PROMOTING CHANGES IN CLINICAL-PRACTICE - TREATMENT TIME AND OUTCOME STUDIES IN A DANISH PUBLIC CHILD DENTAL-HEALTH CLINIC

This paper examines the characteristics of the process of innovation a s applied to provision of dental health to children. The data are from a demonstration project conducted in a Danish public child dental hea lth clinic to evaluate the appropriateness and effectiveness of an ind ividualized and alternative, mainly non-operative, caries treatment st rategy that was implemented in 1987. The aim of the strategy was to av oid operative intervention and sealants, and was based on three princi ples: caries is a localized disease; intensive training in home-based treatment; and individualized risk assessments and controls in conjunc tion with professional plaque removal, The major influence on the inno vation process appeared to be personal education of the personnel, act ive participation in research, and feedback from clinical observations . In 1992 an additional feedback measure was introduced addressing the question: how much time does the individual child spend on treatment during one year? Mean total treatment time varied from 12 min for 1- t o 4-yr-olds to 44-58 min for 7- to 17-yr-olds. About 60% of the total treatment time was used on nan-operative caries treatment (diagnosis, risk assessment, plaque removal, toothbrushing training) and about 25% on operative caries treatment for 3- to 17-yr-olds. The 1-2-yr-olds r equired only non-operative treatment. The new treatment strategy reduc ed operative procedures by 60%, The paper introduces ail easily applic able measure of treatment outcome in terms of teeth that have nor been restored or sealed as a result of regular professional treatment oi c are. The main conclusion drawn is that the dominant moving forces in t he innovation process were professional responsibility and self-adjust ment by a constant learning process involving clinical feedback measur es in conjunction with modern understanding of caries as a localized d isease caused by local evolution of microbial cariogenic biofilms.