Management Of Early Childhood Caries Research Articles

Management of Early Childhood Caries under General Anesthesia at a Tertiary Care Service Hospital: A Retrospective Study

Abstract Introduction: Early childhood caries (ECC) affects almost 50% of preschool children and may lead to chronic pain, halitosis, fever, trismus, poor growth and development, and repeated airway and gastrointestinal infections. Managing this is challenging in the face of anxiety, developmental delay, and other comorbidities in children. This necessitates their management under general anesthesia (GA). Methodology: We carried out a retrospective descriptive study to analyze the characteristics of pediatric patients who underwent oral rehabilitation under GA at a tertiary care service hospital. Results: The data of 20 children inflicted with ECC who underwent full-mouth rehabilitation under GA were analyzed. The majority were boys and the mean age was 69.5 months. Five of these children had comorbidities. The most common indication for GA was the uncooperation of the child. Inhalational induction was carried out for most of them, and postoperatively, two children had emergence delirium and one child had nausea and vomiting. Conclusion: We share our experiences toward standardization of safe anesthesia practices.

Prevalence and Management of Early Childhood Caries in Preschoolers

Prevalence and Management of Early Childhood Caries in Preschoolers

Early childhood caries, climate change and the sustainable development goal 13: a scoping review

BackgroundSustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC).MethodsThe scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported.ResultsThe initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation.ConclusionThe evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Navigating early childhood caries management in children with autism and developmental disorders: A U.S. perspective

Early Childhood Caries (ECC) is a prevalent and preventable oral health concern among children, presenting unique challenges when managing those with autism and developmental disorders. This paper explores navigating ECC management in this population from a U.S. perspective. Understanding the impact of autism spectrum disorder (ASD) and developmental disorders on oral health is crucial, given their higher risk of ECC due to behavioral, dietary, and hygiene factors. Diagnosis and assessment pose particular challenges, requiring tailored approaches to accommodate sensory sensitivities and communication barriers. Preventive strategies encompass parent/caregiver education, customized oral hygiene instruction, dietary counseling, and fluoride varnish application. Behavioral management techniques, such as desensitization and creating a positive dental experience, are essential for successful treatment. Treatment approaches may involve restorative procedures, considering sedation or anesthesia for children with heightened anxiety or sensory issues, often requiring collaboration with multidisciplinary teams. Long-term management emphasizes maintaining oral health habits and regular dental visits, adjusting to changes in behavior and developmental needs over time. Addressing barriers to care, including access, financial constraints, and provider education, is crucial for effective ECC management in this population. ECC management in children with autism and developmental disorders requires a comprehensive, multidisciplinary approach tailored to individual needs. Future research should focus on refining diagnostic techniques, enhancing preventive interventions, and improving access to dental care services for this vulnerable population. By addressing these challenges, we can strive to improve oral health outcomes and quality of life for children with autism and developmental disorders.

Scoping review on the association between early childhood caries and responsible resource consumption and production: exploring Sustainable Development Goal 12

BackgroundThe Sustainable Development Goal 12 (SDG12) promotes patterns that minimize waste and maximize resource utilization. It is therefore plausible that preventing Early Childhood Caries (ECC) and promoting oral health can contribute to sustainable consumption. In addition, sustainable consumption and production can contribute to the control of ECC. This scoping review aimed to explore the possible evidence on the link between ECC and the SDG12 targets.MethodsThis scoping review identified articles on the link between resource consumption and production and caries according to the PRISMA-ScR guidelines. Three electronic databases (PubMed, Web of Science, and Scopus) were systematically searched in August 2023, using specific search terms. Studies written in English, with full text available, addressing dental caries and linked with waste minimization and resource utilization maximisation, with results that could be extrapolated to ECC in children less than 6 years of age) were included. Descriptive statistics were planned to summarize the categories of retrieved papers.ResultsThe initial search yielded 904 articles, with 863 screened for eligibility after the removal of duplicates. No studies were identified that reported data on an association between responsible consumption and production of resources factors and ECC.ConclusionThis scoping review did not identify any articles published in English on evidence of the direct associations between ECC and SDG12 targets. However, there is a plausibility of such a link using minimum intervention dentistry for ECC management as a waste prevention and resource utilisation maximization strategy.

