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Clinical and patient-reported outcomes in children with learning disabilities treated using the Hall Technique: a cohort study

Abstract

Introduction Preformed metal crowns (PMC) placed using the Hall Technique (HT) are effective for managing carious lesions in primary molars and might be tolerable and successful for children with learning disabilities (CLD), possibly avoiding the need for sedation/ anaesthesia.

Aim To investigate the effectiveness of the HT for management of carious lesions in children with learning disabilities through a prospective service evaluation.

Methods Sixteen, 4-12-year-old CLD had 27 carious lesions managed using the HT and were followed-up. Outcomes were: 1) incidence of dental pain/infection; 2) success of treatment outcomes as judged by patients and parents/carers; and 3) adverse outcomes.

Results Twenty seven teeth treated with HT were followed up for five to 87 months (mean = 24) with no episodes of pain and/or infection in treated teeth. Treatment was rated as causing no discomfort in 80% of children and as successful by 98% of children; 96% of parents/carers, and 100% of dentists. Other adverse outcomes; occlusal surface perforation (n = 8; 30%).

Conclusion The HT was acceptable to, and effective in treating carious lesions in CLD who were unable to accept traditional restorative treatment. This alternative treatment option may avoid the need for general anaesthesia.

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Reference

  1. Waldron C, Phadraig C M, Nunn J et al. Oral hygiene programmes for people with intellectual disabilities. The Cochrane Database Syst Rev 2017; DOI: 10.1002/14651858.CD012628.

  2. Lancioni G E, O'Reilly M F. Teaching food preparation skills to people with intellectual disabilities: a literature overview. J Appl Res Intellect Disab 2002; 15: 236-253.

  3. WHO and The World Bank. World Report on Disability. Geneva: WHO and World Bank, 2011. Available at https://www.who.int/disabilities/world_report/2011/report.pdf (accessed December 2019).

  4. Mencap. Mencap; the voice of learning disability 2017. Available from: https://www.mencap.org.uk (accessed December 2019).

  5. Anders P L, Davis E L. Oral health of patients with intellectual disabilities: a systematic review. Special Care Dent 2010; 30: 110-117.

  6. Robertson M D, Schwendicke F, de Araujo M P et al. Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis. BMC Oral Health 2019; 19: 146.

  7. Innes N P, Manton D J. Minimum intervention children's dentistry the starting point for a lifetime of oral health. Br Dent J 2017; 223: 205-213.

  8. Ricketts D, Lamont T, Innes N P, Kidd E, Clarkson J E. Operative caries management in adults and children. Cochrane Database Syst Rev 2013: CD003808.

  9. Schwendicke F, Frencken J E, Bjorndal L et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res 2016; 28: 58-67.

  10. Innes N P, Evans D J, Stirrups D R. The Hall Technique; A randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: Acceptability of the technique and outcomes at 23 months. BMC Oral Health 2007; 7: 18.

  11. Innes N P, Evans D J, Stirrups D R. Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res 2011; 90: 1405-1410.

  12. Hesse D, de Araujo M P, Olegario I C, Innes N, Raggio D P, Bonifacio C C. Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial. Trials 2016; 17: 169.

  13. Narbutaitė J, Innes N P T, Sánchez R M S, Splieth C H, Mačiulskienė V, editors. One-year outcomes of dental caries management using different approaches in primary molars of lithuanian children. Caries research: 64th ORCA Congress: July 5-8 2017, Oslo, Norway: abstracts; 2017: Karger.

  14. Santamaria R M, Innes N P, Machiulskiene V, Evans D J, Splieth C H. Caries management strategies for primary molars: 1-yr randomized control trial results. J Dent Res 2014; 93: 1062-1069.

  15. Al Halabi M, Kowash M, Hussein I. Hybrid child-friendly biological primary molar restorative alternatives to general anaesthesia. Dent Update 2018; 45: 728-741.

  16. Faculty of General Dental Practice. Selection Criteria for Dental Radiography. Third edition, 2013.

  17. Harris J C, Marshman Z, Short J A. Development and qualitative evaluation of a communication tool for children with autism spectrum disorders and other communication difficulties. J Disabil Oral Health 2014; 15: 33-39.

  18. Education Df. National Statistics, Special educational needs in England: January 2019. In Education. Df, editor, 2019.

  19. Santamaria R M, Innes N P, Machiulskiene V, Evans D J, Alkilzy M, Splieth C H. Acceptability of different caries management methods for primary molars in a RCT. Int J Paediatr Dent 2015; 25: 9-17.

  20. Innes N P, Frencken J E, Bjorndal L et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res 2016; 28: 49-57.

  21. Innes N P, Ricketts D, Chong L Y, Keightley A J, Lamont T, Santamaria R M. Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2015: DOI: 10.1002/14651858.CD005512.pub3.

  22. So D, Evans D J, Borrie F et al. Measurement of Occlusal Equilibration Following Hall Crown Placement A Pilot Study. J Dent Res 2015; 94 (Spec Iss A. Abstract no 0080).

  23. Van der Zee V, Van Amerongen W E. Influence of preformed metal crowns (Hall Technique) on the occlusal vertical dimension in the primary dentition. Eur Arch Paediatr Dent 2010; 11: 225-227.

  24. Diéguez-Pérez M, de Nova-García M-J, Mourelle-Martínez M R, Bartolomé-Villar B. Oral health in children with physical (Cerebral Palsy) and intellectual (Down Syndrome) disabilities: Systematic review I. J Clin Exp Dent 2016; 8: e337.

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Acknowledgements

JCH, MDR, JRR and NPTI are indebted to the Sheffield Community & Special Care Dentistry dental nurses who skilfully assisted with patient care, especially Anne French, Andrea Ford and Clair Jenkinson, and to Amit Vora and Rachael Bussell for help collecting follow-up data.

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Correspondence to Mark D. Robertson.

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Robertson, M., Harris, J., Radford, J. et al. Clinical and patient-reported outcomes in children with learning disabilities treated using the Hall Technique: a cohort study. Br Dent J 228, 93–97 (2020). https://doi.org/10.1038/s41415-019-1166-x

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