Minimum intervention oral care – incentivising preventive management of high-needs/high caries-risk patients using phased courses of treatment

Minimum Intervention Oral Care (MIOC) for High-Needs Patients 

This article explores how MIOC principles can be integrated into dental care for high-needs and high caries-risk patients within the NHS system in England. MIOC prioritizes prevention and minimizes invasive procedures, aiming for long-term oral health sustainability. It utilizes a phased approach with personalized care plans, focusing on teamwork and patient education.

Key aspects of MIOC:

• Person-centered: Care plans are tailored to individual needs, preferences, and risk factors.
• Team-based: Dentists, hygienists, therapists, and other healthcare professionals collaborate for optimal care delivery.
• Prevention-focused: Education on oral hygiene, diet, and risk reduction strategies is emphasized.
• Phased approach: Treatment is delivered in stages, with initial focus on stabilizing the oral environment before definitive restorations.
• Risk assessment: Longitudinal monitoring helps guide treatment decisions and track progress.

Benefits of MIOC:

• Improved patient outcomes: Reduced disease progression and need for complex procedures.
• Cost-effectiveness: Prevention can be more cost-effective than treating advanced disease.
• Sustainability: Minimizes interventions and promotes long-term oral health management.
• Equity: Provides accessible, high-quality care for high-needs patients.

Challenges and considerations:

• Remuneration: The NHS payment structure needs to incentivize MIOC implementation.
• Patient expectations: Clear communication is needed to manage expectations about phased treatment.
• Teamwork: Effective collaboration among dental professionals is crucial.

The article proposes a staged approach with personalized care plans (PCPs):

• Stage 1: Comprehensive assessment, initial risk assessment, pain relief, lesion stabilization, and preventive measures.
• Stage 2: Re-evaluation, further personalized care planning based on progress, and definitive restorations if risk is reduced.
• Stage 3: More complex interventions if risk reduction continues.

Effective MIOC implementation requires:

• Teamwork: Delegating tasks to other qualified team members for efficient care delivery.
• Patient education: Promoting healthy habits for long-term oral health maintenance.
• Respecting patient choices: Acknowledging that some patients may prioritize urgent care over ongoing relationships.

Conclusion:

MIOC offers a promising approach for delivering sustainable and equitable oral care to high-needs patients within the NHS system. Implementing MIOC effectively requires collaborative teamwork, clear communication with patients, and a supportive payment structure.