A scoping review on the links between sustainable development goal 14 and early childhood caries

BackgroundThe Sustainable Development Goal (SDG) 14 addresses life below the waters, an important source of protein and contributor to global food security and economic development. Our aim was to explore possible evidence on the links between life below water and early childhood caries (ECC).MethodsThis scoping review identified articles on the link between life below water and caries according to the PRISMA-ScR guidelines. Three electronic databases (PubMed, Web of Science, and Scopus) were systematically searched in January 2023, using specific search terms. Studies written in English, with full text available, addressing life under water, focusing on dental caries in humans, with results that can be extrapolated to control ECC in children less than 6 years of age were included in the review. Descriptive statistics were used to summarize the retrieved papers and graphical presentation was used for visualization.ResultsThere were 224 publications retrieved of which 13 studies, published between 1960 and 2022, were included in the analysis. The papers originated from Asia (7/13), North America (3/13), Europe (1/13), and 2/13 had multi-country authorship. Also, four laboratory studies extracted agents from marine products to determine their efficacy in preventing caries formation and preventing/slowing plaque formation; four letters discussed the caries prevention potential of sea salt as a source of fluoride; and two review articles about the positive effects of extracted marine products for caries prevention. Most (11/13) studies addressed target 14.1 concerned with enriching the marine environment with nutrients and minerals; two addressed target 14.4 focused on ensuring fish stocks are within biologically sustainable levels; two addressed target 14.7 aimed at increasing the economic benefits through sustainable use of marine resources such as fisheries; and one focused on target 14.5 aimed at conserving marine areas by increasing protected areas. In addition, one ecological study assessed the association between the ecosystem and ECC.ConclusionsCurrently, there is little known about the impact of protection of marine and coastal ecosystem from pollution and ocean acidification on the risk of ECC. Further evidence on possible associations between life below water and ECC management is needed.

Perceived Outcomes, Parental Satisfaction, and Oral Health-Related Quality of Life After Full Mouth Rehabilitation Under General Anesthesia for Early Childhood Caries.

The aim of this article is to evaluate the perceived outcomes, parental satisfaction, and oral health-related quality of life after full mouth rehabilitation under general anesthesia for children with early childhood caries. A total of 200 children requiring full-mouth rehabilitation under general anesthesia for the management of early childhood caries were recruited for the study. Perceived outcomes, oral health-related quality of life, and parental satisfaction were evaluated at the follow-up visit after six months. All participants reported back for the follow-up visit after six months. Oral health-related quality of life after full-mouth rehabilitation showed statistically significant improvement at follow-up (P <0.001); 97.5% of the parents were satisfied with the treatment. Perceived outcomes were found to be satisfactory, and a significant improvement (P <0.001) was seen after treatment. The perceived outcomes of participating parents were met. Significant improvement in oral health was seen after full-mouth rehabilitation under general anesthesia. Parental satisfaction was found to be high at the follow-up visit after six months. Parents found the improvement in the oral and general health of their child to be significant.

Influence of Artificial Intelligence-Driven Diagnostic Tools on Treatment Decision-Making in Early Childhood Caries: A Systematic Review of Accuracy and Clinical Outcomes.

Early detection and accurate prediction of the risk of early childhood caries (ECC) are essential for effective prevention and management. This systematic review aims to assess the performance and applicability of machine learning algorithms in ECC prediction and detection. A comprehensive search was conducted to identify studies utilizing machine learning algorithms to predict or detect ECC. The included (n = 6) studies demonstrated high accuracy, sensitivity, specificity, and area under the receiver operating characteristic (AUC) values related to predicting and detecting ECC. The application of machine learning algorithms contributed to enhanced clinical decision-making, targeted preventive measures, and improved ECC management. The studies also highlighted the importance of considering multiple factors, including demographic, environmental, and genetic factors, when developing dental caries prediction models. Machine learning algorithms hold significant potential for ECC prediction and detection, having promising performance outcomes. Due to the heterogeneity of the studies, no meta-analysis could be performed. Moreover, further research is needed to explore the feasibility, acceptability, and effectiveness of integrating these algorithms into dental practice. This approach would ultimately contribute to enabling more effective and personalized dental caries management and improved oral health outcomes for diverse populations.

