Assessing Cost Effectiveness of Implementing a

Minimal Intervention Dentistry Approach in

Community Dental Clinics - Clinical Trial (ACE

MID Study)

Ms. Kerina Princi

Oral Health Practice Research Unit

(OHPracRU)

Minimal Intervention Dentistry

Focus on maximum conservation of demineralised but non-cavitated enamel and dentine.

A departure from the traditional surgical approach to the management of the early carious lesion.

It creates an opportunity for “early identification” of the disease and promotion of a ‘healing’ process in its management.

This can be achieved across all ages, from preschool to older adults.

Minimal Intervention Dentistry Minimal Intervention Dentistry (MID) consists of five basic elements in the management of dental caries:

– Identification of risk factors at the individual level

– Remineralisation of early non-cavitated active lesions

– Implementation of individualised preventive strategies

– Where appropriate, placement of restorations in teeth with cavitated lesions using minimal cavity designs

– Where appropriate repair (rather than replacement) of defective restorations

Benefits of MID in Public Dentistry

MID has the potential to:

• Improve management of the dental caries disease

• Enable early identification and ‘healing’ of the condition

• Reduce need for complex restoration in adults

• Increase retention of the natural dentition

• Create opportunities for patient self-management of dental caries

condition

• Address worsening public oral health

Adolescent oral health in Australia

Australian teenagers are at increased risk of

developing dental disease. Between 40% and 57% of

12-15 year old teenagers have had one or more

permanent teeth affected by decay. The average

number of teeth affected increases with age.

What are we doing?

Undertaking a clinical trial to assess the cost

effectiveness of implementing a MID approach to a

group of community public dental patients

(adolescents aged 11-14 years) who are at high risk to

dental caries as compared to ‘current practice’.

Study Partners

Participating Community Dental Clinics

What are the objectives?

Demonstrate a reduction in the number of new and

progressing carious lesions amongst the participants

who have undertaken the MID approach.

Demonstrate if MID is ‘value for money’.

Cont..

• Assess the acceptance of the MID approach

amongst clinicians, agency staff and management.

• Identify barriers and enablers to adopting the MID

approach amongst the clinicians, agency staff and

management, adolescents and their carers.

Who are we recruiting to the study?

504 participants aged between 11-14 years

who are at high risk to dental caries

(42 participants from each of the twelve community

dental clinics)

Participant Recruitment

• Adolescents who are attending their 12, 18 or 24 month

recalls and have active disease present may be eligible to

join the study

• New adolescent patients who have active disease present

may also be eligible to join the study

What’s different about this study?

• Implementing an innovative workforce model where DAs

with Cert IV in Oral Health Promotion (OHP) will implement

the MID preventive strategies to the intervention

participants.

• DA with Cert IV in OHP are trained in the application of

fluoride varnish.

• First study of its kind in Australia in the public dental sector.

• Community based study.

Intervention vs Control Groups

All participants –examined by the study oral health

examiner at baseline, 12 and 24 months

Control

• Receive standard care including referrals to the

community dental therapist for restorations as per

the community dental clinic protocol.

Cont..

Intervention

• Participants will receive the MID preventive

strategies at baseline, 3, 6, 12, 18 and 24 month

recalls.

What care will the intervention

participants receive?

• Saliva testing at baseline and 24 months to identify those

with an increased risk to dental caries as a result of a low

salivary flow (Issued with Tooth Mousse)

• Diet counselling

• Oral hygiene instructions

• Individual agreed homecare plan

• Issued with disclosing tables

• Duraphat applied to all tooth surfaces

What will the adolescents receive for

participating in the study? Intervention participants will receive an oral care pack at each recall consisting of:

• Soft bristled toothbrush

• 5000ppm toothpaste (Neutrafluor)

• Waxed floss

• Disclosing Tablets

• Oral health promotion resources and

• Tooth Mousse (if low salivary flow only)

All participants will also receive a birthday card in the first and second year of the study.

Cont..

• Control participants will receive a $10 gift card at

the 12 and 24 month recall examinations.

• At the end of the study, the control participants will

receive the oral care pack and all health promotion

resources issued to the intervention participants.

What data are we collecting?

• Bleeding Index, ICDAS II, Plaque Index

• Participant and parent socio-economic data

• Oral Health knowledge, attitudes and behaviours

(participants and carers)

• Clinician's baseline knowledge, attitudes,

acceptance and perceptions of MID

Cont..

• Appraisal of current agency recall systems.

• Identify challenges to adoption of MID from all

stakeholders.

• Feedback from focus groups.

• Economic appraisal of MID undertaken by

Deakin University.

What have we done so far in the study?

Participant Screening

Clinicians at the participating CDCs are screening the

adolescents for their suitability to join the study.

Recently launched an online CPD learning module to

assist clinicians to screen adolescents.

Cont..

Participant Recruitment

Recruited over 35 participants

20 participants examined at six CDCs

Cont..

Collected questionnaire data relating to clinicians’ knowledge and attitudes to MID.

Collected information on the current agency recall processes and procedures.

What impact might this study have on

public dentistry?

• Build evidence which will influence a practice change to

the management oral health disease, namely caries

management.

• Change in funding model and policy development.

• Put forward alternative workforce models.

With a focus on prevention, long term this

approach aims to break the cycle of complex

restorative care and reduce the demand on the

public dental system.