title: Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.
abstract: An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.
authors.affiliation: Dental Medicine and Health Policy and Management, Columbia University Medical Center, New York, N.Y., USA; Children's Dental Health Project, Washington, D.C., USA.
authors.forename: Burton L
authors.initials: BL
authors.lastname: Edelstein
authors.affiliation: Department of Dentistry, Boston Children's Hospital, Boston, Mass., USA; Developmental Biology (Pediatric Dentistry), Harvard School of Dental Medicine, Boston, Mass., USA. manwai.ng@childrens.harvard.edu.
authors.forename: Man Wai
authors.initials: MW
authors.lastname: Ng
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease; D019058:Community Networks; D003731:Dental Caries / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D015438:Health Behavior; D006267:Health Education, Dental; D006801:Humans; D007223:Infant; D009909:Oral Health; D010348:Patient Care Team; D012648:Self Care