UBC Theses and Dissertations
An exploratory study of a contemporary caries management protocol in high risk immigrant children Ng, Carter Kar Tat
Objectives: ‘Project Smile-Aid’ (PS-A) was developed as a multi-faceted intervention to manage severe early childhood caries in young low-income, immigrant children attending a public health clinic in Vancouver, Canada. The aims of this pilot study are to: 1) Assess the feasibility and practicality of delivering the PS-A ‘intervention’ in a community setting, 2) Explore the association between the ‘intervention’ and stabilization of dental caries and parent, family, and child quality of life; 3) Assess the acceptance of the ‘intervention’ by the parents. Methods: PS-A ‘interventions’ included caregiver counselling about diet and toothbrushing employing a motivational interviewing-style approach; interim therapeutic restorations (ITRs); and topical remineralization agents (fluoride varnish and CPP – ACP) applied in clinic and at home. Children aged 1 - 12 years of age with extensive caries were recruited over a 12 month period. One calibrated clinician completed dental assessments using ICDAS, delivered the intervention and recorded measurements at baseline and follow-up visits. Parental satisfaction was rated following the ‘intervention.’ Also, caries status, oral hygiene, child’s behaviour and Early Childhood Oral Health Impact Survey (ECOHIS) scores were compared to baseline at 3, 6 and 9 month intervals. Results: Fifty-two children participated: 22 girls, 30 boys. Child’s age, mean (SD), was 31.9 (10.7) months. Behaviour often impeded placing ITRs, but 27/52 (53%) of children had > 1 ITR, typically on maxillary incisors. The mean (SD) ITR survival time was 5.3 (1.5) months. Plaque scores at follow-up did not demonstrate significant improvement from baseline. Overall, ICDAS scores remained the same, suggesting stabilization of caries. Parental satisfaction with the ‘interventions’ was uniformly positive. Further, decreased mean parental ECOHIS scores suggested improvement in parental quality-of-life over time. However, child-domain ECOHIS scores were challenging to interpret, likely because some items of the instrument did not apply to such young children. Conclusions: PS-A proved feasible in a community setting. As measured by ECOHIS, parental quality of life appeared to improve. A reduction in caries progression was evident. Low-income, immigrant parents welcomed the PS-A strategy as an opportunity to “do something” to improve their child’s dental health.
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