Early childhood caries- Etiology, prevention and management: A Review

Early Childhood Caries (ECC) is a severe debilitating disease affecting the primary dentition of young children in both developing and industrialized countries. Historically, the management of ECC has a global scenario showing operative management of the disease. The contemporary method of preventing the carious process mainly focuses on dietary factors, host factors and removal of plaque biofilm. Enamel demineralization is caused by acidogenic and aciduric bacteria. Colonization of microorganisms in the mouth of children can occur via horizontal or vertical transmission or both. The bacteria present in dental plaque metabolize sugars and starches to produce acids, which lowers the pH in the mouth and promotes loss of minerals from the tooth surface. Sucrose is the most common sugar and when metabolized, produces dextrans which promote superior bacterial adhesion to teeth. Visible plaque on the labial surfaces of the maxillary incisors were strongly associated with the caries development. Saliva buffers plaque acids, aids in oral clearance and acts as a reservoir for minerals to assist in the mineralization of enamel. Most studies have put forward a correlation between bed time use of bottles with sweetened contents especially lactose. One of the factors included by Newbrun in factors causing dental caries is time. The CPP-ACP complex, an effective remineralizing complex preventing the acidic environment reduce incidence of caries. Conventional probiotics comprised of lactobacilli and bifidobacterium which were mainly of intestinal origin; the contemporary probiotic research has brought forward that oral diseases like dental caries, periodontal problems and candida infections have direct link with oral microbial disequilibria. A promising new approach towards primary prevention of the disease is to target the infectious component of Early Childhood Caries by preventing or delaying acquisition of Streptococcus mutans at an early age.

Expert consensus on clinical management for early childhood caries.

Early childhood caries (ECC) is the most prevalent chronic oral disease and one of the worldwide public health problems of great urgency for children. ECC can affect children's teeth, dentition, craniomaxillofacial, and general health and development. Therefore, through dental caries etiologies and caries risk assessment, patient-centered, personalized planning and a combination of prevention and treatment should be implemented in the clinical management for ECC. Periodic and continuous cycle management can only be accomplished with the cooperation of medical staff, children, and their guardians. This expert consensus will expound the clinical management of ECC in the following aspects: caries risk assessment, early clinical prevention, treatment strategies, and postoperative management.

Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey.

BackgroundOral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce.ObjectiveWe aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries.MethodsA cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean’s Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children’s nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with κ>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors.ResultsData collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward.ConclusionsThis study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent.International Registered Report Identifier (IRRID)PRR1-10.2196/33552

Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial.

The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 - 1.89) in the NFG and 1.33 (95% CI = 0.75 - 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 - 2.25) in NFG and 1.40 (95% CI = 0.75 - 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.

Cost-Effective analysis of silver diamine fluoride in comparison to glass ionomer cement along with fluoride varnish in the management of early childhood caries in anganwadi centers of Mangalore: A randomized control trail

Introduction: Early childhood caries (ECC) is a major public health challenge affecting preschool children. Silver diamine fluoride (SDF) is a noninvasive, alternative method to surgical intervention in the treatment of ECC. It has also shown to inhibit the development of new carious lesions. Materials and Methods: An open-labeled randomized controlled trail was conducted among 200 Anganwadi children. They were divided into two groups: Group A received oral prophylaxis and application of 38% SDF and Group B received oral prophylaxis, restoration using glass ionomer cement (GIC) and application of 5% sodium fluoride varnish (FV). The effectiveness in reduction of dental caries was assessed based on its ability to result in a positive outcome postintervention. Cost-effectiveness analysis, from the service provider perspective, was conducted to evaluate the effectiveness of SDF when compared to GIC followed by the application of FV. Average cost-effectiveness ratio and incremental cost-effectiveness ratio (ICER) for all the specific outcomes were assessed. Results: The average cost for converting an individual tooth from active caries to inactive caries using SDF was 67.30 Indian Rupees (INR), whereas the same was 225.5 INR using GIC with FV. The ICER of the interventions for the total number of inactive caries postintervention was measured at −89.9, implying that Incremental costs of one extra tooth of active caries to be converted into inactive caries using SDF will cost 89.9 INR less compared to the same outcome using GIC with FV. Conclusions: Thus, the study showed that SDF was cost-effective when compared to GIC in restoring active carious lesions.

In Vitro and In Vivo Anti-infective Potential of Thymol Against Early Childhood Caries Causing Dual Species Candida albicans and Streptococcus mutans

