Health Department of Western Australia, Western Australia Dental Health Services, Research and Evaluation, Perth, Australia.
Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia.
Community Dent Oral Epidemiol. 2022 Dec;50(6):513-521. doi: 10.1111/cdoe.12704. Epub 2021 Nov 23.
The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control).
Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities.
Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group.
The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.
儿童龋病的管理具有挑战性，其治疗对澳大利亚原住民儿童的儿童口腔健康相关生活质量（COHRQoL）和牙科焦虑的影响尚不清楚。本研究的目的是比较使用无创伤性修复治疗和 Hall 技术（ART/HT：试验）或标准护理（对照）治疗儿童龋病（ECC）后大约 12 个月时 COHRQoL 和牙科焦虑的影响。
西澳大利亚州西北部的同意原住民社区被随机分为早期（试验）或延迟（对照）干预以管理 ECC。儿童及其父母/照顾者在基线和随访时完成了一份问卷。该问卷通过代理报告的幼儿口腔健康影响量表（ECOHIS）和儿童龋病影响和体验问卷（CARIES-QC）来获取 COHRQoL 信息。试验组在基线时接受了 ART/HT 护理，而对照组则被建议通过社区内可用的常规护理选项寻求护理。随访时，两组均使用 ART/HT 方法进行护理。使用适当的配对（t 检验，Wilcoxon 配对检验）评估组内从基线到随访的平均评分变化，并使用非配对检验（t 检验）进行组间比较。使用广义估计方程（GEE）对缺失数据进行多次插补后进行多变量回归分析，控制社区内的聚类。
25 个社区和 338 名儿童（平均年龄 3.6 岁，标准差 1.7）参加了这项研究（试验组 177 名）。一名儿童因基线和随访时的问卷和临床数据缺失而被排除在分析之外。基线时，试验组儿童年龄较大（试验组 3.8 岁，95%CI 3.6-4.1；对照组 3.3 岁，95%CI 3.1-3.6），龋病经验较高（试验组 dmft 4.4，95%CI 3.8-5.0；对照组 dmft 3.1，95%CI 2.5-3.7），但两组间 COHRQoL 或焦虑水平无显著差异。随访时，延迟干预组的家长报告 COHRQoL 恶化（ECOHIS 家庭影响部分恶化 70%，ECOHIS 总分恶化 37%），而早期治疗组儿童的牙科焦虑减少了 8%。
ART/HT 方法的应用是可行的、有效的，并对偏远社区的原住民儿童的口腔健康相关生活质量和儿童牙科焦虑产生了积极影响。本研究中测试的护理模式应进一步开发，纳入主流服务提供计划。
