Inventi Impact: OroDental

Inventi:hod/19211/16

A New Primary Dental Care Service Compared with Standard Care for Child and Family to Reduce\nthe Re-occurrence of Childhood Dental Caries (Dental RECUR): Study Protocol for a Randomised\nControlled Trial

Background: In England and Scotland, dental extraction is the single highest cause of planned admission to the\nhospital for children under 11 years. Traditional dental services have had limited success in reducing this disease\nburden. Interventions based on motivational interviewing have been shown to impact positively dental health\nbehaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The\nobjective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated\ninterview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing\nthe re-occurrence of dental decay in young children with previous dental extractions.\nMethods/Design: This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants,\ninitially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under\ngeneral anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be\nconducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services\nacross the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of\nmotivational interviewing) delivered between enrolment and 6 weeks post-extraction, followed by directed\nprevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be\nthe dental caries experienced by 2 years post-enrolment at the level of dentine involvement on any tooth in either\ndentition, which had been caries-free at the baseline assessment.\nDiscussion: The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of\nengagement with dental care makes the children and their families scheduled for extraction particularly difficult to\nrecruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing\nthe Dental RECUR protocol during the recruitment phase.