Abstract
BackgroundDespite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children.Methods/designWe describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4–15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care.DiscussionThe current project seeks to take advantage of mobile technology to acquire dental images from a child’s mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.
Highlights
Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries
A copy of the screening results will be mailed to the parents of children in the teledental group that includes advice on the pathway of dental care or oral health promotion (OHP) material based on the assessment of dental images
The proposed study is innovative because it investigates the use of an equitable, low-cost, and mobile technology and the Internet to provide a foundation of equitable dental care for school children
Summary
The proposed study is innovative because it investigates the use of an equitable, low-cost, and mobile technology and the Internet to provide a foundation of equitable dental care for school children. Improving the population’s oral health is challenging, with an unequal distribution of the dental workforce and scarcity of resources making the transition to the prevention of dental diseases difficult Many children, those from advantaged backgrounds who attend for a routine check-up, are free of dental diseases and consuming most scarce resources. Children who screened positive can have a quick pathway to receive appropriate treatment while those who are at low-risk or caries-free will receive preventive care This is important, as this could alleviate the anxiety of patients and if necessary, initiate earlier intervention. This strategy could help direct specific dental care towards children that need it more and contributing to reducing inequalities in child oral health. It is anticipated that data analysis will be completed in July 2020 with study completion achieved by October 2020
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