Abstract
BackgroundConsensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized.MethodsThis retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time.ResultsApproximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95 % CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95 % CI: -0.65, -0.08).ConclusionsThese results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0097-4) contains supplementary material, which is available to authorized users.
Highlights
Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal
In two studies drawn from patient datasets, counseling adult patients at high caries risk to use fluoride toothpaste was associated with later classification into a lower risk category in one study [14], but in the other, fluoride therapy was not associated with significantly lower caries increment [15]
In the present retrospective observational study, we aimed to evaluate caries management outcomes based on electronic patient records at a university clinic where CAMBRA is emphasized: whether caries increment would be reduced among high-risk patients who received non-operative anti-caries agents
Summary
Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized. Chaffee et al BMC Oral Health (2015) 15:111 as high risk, CAMBRA clinical guidelines recommend providing antibacterial therapy (e.g., chlorhexidine or xylitol products) and remineralizing agents (e.g., highconcentration fluoride toothpaste) to manage caries as a disease process [10]. Few studies have evaluated the effectiveness of non-operative anti-caries management among adults at high caries risk. In two studies drawn from patient datasets, counseling adult patients at high caries risk to use fluoride toothpaste was associated with later classification into a lower risk category in one study [14], but in the other, fluoride therapy was not associated with significantly lower caries increment [15]
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