CDA Essentials 2016 • Volume 3 • Issue 5 - page 25

25 Volume3 Issue5 |
Issues and People
Resumecomprehensive riskmanagement care
Printedwithpermissionof IanMcConnachie,DDS,MS,FRCD(C)
RiskManagementAlgorithm
EarlyChildhoodCaries
AnticipatoryGuidance
Diet
Growthanddevelopment
Commitment toappropriate
periodicityof o cecare
Motivational interviewing
LowRisk High risk:
cavitated lesions
Moderate tohigh risk:
non-cavitated lesions
Reducedperiodicityand
treatments:
Annual visits
Introduction toprophylaxis
as childdevelopment
progresses
X-rays requiredat a laterdate
Patient statusdeteriorates?
Assess for:
Antimicrobials
–Topical fluoride
–Sealants
–Appropriateperiodicity
Patientbecomeshigh risk?
Restorationneed ed?
Stagedcare:
Systematicdesensitization
Antimicrobials
Topical uoride
–Atraumatic restorative treatment (ART)
Glass ionomer (GI) sealants
Appropriateperiodicity
(May include initial sedationvisit(s) tocontrol painand infection.)
Unstableclinical situation?
Permanent restorationwithorwithout sedation
Stagedcarewhilewaiting
forgeneral anesthesia
*Decision to treator refer cancomeat any stage.
Treatmentunder
general anesthesia
Completionof
restorative treatment
Yes
No
No
No
No
Yes
Yes
Yes
Theelementsof thefirst dental visit arebroadand
build important links:
 Parent interview
 Assessment of parentalmotivation
 Visual exam toassess risk
 Development of a riskmanagement protocol
 Oral hygiene instructions
 Applicationanddispensationof preventive
therapies
“Havingexamined thechildand taken in the
relevant information,wecanposition them into
themost appropriate risk categoryusingone
of theassessmentmodels available,with the
3general categoriesbeing low risk,moderate
tohigh risk (non-cavitated lesions), andhigh risk
(cavitated lesions),” addsDr.McConnachie.
Riskmanagement
“As careproviders,weneed tofirst decidehow
far into thealgorithmwearecomfortablegoing,
andatwhat pointweneed to refer toanother
clinician—and thisobviously includesbuilding
a relationshipwith thepediatric
specialist, consistentwithour
ownphilosophyof care,”
emphasizesDr.McConnachie.
Dr.McConnachieencourages
dentists to take theplunge
and treat youngpatients: “Start
slowly. Get comfortablewith the
lower-riskpatients. Startwith
thefirst exambyfirst birthday.
Build skills. AlwayshaveaplanB,
andbeprepared toenjoy the
experience!” a
Visit OasisDiscussions to
watchavideo interviewwith
Dr.McConnachie.
Thevideo includes anoverview
ofDr.McConnachie’s algorithm
for ECC riskassessment
andmanagement, and
thepresentationof
ECC risk-management cases.
oasisdiscussions.ca
/2015/06/09/eccp
ShareYourExperience
Doyou see infants inyour practice?
Haveyouadopteda riskmanagement approach toECC?
Sendyour feedback to oasisdiscussions@cda-adc.ca or call 1-855-716-2747.
Forourreaders inOntario, further informationon
thistopicwasrecently featured inOntarioDentist
magazine:
McConnachie, I.Newsolutions forgeneral
practitioners intreatingearlychildhoodcaries.
OntarioDentist.2016;93(2):23-25.
McConnachie, I.Stagedcare–newsolutions
fortreatingearlychildhoodcaries.
OntarioDentist.2016;93(3):32-36.