scholarly journals Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial

10.2196/17840 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e17840
Author(s):  
Suchitra Nelson ◽  
Jeffrey M Albert ◽  
Peter Milgrom
Keyword(s):  
Older Adults ◽  
Dental Caries ◽  
Low Income ◽  
Cluster Randomized Trial ◽  
Fluoride Varnish ◽  
Atraumatic Restorative Treatment ◽  
Silver Diamine Fluoride ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Caries Lesions

Background The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults. Objective This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish. Methods A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment. Results The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023. Conclusions This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings. Trial Registration ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926 International Registered Report Identifier (IRRID) DERR1-10.2196/17840

scholarly journals Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial (Preprint)

2020 ◽  
Author(s):  
Suchitra Nelson ◽  
Jeffrey M Albert ◽  
Peter Milgrom
Keyword(s):  
Older Adults ◽  
Dental Caries ◽  
Low Income ◽  
Cluster Randomized Trial ◽  
Fluoride Varnish ◽  
Atraumatic Restorative Treatment ◽  
Silver Diamine Fluoride ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Caries Lesions

BACKGROUND The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults. OBJECTIVE This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish. METHODS A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment. RESULTS The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023. CONCLUSIONS This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings. CLINICALTRIAL ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17840

scholarly journals Atraumatic Restorative Treatment-Sealed versus Nonsealed First Permanent Molars: A 3-Year Split-Mouth Clinical Trial

2020 ◽  
Vol 55 (1) ◽  
pp. 12-20
Author(s):  
Daniela Hesse ◽  
Camila de Almeida Brandão Guglielmi ◽  
Daniela Prócida Raggio ◽  
Marcelo José Strazzeri Bönecker ◽  
Fausto Medeiros Mendes ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Income ◽  
Cox Regression ◽  
Caries Experience ◽  
Rank Test ◽  
Atraumatic Restorative Treatment ◽  
Restorative Treatment ◽  
Permanent Molars ◽  
Caries Lesions ◽  
First Permanent Molars

To investigate the efficacy of atraumatic restorative treatment (ART) sealants vs. no sealant in preventing the development of dentine caries lesions in first permanent molars over a period of 3 years. A total of 187 schoolchildren (aged 6–8 years) from a low-income population presenting the 4 first permanent molars without clinically detectable dentine caries lesions were selected to be part of a split-mouth clinical trial. All 4 first permanent molars were investigated in this trial and the children’s mouth was split vertically into left and right sides; therefore, 2 molars were randomly allocated to receive ART sealants, while the other 2 molars remained nonsealed. All children received toothbrushing instructions and dietary advice every 6 months for a period of 3 years. Clinical evaluations were performed after 3, 6, 12, 18, 24, and 36 months and both sealant retention and dental caries were scored. Kaplan-Meier survival analysis, log-rank test, and Cox regression with shared frailty analysis were performed. A cavitated dentine caries lesion was considered a failure. The cumulative survival rates of dentine cavity-free first permanent molars were 90% for ART-sealed molars and 90.8% for nonsealed molars, with no statistically significantly difference between sealed and nonsealed molars (<i>p</i> = 0.70). The retention of sealants was not associated with the development of cavitated dentine caries and children presenting a higher baseline caries experience had greater chances of developing dentine lesions. In conclusion, the application of ART sealants was not more efficacious than nonsealing in reducing the development of dentine cavitated lesions in first permanent molars.

scholarly journals Silver diamine fluoride, atraumatic restorations, and oral health-related quality of life: Results from the CariedAway cluster randomized trial

2021 ◽  
Author(s):  
Ryan Richard Ruff ◽  
Tamarinda J Barry Godin ◽  
Topaz Murray Small ◽  
Richard Niederman
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Dental Caries ◽  
Atraumatic Restorative Treatment ◽  
Health Related Quality ◽  
Silver Diamine Fluoride ◽  
Related Quality ◽  
Health Related ◽  
Cluster Randomized

