Not just drilling and filling: Adopting a disease management approach to manage early childhood caries

Objectives: Early childhood caries (ECC) is one of the most prevalent chronic diseases in children and is largely influenced by social/behavioral factors. Studies have shown that a disease management (DM) approach is effective in managing ECC rather than relying solely on restorative treatment; however, implementing this requires significant system changes. To accelerate adoption of the DM approach, the DentaQuest Institute launched an initiative to create a national network of practices around using data to successfully adopt and spread DM protocols for ECC, including risk-assessment, self-management goal setting, and risk-based recall along with restorative treatments to reduce new cavitation, complaints of pain, and referrals to operating rooms.

Method: Over multiple building phases, 32 current practices collect monthly systems data as well as qualitative data and use this to track their progress, analyze gaps, and generate ideas to successfully implement the DM protocols into practice. Practices collaborate to exchange ideas and advice on adopting components of the DM protocols through regular meetings and project support designed to foster shared learning.

Results: In Phase 2, new cavitation, pain, and referrals decreased from baseline levels. Data collection for Phase 3 is ongoing and process measures have positive indications.

Conclusions: Based on experience, the initiative helped practices successfully adopt components of the DM protocols and create system changes that resulted in improved care delivery and patient outcomes. Preliminary Phase 3 results show positive changes in process measures indicating that the initiative has helped practices test important process changes that are beginning to improve health outcomes.