Local Dental Health Initiative Sees Positive Results

The program from Boston Children’s Hospital is spreading across the country.

Dentist's Office Image via Shutterstock.

Dentist’s Office Image via Shutterstock.

Early childhood caries (ECC) can be a devastating disease when it occurs in children under the age of five. The disease, also known as bottle rot or baby bottle caries, is a disease characterized by severe tooth decay in infants or young children. It’s a common bacterial infection—so common, in fact, that at times it has affected more than 300,000 U.S. children, especially those in minority and rural populations, according to the American Academy of Pediatric Dentistry.

But doctors from the DentaQuest Institute, Boston Children’s Hospital, and the St. Joseph Hospital for Specialty Care in Providence are making an effort to improve childhood dental health through the Early Childhood Caries Initiative, which was implemented in 2008 to help manage and prevent dental disease in children. The program assesses and identifies high-risk patients, teaches families prevention practices like using fluoride and sealants, and implements a regimented appointment schedule for high-risk patients. Overall, these methods have worked. During phase one, in which the teaching methods were used only at Boston Children’s and St. Joseph’s, the DentaQuest Institute reported that new tooth decay after three visits was reduced by 65 percent in 18 months at Boston Children’s. At St. Joseph’s, new tooth decay was reduced by 42 percent.

During phase two, the methods were spread to community health centers in the Boston area, which Dr. Rob Compton, the executive director of the DentaQuest Institute, describes as “less controlled,” making an initiative like this more difficult to implement. Still, the results were positive. On the DentaQuest Institute website, researchers announced that there was a 28 percent reduction in additional tooth decay at those community centers, simply because doctors made concerted efforts to teach parents how to take care of their children’s teeth.

Through the initiative, doctors at the three organizations have effectively reduced the costs of care, the number of children affected by ECC, and the number of children who require surgery each year because of tooth decay, says Compton. “The folks at Boston Children’s Hospital teach families how ECC is transmitted and help parents establish goals for their children,” he says. “They show them how to clean their children’s teeth properly, and teach them that tooth decay stems from a bacterial infection that kids get from their parents when parents heat up food and taste it, or when they kiss their children on the lips.”

Many children with ECC also have to spend time in the operating room. A two-year-old who requires root canals and crowns cannot be treated without anesthesia, Compton explains, but the wait for surgery was often six to seven months at Boston Children’s before the implementation of the new initiative. After 18 months, DentaQuest Institute researchers found that they had reduced not only tooth decay, but the number of children who needed surgery also fell from 21 percent to 11 percent, further improving treatment and patient experience.

“Under the traditional way of treating ECC, the cost of care for high risk children was $25,000,” Compton says. “After the change in protocol, the costs for those same children was $18,000, which is a major cost reduction. The triple aim for healthcare is to increase healthcare outcomes, increase access to healthcare, and reduce costs, but most organizations have not been able to achieve all of those aims at the same time. With this initiative, Boston Children’s has achieved all three.”

The Early Childhood Caries Initiative has been so successful that it will soon spread to other areas of the country as a part of phase 3. Compton says that during the next year, they hope to implement the system in 35 to 40 new sites around the country to reduce new tooth decay, reduce the cost of treatment, and improve patient care. Plus, now that they know the model works, Compton says they are hoping to team up with federal organizations to spread the program’s methods to other areas of healthcare, too.