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Title In Adult Dental Patients, Weak Evidence Suggests That Using A caries Risk Assessment To Guide Treatment Planning May Result In Lower caries Incidence
Clinical Question In an adult dental patient, does the use of a caries Risk Assessment instrument to guide treatment planning result in a lower caries incidence?
Clinical Bottom Line In an adult dental patient, using a caries risk assessment to guide treatment planning results in lowered caries risk and may result in lower caries incidence, according to a randomized controlled trial. caries increment (change in DMFS) was lower in the treatment group, though other measures of caries incidence showed no statistical difference between the treatment and control groups. Saliva testing, as done as part of the CRA, may not be practical for all patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22472515Featherstone/2012231 adult dental patientsRandomized Controlled Trial
Key resultscaries increment over the 2 year follow-up period was 3.5 for the treatment group of high caries-risk patients and 4.6 for the control group of high caries-risk patients (p value = .02). Other measures of caries incidence showed no statistically significant difference between the groups. The intervention group also had a statistically significant decrease in caries risk over the 2-year follow-up period after treatment using the caries risk assessment (OR 3.25, p value <.05).
Evidence Search "dental caries"[MeSH Terms] AND "risk assessment"[MeSH Terms] AND Randomized Controlled Trial[ptyp]
Comments on
The Evidence
The study was a randomized controlled trial, with equal numbers of patients assigned to control and treatment groups. The groups were demographically similar. Patients were followed over a 2 year period. Only 45% of the control group and 52% of the treatment group patients completed the entire study. Patients and clinicians were not blinded to the assigned group or the treatment being performed. The treatment group relied on patient self-reports to judge compliance with chlorhexidine mouth rinse use and tooth brushing. Though this is a randomized controlled trial, the patient drop-out rate, the lack of blinding, and the reliance on self-reporting limit the strength of the results. Because the quantitative results were equivocal, with some measures of caries incidence showing an improvement in the treatment group and others showing no difference, this study provides weak evidence in support of the Clinical Bottom Line.
Applicability Patients enrolled in the study had 1-7 cavitated lesions, so the results may not be applicable to patients at lower risk for caries or for patients not in need of restorative treatment. Salivary levels of S. Mutans, Lactobacilli, and fluoride were measured for all patients in the study. It may not be practical to test saliva for low caries risk patients in a typical dental practice, but should be considered for high risk patients. Patients in the intervention group who were scored as high-risk patients on their caries risk assessment received dietary counseling, 1.1% NaF gel application, home hygiene counseling, 1,100 ppm F toothpaste and 0.12% chlorhexidine mouthrinse. Low caries risk patients in the intervention group received dietary and home hygiene instructions and 1,100 ppm F toothpaste. Any of these interventions could be implemented in a typical dental practice.
Specialty/Discipline (Public Health) (General Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords caries Risk Assessment, caries, prevention
ID# 2392
Date of submission: 04/01/2013spacer
E-mail adamsec@livemail.uthscsa.edu
Author Evan Adams
Co-author(s) e-mail
Faculty mentor/Co-author David Cappelli, DMD, MPH, PhD
Faculty mentor/Co-author e-mail cappelli@uthscsa.edu
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