 50. Baseline measures [dental health status, oral hygiene, child’s behaviour, Early Childhood Oral Health Impact Survey (ECOHIS) scores] will be compared with measures at post-‘Intervention’ intervals. One calibrated clinician recorded baseline measures and delivered the ‘intervention.’ All instruments, supplies and overhead costs, including dental assisting, were grant funded.  To enhance the support of clinic staff for this departure from customary caries management, staff was consulted during all planning phases. An interactive ‘in-service’ presentation was held prior to project launch.

Results: To date, 21 eligible parent-child dyads have been approached, have agreed to participate and the ‘Intervention’ has been delivered to all 21 children [mean age 2.8y]. Placement of multiple ITRs in active, pre-cooperative children is a significant challenge.  Despite the challenges of child behaviour, parental satisfaction with their child’s response 48-hours post-‘intervention’ is overwhelmingly positive. Clinic-related issues (e.g. operatory availability) remain major obstacles to delivering the ‘intervention’ in this public setting.

Conclusions: Low-income, immigrant parents are eager to participate in stabilizing their child’s caries when wait-times for definitive treatment are lengthy. However, operational issues and overcoming staff scepticism challenge innovation in customary caries management protocols.  Funded by 2010 UBC Dentistry ‘Pilot Project’ Grant.