Arrow P, Piggott S, Carter S, McPhee R, Atkinson D, Mackean T, Kularatna S, Tonmukayakul U, Brennan D, Nanda S, Palmer D, Jamieson L
Western Australia Dental Health Services, Research and Evaluation, Health Department of Western Australia, Perth, Western Australia, Australia.
Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
JDR Clin Trans Res. 2021 Oct;6(4):430-439. doi: 10.1177/2380084420963949. Epub 2020 Oct 3.
The management of early childhood caries (ECC) is challenging.
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.
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.
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.
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.
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.
幼儿龋齿（ECC）的管理具有挑战性。
在澳大利亚偏远的原住民社区中，对基于非创伤性修复治疗和霍尔技术（ART-HT）的ECC护理模式进行评估。
邀请西澳大利亚州西北部的原住民社区参与，同意参与的社区被随机分为ECC管理的早期干预组或延迟干预组。在基线和11个月随访时对儿童进行检查。早期干预组（试验组）在基线时接受基于ART的牙科护理，而延迟干预组（对照组）则被建议通过社区内现有的常规护理途径寻求护理。在随访时，两组均由经过校准的检查人员进行检查，并采用ART-HT方法提供护理。使用配对检验来测试从基线到随访期间龋齿经历的变化。对缺失数据进行多次插补后的多变量分析使用广义估计方程（GEE），以控制社区内的聚类情况。
共有25个社区和338名儿童（平均年龄 = 3.6岁，标准差1.7）参与了研究（试验组 = 177名）。在随访时，对231名儿童进行了检查（保留率68%，试验组 = 125名）。在随访时，试验组儿童的补牙数量更多（试验组补牙数 = 1.2颗，对照组补牙数 = 0.2颗，P < 0.001），龋齿数量减少（试验组平均龋齿数减少0.7颗，对照组平均龋齿数增加1.0颗，P < 0.001）。对基线龋齿经历、年龄、性别和社区水氟水平进行控制的GEE分析发现，对照组在随访时未治疗龋齿的发生率增加（相对风险 = 1.4，P = 0.02），补牙率降低（相对风险 = 0.2，P < 0.001）。
一种依赖微创非创伤性方法原则的护理模式能够为澳大利亚偏远原住民社区的幼儿（<6岁）提供有效的牙科服务，从而提高护理水平并改善口腔健康。
这项整群随机试验在澳大利亚偏远原住民社区中对患有ECC的幼儿的多成分牙科护理模式进行了测试。该干预措施基于采用包括预防性护理、非创伤性修复治疗和霍尔技术（ART-HT）在内的微创技术的非创伤性方法，提供了更多的修复性护理并降低了龋齿发生率。这种护理模式比现有的标准护理更有效，应纳入主流服务提供项目中。
