Implementing a disease management standard operating procedure in a contemporary private pediatric dental practice

Dental caries is a prevalent childhood condition with significant health and economic consequences. Disease management techniques, such as silver diamine fluoride (SDF) and sealants, have emerged as alternatives to traditional restorative care. This study describes the implementation of a disease management protocol in a large, multi-site private pediatric dental practice.

A retrospective descriptive cohort analysis was conducted using de-identified electronic health record data from Montshire Pediatric Dentistry at one of its nine locations between August 2018 and June 2025. Children with at least two visits were included. Visits and procedures were categorized by caries subtype and treatment type. Escalation was defined as progression from disease management to higher-intensity interventions including restoration or other significant treatment. Descriptive statistics formed the basis of analysis.

Among 8,857 children, 41.9% were caries-free. Disease management procedures dominated treatment types, with SDF and sealants most common. Among children with caries, 46% had treatment or disease management initiated at their initial visit, and 35% experienced a higher-intensity treatment escalation over the duration of care, primarily in severe subtypes (Grade III and V). Median time to higher-intensity treatment escalation was approximately 547 days, and median duration of care from initial to final treatment was 637 days.

Disease management procedures can be successfully implemented in private practice. Many children treated at this practice had treatment initiated at their first practice visit, and higher-intensity treatments occurred nearly a year and a half after initial treatment.