Minimal Intervention Dental Care
Dental health care is included in the Affordable Health initiative (AHI) Health Promoting School (HPS) model because dental decay is the single most prevalent human disease in the world recording 2.5 billion cases (secondary dentition) and 600 million cases (secondary dentition) worldwide. Dental caries care remains neglected worldwide for three decades.
AHi HPS model includes several interlinked health promotion interventions to encourage adopting a healthy lifestyle. By example, dietary investigation (diet inventory) and data analysis are used to guide the school children towards an achievable goal and to design tailored interventions. Human development teaching addresses major social-psychological determinants of health behaviour (i.e.: motivation). Both are delivered through a set of five school class sessions for each topic: introduce a topic using e-learning and apply a quiz game (first session); moderate a debate on the topic a week later (second session), moderate a topical group discussion in the following week (third session) and set an individual goal for each topic (last session). A health topic (i.e.: diet) and a human development topic (i.e.: self-esteem) are addressed monthly. The Health Detective game helps to consolidate adopting a healthy lifestyle. Healthy food distribution addresses the socio-economic barriers to adopt a healthy diet. Supervised hand washing and tooth brushing with fluoridated toothpaste is provided in the hygiene practice school activity. See the full AHI HPS model for details.
The AHI Minimal Intervention Dental Care Approach offers an operational model for the FDI White Paper on Dental Caries Prevention and Management. In addition to addressing the burden of dental caries, the AHI HPS intervention offers an operational for WHO HPS concept, to integrate oral and general health care and to reduce health inequities. A description of the AHi HPS model is presented elsewhere.
AHI HPS model adopts the principles of minimum intervention dentistry and focusses on preventive dental care based on the interception of disease at an early stage. The AHI HPS model treatment plan is presented bellow. Individual treatment plan is derived from CAST categories.
Relevant information to assess the dental care plan presented below:
The AHi Dental Care Plan was designed to be run at the school setting. It adopts an incremental approach enrolling school children from the age of 6 years old and engaging them until they leave school.
At the age of 6-8-year-old, children have a mixed dentition, and first molars erupt and go through a post maturation during this period. As this is the most vulnerable period to caries development, the AHi Dental Care Plan has included application of pits and fissures sealants to first molars.
This Dental Care Plan is applicable to 6-8-year-old school children. Another plan is suggested for older age groups.
Supervised tooth brushing with fluoride toothpaste twice a day at school is provided to all children. For this reason, the AHi Dental Care Plan has not included professionally applied fluoride therapy.
Dental Care Plan: CAST name, Code and Description followed by Treatment plan.
-Sound (0): no visible evidence of a distinct carious lesion is present.
Primary teeth: No action.
Secondary teeth: application of sealant to pits and fissures to first molars. Alternatively, application of sealant to pits and fissures to first molar only in children with experience of caries in primary teeth or no action.
-Sealant (1): pits and/or fissures are at least partially covered with a sealant material.
Primary teeth: no action.
Secondary teeth: repair or application of new sealant to pits and fissures to first molar.
-Restoration, otherwise sound (2): a cavity is restored with an (in)direct restorative material and the tooth is sound.
No action.
-Enamel (3): distinct visual change in enamel only. A clear caries related discoloration is visible, with or without localised enamel breakdown.
Primary teeth: no action, or alternatively, cariostatic treatment with application of 38% (44,800 ppm fluoride ions) silver diamine fluoride.
Secondary teeth: application of fissure sealants to pits and fissures to first molars. Additionally, it may include application of 38% (44,800 ppm fluoride ions) silver diamine fluoride to smooth surfaces to arrest dental caries, but this may be unnecessary in the presence of supervised tooth brushing with fluoride toothpaste.
-Dentine (4): internal caries-related discoloration in dentine. The discoloured dentine is visible through enamel which may or may not exhibit a visible localised breakdown of enamel.
Primary and secondary teeth: application of an adhesive restoration material after selective carious removal (ideally with glass–ionomer or alternatively with zinc polycarboxylate cements). Alternatively, cariostatic treatment with 38% (44,800 ppm fluoride ions) silver diamine fluoride to arrest dental caries into dentine may be adopted.
-Distinct cavitation into dentine (5): The pulp chamber is intact.
Primary teeth: application of an adhesive restoration material after selective carious removal (ideally with glass–ionomer or alternatively with zinc polycarboxylate cements). Alternatively, application of 38% (44,800 ppm fluoride ions) silver diamine fluoride to arrest dental caries into dentine may be adopted.
Secondary teeth: application of an adhesive restoration material after selective carious removal using hand-instruments (ideally with glass–ionomer or alternatively with zinc polycarboxylate cements).
-Pulp (6): Involvement of the pulp chamber. Distinct cavitation reaching the pulp chamber or only root fragments are present.
Primary teeth: extraction.
Secondary teeth: extraction when referral to root canal treatment is not available.
-Abscess/Fistula (7): A pus containing swelling or a pus releasing sinus tract related to a tooth with pulp involvement.
Primary teeth: Extraction.
Secondary teeth: extraction when referral to root canal treatment is not available.
-Lost (8): The tooth has been removed because of dental caries.
Primary and secondary teeth: no action.
-Other (9): Defective restoration with or without recurrent caries.
Primary and secondary teeth: seal or repair the restoration, if possible, rather than replace the defective restoration. Otherwise, as for code 5 (Secondary teeth); application of a new adhesive restoration material after selective carious removal using hand-instruments (ideally glass–ionomer or alternatively zinc polycarboxylate cements).
Recommended reading:
Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub5
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278
Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002781. DOI: 10.1002/14651858.CD002781.pub2