Early childhood caries (ECC), a severe form of caries due to cross-kingdom interaction of Candida albicans and Streptococcus mutans, is a serious childhood dental disease that affects majority of the children with poor background. The present study investigated the anti-infective potential of thymol against C. albicans and S. mutans dual species for the management of ECC. Thymol, a plant derivative of the monoterpene group, has been well known for its numerous biological activities. Thymol at 300 μg/ml concentration completely arrested growth and proliferation of dual species of C. albicans and S. mutans. Rapid killing efficacy of pathogens, within a span of 2 min, was observed in the time kill assay. In addition, at sub-inhibitory concentrations, thymol effectively diminished the biofilm formation and virulence of both C. albicans and S. mutans such as yeast-to-hyphal transition, hyphal-to-yeast transition, filamentation, and acidogenicity and acidurity, respectively, in single and dual species state. qPCR analysis was consistent with virulence assays. Also, through the invertebrate model system Galleria mellonella, in vivo toxicity and efficacy of the phytocompound was assessed, and it was found that no significant toxic effect was observed. Moreover, thymol was found to be proficient in diminishing the infection under single and dual state in in vivo condition. Overall, the results from the present study illustrate the anti-infective potential of thymol against the ECC-causing dual species, C. albicans and S. mutans, and the applicability of thymol in medicated dentifrice formulation.

Management options of early childhood caries.

Data sources The review searched for articles via Medline up to March 2019 for English language papers only.Study selection Two authors screened the reviews initially against the inclusion and exclusion criteria. Discrepancies were discussed with all authors for the final decision. Due to a low number of higher-level studies on non-operative caries management (NOCM; excluding silver diamine fluoride [SDF]), studies other than randomised controlled trials, systematic reviews and meta-analyses were included to allow some collation of evidence for an overview to be gained.Data extraction and synthesis Data extracted included setting, participants, focused question, search results, comparators, main outcomes and conclusion. Data for SDF was collated separately to other NOCM due to the higher level of evidence and its use in cavitated lesions as well as non-cavitated carious lesions.Results Five systematic reviews investigated SDF use. All the reviews demonstrated SDF to be an effective management tool for arresting early caries. Ten studies looked at NOCM, which showed fluoride varnish has a moderate effect on arresting carious lesions, but the evidence was of low level. For restorative approaches, a low level of evidence showed resin restorations to have a higher failure rate than composite strip crowns, regardless of general anaesthesia, and more so than stainless steel or zirconia crowns.Conclusions SDF is an effective tool in the management of early childhood caries.

Strategic Management of Early Childhood Caries in Thailand: A Critical Overview.

The aim of this report was to advocate early childhood caries (ECC) and share strategic management in Thailand, despite over two decades of free Universal Health Coverage including oral healthcare. The recent Thai national oral health survey in 2017 indicates the very high prevalence of ECC, with an average of three carious teeth affected in 53% of 3-year-old children. This is despite the efforts of the Ministry of Public Health that has launched several interventional programs ranging from an upstream policy that prohibits sugar additions in baby formula milk to downstream remediations such as advocating and encouraging toothbrushing with fluoride toothpastes. Nevertheless, ECC is strongly predicated by other key factors including the family and community commitment and participation, as embodied in the current World Health Organization guidelines. These encompass three different tiers of community-level prevention: primary, secondary, and tertiary. Accordingly, the following strategies for ECC management in Thailand should be based at primary care clusters (PCC) in sub-district health centers, with the assistance of inter-professional health teams. These include community education on the importance of deciduous teeth and effective toothbrushing with fluoride toothpaste (primary prevention), regular examination and detection of ECC lesions and early intervention (secondary prevention), insertion of non-invasive preventive restorations using cost-effective atraumatic restorative treatment (ART) or simplified and modified ART (SMART) (tertiary prevention), and, finally, effective follow-up and monitoring systems. It is anticipated that this triple tier approach to ECC management will improve not only the oral health but also the overall children's health.

Early Childhood Caries in Indigenous Communities.

The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian and Alaska native) is a major child health disparity when compared with the general population of both countries. Early childhood caries (ECC) occurs in Indigenous children at an earlier age, with a higher prevalence, and at much greater severity than in the general population. ECC results in adverse oral health, affecting childhood health and well-being, and may result in high rates of costly surgical treatment under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, but the social determinants of health are particularly important. This policy statement includes recommendations for preventive and clinical oral health care for infants, toddlers, preschool-aged children, and pregnant women by primary health care providers. It also addresses community-based health-promotion initiatives and access to dental care for Indigenous children. This policy statement encourages oral health interventions at early ages in Indigenous children, including referral to dental care for the use of sealants, interim therapeutic restorations, and silver diamine fluoride. Further community-based research on the microbiology, epidemiology, prevention, and management of ECC in Indigenous communities is also needed to reduce the dismally high rate of caries in this population.

