JMIR Publications

ABSTRACT

Background:

Australian Aboriginal children experience dental decay at more than twice the rate of non-Aboriginal children. The interim report of the Select Committee enquiry into the provision of and access to dental services in Australia noted that the rate of potentially preventable hospitalisations was highest among 5-9-year-old children, and was higher among Indigenous Australians and among those living in remote locations. The application of a silver fluoride solution (AgF) to decayed surfaces has been shown to be effective in stopping the decay process and reducing the occurrence of new decay, but has had limited testing in the Australian context.

Objective:

The study aims to evaluate the feasibility of utilising the skills of an Aboriginal Health Practitioner (AHP) to undertake the application of AgF to carious primary molars to arrest the caries progression and prevent occurrence of new caries among young Aboriginal children in remote communities.

Methods:

A cluster-randomised controlled trial design with communities randomised, stratified on caries level and water fluoridation status. The trial will recruit 640 children (aged 6 mths-7 years) from 30 communities. Informed consent will be obtained. Each child will be examined by a calibrated examiner and subsequently by an oral health practitioner who will prescribe to an AHP the teeth to be treated with silver fluoride (AgF) at baseline for the intervention group. AgF (38%) applied for 1 minute (0.004ml per tooth). Control group provided with standard minimally invasive care using the Atraumatic Restorative Treatment and/or Hall Technique crowns (ART/HT). Annual follow-up for 2 years to assess caries arrest and prevention by blinded calibrated examiners and AgF reapplied as required. Child oral health-related quality of life and dental anxiety will be elicited through validated questionnaires. Test of proportions will be use to evaluate the proportion of lesions arrested and proportion of surfaces at risk that decayed over the follow-up. Multiple logistic regression with appropriate control for clustering of teeth and communities will be used to evaluate caries arrest controlling for potential confounding factors.

Results:

This pragmatic study will inform the development of models of care suitable for dental services in rural and remote communities in Australia.

Conclusions:

The study will test the effectiveness and feasibility of a non-oral health professional to apply AgF to achieve caries arrest and prevention. Clinical Trial: Registered with the Australian and New Zealand Clinical Trials Registry: ACTRN12624000457549p on 15 April 2024. https://www.anzctr.org.au/