Clinical Update quiz
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Each month, the Clinical Update is published online. There are 11 Clinical Updates per year (February - December). This service is available to ADAVB and ADATas members only. Members can log in to view and answer the Clinical Update questions. If you answer at least eight out of 10 questions correctly, you will receive one hour of scientific CPD.
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September 2026 Clinical Update
Kumar H, Nanayakkara S, Tsai C, Rauniyar A, Kucera A. Investigating the impact of a chronic disease management protocol on reducing the need for dental general anaesthesia for treating early childhood caries in Australia. Australian Dental Journal, 2026;0:1–17.
https://doi.org/10.1111/adj.70057
Prepared by: Dr Francis Chan
Introduction
Early Childhood Caries (ECC) is defined as the presence of one or more carious teeth in children under the age of 6 years. It is reported to affect 48% of pre-school children globally. Children with ECC often present with pain and require extensive dental procedures, frequently warranting dental treatment under general anaesthesia (GA). In Australia, public GA waiting times to treat ECC can be over one year. Protective stabilisation is not utilised in Australia, and instead the focus is on non-maleficence and positive behaviour guidance. Oral/intravenous sedation for dental treatment in children is less common, as additional postgraduate training and compliance with strict regulatory standards is required. This leads to further reliance on treatment under GA when modalities such as nitrous oxide sedation and behaviour management techniques are insufficient, resulting in increased GA waiting times.
Continuation or recurrence of disease with attendant negative impacts on the quality of life is likely until the caries balance is altered. A collaborative effort by clinicians, patients and their families to treat ECC as a chronic condition is required. Chronic Disease Management (CDM) focuses on empowering patients and their families to play a central role in addressing their chronic condition at home and selecting their own disease management goals. Instead of telling the patient what to do, this approach utilises motivational interviewing delivered via a trained multidisciplinary team of health professionals. This can involve modifying diet and oral hygiene practices, using fluoridated products, and increasing disease management visits (DMV) according to individual need and disease severity.
A 2008 US-based CDM protocol developed by Ng et al. investigated a three-year quality improvement project across seven sites in the United States. Compared with historical controls, the group that received the CDM protocol experienced fewer new cavitated lesions (28% improvement), reduced instances of new pain (27% improvement), and fewer referrals for treatment under GA (36% improvement). However, investigating the effect of this CDM protocol and its impact on the need for dental GAs in Australia has not yet been documented.
A CDM protocol (the Steps to Smiles Program) based on the work of Ng and colleagues was introduced and tailored to the Australian population. This study aimed to investigate its effect on preventing the need for dental treatment under GA for patients with ECC. The effect of silver fluoride treatment as an added intervention on the prospective group was also analysed.
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