Objective: Silver diamine fluoride (SDF) is a non-surgical treatment for the arrest and prevention of dental caries that results in irreversible black staining of dental decay. The objective of this study was to evaluate the impact of SDF treatment on oral health-related quality of life (OHRQoL) relative to a standard package of glass ionomer sealants and atraumatic restorative treatment. Methods: CariedAway is a pragmatic, longitudinal, cluster-randomized non- inferiority trial of non-surgical interventions for caries. Secondary study outcomes included OHRQoL and academic performance. Oral health-related quality of life was measured at each study visit using the Child Oral Health Impact Profile. Change in OHRQoL was assessed using linear regression and non-inferiority was determined using t-tests. Results: Untreated decay at baseline was associated with signifcantly worse ORHQoL and treatment in both groups resulted in incremental improvement. Quality of life in children receiving silver diamine fluoride was non-inferior to those receiving sealants and ART at least six months post-treatment. Additionally, change in OHRQoL did not depend on the severity of baseline decay. Conclusions: ORHQoL is related to untreated dental caries, however no appreciable change was observed following SDF treatment relative to standard preventive therapies.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial

2020 ◽  
pp. 238008442096394
Author(s):  
P. Arrow ◽  
S. Piggott ◽  
S. Carter ◽  
R. McPhee ◽  
D. Atkinson ◽  
...  
Keyword(s):  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Caries Experience ◽  
Atraumatic Restorative Treatment ◽  
Model Of Care ◽  
Aboriginal Communities ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Delayed Intervention

Introduction: The management of early childhood caries (ECC) is challenging. Objectives: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Methods: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. Results: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. Conclusion: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. Knowledge Transfer Statement: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

Prognostic understanding, hospitalization, and hospice use among older patients with advanced cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12037-12037
Author(s):  
Kah Poh Loh ◽  
Christopher Seplaki ◽  
Reza Yousefi Nooraie ◽  
Jennifer Leigh Lund ◽  
Ronald M. Epstein ◽  
...  
Keyword(s):  
Older Adults ◽  
Advanced Cancer ◽  
Generalized Estimating Equations ◽  
Older Patients ◽  
Cluster Randomized Trial ◽  
Response Options ◽  
Lower Odds ◽  
Poor Understanding ◽  
Cluster Randomized ◽  
Hospice Use

12037 Background: Poor prognostic understanding of curability is associated with lower hospice use in patients with advanced cancer. Little is known if this holds true for older adults specifically. In addition, prognostic understanding are variably assessed and defined in prior studies. We evaluated the associations of poor prognostic understanding and patient-oncologist discordance in both curability and survival estimates with hospitalization and hospice use in older patients with advanced cancer. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (URCC 13070: PI Mohile) that recruited 541 patients aged ≥70 with incurable solid tumor or lymphoma considering any line of cancer treatment and their oncologists. At enrollment, patients and oncologists were asked about their beliefs about cancer curability (options: 100%, > 50%, 50/50, < 50%, 0%, and uncertain) and estimates of patient’s survival (options: 0-6 months, 7-12 months, 1-2 years, 2-5 years, and > 5 years). Non-0% options were considered poor understanding of curability (uncertain was removed from the analysis) and > 5 years was considered poor understanding of survival estimates. Any difference in response options was considered discordant. We used generalized estimating equations to estimate adjusted odds ratios (AOR) assessing associations of poor prognostic understanding and discordance with hospitalization and hospice use at 6 months, adjusting for covariates and practice clusters. Results: Poor prognostic understanding of curability and survival estimates occurred in 59% (206/348) and 41% (205/496) of patients, respectively. Approximately 60% (202/336) and 72% (356/492) of patient-oncologist dyads were discordant in curability and survival estimates, respectively. In the first 6 months after enrollment, 24% were hospitalized and 15% utilized hospice. Poor prognostic understanding of survival estimates was associated with lower odds of hospice use (AOR 0.30, 95% CI 0.16-0.59) (Table). Discordance in survival estimates was associated with greater odds of hospitalization (AOR 1.64, 95% CI 1.01-2.66). Conclusions: Prognostic understanding may be associated with hospitalization or hospice use depending on how patients were queried about their prognosis and whether oncologists’ estimates were considered.[Table: see text]

scholarly journals One-year follow-up of Atraumatic Restorative Treatment(ART) for dental caries in children undergoing oncohematological treatment: a pragmatic trial

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Cíntia Ferreira Gonçalves ◽  
Mariana Vargas Lindemaier e Silva ◽  
Luciane Rezende Costa ◽  
Orlando Ayrton de Toledo
Keyword(s):  
Dental Caries ◽  
Pragmatic Trial ◽  
Atraumatic Restorative Treatment ◽  
Restorative Treatment ◽  
One Year
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