Silver Diamine Fluoride Protocol for Reducing Preventable Dental Hospitalisations in Victorian Children.

INTRODUCTION: This study was designed to assess whether a dental caries management protocol combining a single application of 38% silver diamine fluoride (SDF) with comprehensive oral health education will successfully divert high-risk children from dental treatment under dental general anaesthesia (DGA), arrest active caries in primary teeth, and improve parent-reported child oral health-related quality of life (OHRQoL). METHODS: Children aged 2 to 10 years, who attended two public dental agencies in Victoria, Australia, and were unable to tolerate restorative treatments in the clinic setting, elected to participate in either a 38% SDF intervention protocol or, alternatively, referral for DGA. Follow-up examinations were completed at 6 months to assess caries progression, decayed missing filled tooth index, PUFA index (pulpal involvement, ulceration, fistula, abscess), DGA referral rates, and OHRQoL (Early Childhood Oral Health Impact Scale [ECOHIS]). RESULTS: Of the total sample, 89.5% of children (n = 102) [mean (SD) age, 4.1 (1.0) years] with 401 active carious lesions elected to participate in the 38% SDF protocol; 10.5% (n = 12) of parents opted for referral for treatment under DGA. The proportion of active caries subsequently arrested at follow-up (number of arrested lesions/number of lesions treated) was 0.78 (95% CI, 0.69 to 0.87). There was an 88% reduction in referrals for DGA in eligible children over the 6-month period. The 38% SDF intervention group showed a significant improvement in ECOHIS scores at follow-up (P < .001). DISCUSSION: Adoption of the 38% SDF intervention protocol resulted in a significant reduction in the rate of preventable dental hospitalisations. Most parents opted against referral for DGA. Parent-reported OHRQoL for children improved significantly.

Oral health-related quality of life changes in children following dental treatment under general anaesthesia: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of studies that have employed the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the oral health-related quality of life (OHRQoL) changes in children following dental treatment under general anaesthesia (DGA). METHOD: A systematic search of 5 databases was conducted in accordance with the PRISMA guidelines. The inclusion criteria were use of ECOHIS and COHRQoL, pre-and post-operative assessments, patients aged between 0 and 16 years, no restrictions on the follow-up period and DGA. The primary outcome measure was changes in quality of life for both the children, which was based on mean difference (MD). Twenty-two articles were included in the meta-analysis. RESULTS: A favourable outcome in OHRQoL was identified in all studies. The combined MD for ECOHIS and COHRQoL were 1.62 [95% CI 1.52-1.71; P < 0.00001; I2 = 0%] and 0.86 [95% CI 0.74-0.99; P < 0.00001; I2 = 0%], respectively, both with no evidence of heterogeneity. CONCLUSION: There is evidence to support that the OHRQoL of children was improved, with large effect size, in the short-term following DGA. CLINICAL RELEVANCE: Dental treatment under GA significantly improved the OHRQoL of children.

Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia.

OBJECTIVES: To assess changes in the oral health-related quality of life (OHRQoL), after comprehensive oral rehabilitation under general anaesthesia (CORGA), among children (i) <6 years using the Early Childhood Oral Health Impact Scale (ECOHIS) and (ii) aged 6-14 years using the child oral health-related quality of life (COHRQoL) instrument. METHODS: A total of 136 healthy children who had CORGA were recruited over a period of 12 months. The parent or caregiver of the study participants completed the age-appropriate questionnaire prior to the dental treatment and at the subsequent follow-up appointments (2 weeks and 3 months). Data were analysed using repeated-measures anova and Bonferroni tests. RESULTS: The overall ECOHIS scores decreased significantly (P < 0.001) demonstrating large effect sizes. The greatest decreases were for the domains of child oral symptoms (57.5%) and psychology (38.7%) in the child impact section (CIS) and for the domain of parental distress (38.9%) and family function (40%) in the family impact section (FIS). For COHRQoL, the overall P-CPQ and FIS scores decreased significantly for all items (P < 0.001), demonstrating large effect sizes. The greatest decreases were for the domains of oral symptoms (77.7%), functional limitations (74.3%), and the FIS (80.1%). CONCLUSIONS: The OHRQoL of children in both age groups (<6 and 6-14 years) was significantly improved after CORGA.