O diamino fluoreto de prata no controle da cárie na primeira infância durante a pandemia da COVID-19

Objetivo: Abordar aspectos de interesse clínico relacionados ao uso do diamino fluoreto de prata (DFP) no controle da cárie na primeira infância (CPI) durante a pandemia da COVID-19. Métodos: A busca para revisão de literatura foi executada na base de dados PubMed. Os descritores foram escolhidos pela importância na delimitação do tema e a síntese da literatura foi realizada de acordo com os tópicos: (1) efetividade clínica, indicações e limites do DFP e (2) uso clínico do DFP no contexto da COVID-19. Resultados: A pandemia da COVID-19 afeta todos os setores da sociedade, e, especialmente para o odontopediatra, impõe desafios em um cenário de difícil tomada de decisão e passível de contaminação. O tratamento da doença cárie com DFP ganha uma conotação importante pela sua eficácia na paralização da atividade de cárie, prevenção de novas lesões, segurança, facilidade de uso e baixo custo. Além disso, o DFP é considerado uma terapia minimamente invasiva que dispensa uso de instrumentos rotatórios (que tem alto potencial contaminante via dispersão de aerossol), e reduz complicações como pulpite e perda dentária e, portanto, o número de consultas. O DFP é também uma opção clínica na qual há uma maior aceitação comportamental pela criança. Como ponto negativo, o DFP pode causar insatisfação estética devido ao escurecimento da superfície afetada. Conclusão: O controle de lesões de cárie em crianças com CPI utilizando DFP, durante a pandemia da COVID-19, é uma opção eficaz, barata, de fácil aplicação e que oferece menos riscos de contaminação pelo coronavírus.

Application of Golden Nanoparticles against Streptococcus Mutans for Prevention of Caries Lesions

Background: Dental caries also known as baby bottle tooth decay, is a critical public health problem around the world for which Streptococcus mutans (S.mutans) has been introduced as the main infectious etiology. In the past two decades, nanotechnology has permitted the development of new materials with antimicrobial properties. The aim of this study was to compare the bactericidal and bacteriostatic effects of three golden nanoparticles (SP, NR, and CS) on S.mutans.&#x0D; Methods: To determine the minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs), a liquid dilution method was applied.&#x0D; Results: All golden nanoparticles (GNPs) showed antimicrobial activity with no statistically significant differences (&gt; 0.05) in MIC or MBC.&#x0D; Conclusion: Our findings revealed that the size and shape of the nanoparticles did not significantly affect the antimicrobial properties of the GNPs. This finding might be useful for achieving important clinical effects with reduced toxicity in the management of early childhood caries in future in vivo studies.

Minimally Invasive Dentistry: Parent/Carer Perspectives on Atraumatic Restorative Treatments and Dental General Anaesthesia to the Management of Early Childhood Caries.

Introduction: Parents of children treated under dental general anaesthesia (DGA) have reported feelings of concern and anxiety. This study elicited the views of parents/carers (P/C) of children with early childhood caries (ECC) who participated in a randomised trial (core study) which tested the effectiveness of care under DGA or care using alternative minimally invasive Atraumatic Restorative Treatment and the Hall Technique approaches (ART/HT).Methods: P/C of children treated using the ART/HT (test) approach or care under a DGA (control) were interviewed. Focus group semi-structured interviews with P/C were undertaken in community facilities. The transcripts were read and inductively coded into domains to identify emergent themes. The codes were entered into NVivo software to assist data management and were further refined into broad themes.Results: Seven grouped interviews with 14 participants were conducted and one test participant provided a written response. Four groups with eight test participants; two groups with four control participants; and one combined group with one test and one control participant were interviewed. Five broad themes emerged after thematic analysis: (1) Impacts on the child and the family; (2) Child-/family-centred care; (3) Timeliness of care; (4) Affordable care; (5) Accessible care. Impacts were related to that of the effects of the disease, and of the care for the disease. Child-centred/family-centred care (CCC) was a source of appreciation by P/C of both groups when it was experienced. Frustration at the lack of timely care of their child's treatment needs, coupled with the perceived expensiveness of care and difficulties in physically getting to the location for a specialist consultation was expressed by P/Cs in the study.Discussion: The use of the ART/HT enabled the establishment of a relationship between the clinical team and the child and P/C which was central to the delivery of CCC. P/Cs in the DGA arm of the study expressed dissatisfaction more often with the issues of timely care, cost of care and accessibility of care. P/C of both groups were equally satisfied with the treatment, where treatment had been received in a timely, child-centred manner.Conclusion: The findings suggest that minimally invasive approaches which facilitated CCC are acceptable alternative options to the DGA and should be considered for the management of ECC.Australian New Zealand Clinical Trials Registry: ACTRN12616001124426.