One component of the Virtual Dental Home is the use of interim therapeutic restorations (ITR) by community dental teams. The ITR procedure is not new, it is endorsed by the World Health Organization and has been utilized in dentistry for over 25 years. ITR is a preventive technique used to put teeth with cavities into a holding pattern, to slow or stop progression of the disease, and to allay possible discomfort experienced by the patient. ITR is designed to bridge the gap between the point at which a cavity is first diagnosed, generally in a remote setting, and the time it takes a patient to access dental care in a conventional office.
ITR is a procedure that involves removing infected tooth structure utilizing hand instruments for manual excavation. In some settings this is referred to as a "scoop and fill technique." This type of excavation is generally not painful and therefore requires no dental anesthetic. The softer affected tooth structure is scooped away utilizing hand instruments. The remaining "cavity" is then filled with an adhesive restorative material. Studies support the use of Glass-ionomer restorative materials because they are less sensitive to moisture contamination, they provide a strong bond to healthy tooth structure, and they release fluoride which stimulates remineralization and inhibits the rate at which the bacteria are able to produce acids. Randomized clinical trials have shown that these types of temporary restorations, on average, last 1 to 2 years.
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| A common example of tooth decay in one young patient. |
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| The result of ITR. |
The American Academy of Pediatric Dentistry (AAPD) has released a formal policy statement in support of ITR. The AAPD “recognizes ITR as a beneficial provisional technique in contemporary pediatric restorative dentistry. ITR may be used to restore and prevent the progression of dental caries in young patients, uncooperative patients, patients with special health care needs, and situations in which traditional cavity preparation and/or placement of traditional dental restorations are not feasible. ITR may be used for caries control in children with multiple carious lesions prior to definitive restoration of the teeth.”
In the Colorado SMILES Dental Project, ITR will be incorporated into a comprehensive system of care, where dental hygienists are deployed into communities to provide access to care in underserved areas of our state. The licensed and permitted dental hygienists will work closely in a telehealth-connected team to provide preventive services such as cleanings, fluoride applications, dental sealants, education, and x-rays. The patients’ records are then sent to a licensed Colorado dentist, using telehealth technology, who reviews the records and makes a treatment plan. For patients who can be cared for in the community, the dentist can determine the next steps with care. Patients with more severe needs that can only be treated by a dentist will be sent to the dental clinic for care.
Using this combination of on-site care, temporary restorations, and follow-up care in dental clinics as needed, the SMILES Dental Project hopes to bring needed dental care to communities across Colorado.
