title: Outcomes assessment an intervention strategy to improve parental compliance to follow-up evaluations after treatment of early childhood caries using general anesthesia in a Medicaid population.
abstract: Young children from low-income families are at risk for the development of early childhood caries (ECC) that can progress to severe oral disease. Treatment of this condition often requires extensive rehabilitation using general anesthesia in an ambulatory care facility. These children, presenting with neglected oral health, frequently face major obstacles to accessing dental care in a timely manner. Recently, several retrospective studies reported poor follow-up compliance (return for recall evaluations) in children treated for ECC using general anesthesia (GA). The purpose of this study was to provide a prospective analysis of an intervention strategy aimed at improving follow-up compliance in this population. Results of the analysis suggested that the insertion of an additional pre-operative consultation appointment failed to improve significantly compliance to follow-up evaluations or change parental dental health knowledge and preventive practices. Patient variables studied also failed to discriminate influences on predicting compliant behavior. Although retreatment (relapse) was prevalent among those patients who complied with follow-up evaluations, a statistically significant improvement in plaque, gingival, and mutans streptococci scores were demonstrated, following the degree of aggressive restorative treatment typically provided using general anesthesia. These findings are contrary to those reported from conventional restorative therapy and might reflect a beneficial outcome of an aggressive restorative approach. Further investigation is required to identify an intervention strategy that improves follow-up compliance and reduces the costly ravages of dental neglect in young children from low-income families.
authors.affiliation: Department of Pediatric Dentistry, University of Florida, P.O. Box 100426, Gainesville, Florida 32610-0426, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Primosch
authors.forename: C M
authors.initials: CM
authors.lastname: Balsewich
authors.forename: C W
authors.initials: CW
authors.lastname: Thomas
mesh_terms: D000766:Anesthesia, Dental; D000768:Anesthesia, General; D001294:Attitude to Health; D002675:Child, Preschool; D003376:Counseling; D003731:Dental Caries / Q000628:therapy*; D003773:Dental Plaque / Q000517:prevention & control; D003793:Dental Restoration, Permanent; D005260:Female; D005500:Follow-Up Studies; D005882:Gingival Diseases / Q000517:prevention & control; D006267:Health Education, Dental; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009909:Oral Health; D009910:Oral Hygiene; D017063:Outcome Assessment, Health Care; D010290:Parents; D010349:Patient Compliance; D011203:Poverty; D011446:Prospective Studies; D012017:Referral and Consultation; D012463:Saliva / Q000382:microbiology; D013223:Statistics as Topic; D013295:Streptococcus mutans / Q000254:growth & development; D016896:Treatment Outcome