Anti-Caries Agents and Dental Caries Among High-Risk Adults
Anti-Caries Agents and Dental Caries Among High-Risk Adults
Despite long-standing consensus supporting minimal intervention and non-operative preventives for caries management in dental practice, a prevention-oriented strategy is far from reaching universal adoption: for example, many dentists favor restoration placement over non-operative therapy for enamel-confined lesions. In contrast to traditional reliance on surgical means, a risk-based approach to the clinical management of dental caries stresses individualized treatment decisions based on patients' behavioral and biological characteristics, with an emphasis on caries prevention and preservation of tooth structure.
Caries Management by Risk Assessment (CAMBRA) is one approach that has been proposed for patient-specific caries management. First, in a risk assessment stage, the clinician is guided to categorize a patient's caries risk based on an overall assessment of disease indicators, caries protective factors, and caries predisposing factors. For adults categorized as high risk, CAMBRA clinical guidelines recommend providing antibacterial therapy (e.g., chlorhexidine or xylitol products) and remineralizing agents (e.g., high-concentration fluoride toothpaste) to manage caries as a disease process. The CAMBRA approach has been firmly adopted in the university clinic in which this study was based.
Relatively few studies have evaluated the effectiveness of non-operative anti-caries management among adults at high caries risk. A recent randomized controlled trial reported that combined antibacterial and fluoride preventive therapy could lower caries risk and suggested a reduction in 2-year caries increment among initially high-risk patients. The widespread implementation of electronic health records represents an opportunity to evaluate the effectiveness of personalized treatments in real practice. 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, but in the other, fluoride therapy was not associated with significantly lower caries increment.
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: specifically, whether caries increment would be reduced among high-risk patients who received non-operative anti-caries agents. We hypothesized that among initially high-risk individuals, caries increment will be lowest among those patients who received non-operative anti-caries agents repeatedly over time.
Background
Despite long-standing consensus supporting minimal intervention and non-operative preventives for caries management in dental practice, a prevention-oriented strategy is far from reaching universal adoption: for example, many dentists favor restoration placement over non-operative therapy for enamel-confined lesions. In contrast to traditional reliance on surgical means, a risk-based approach to the clinical management of dental caries stresses individualized treatment decisions based on patients' behavioral and biological characteristics, with an emphasis on caries prevention and preservation of tooth structure.
Caries Management by Risk Assessment (CAMBRA) is one approach that has been proposed for patient-specific caries management. First, in a risk assessment stage, the clinician is guided to categorize a patient's caries risk based on an overall assessment of disease indicators, caries protective factors, and caries predisposing factors. For adults categorized as high risk, CAMBRA clinical guidelines recommend providing antibacterial therapy (e.g., chlorhexidine or xylitol products) and remineralizing agents (e.g., high-concentration fluoride toothpaste) to manage caries as a disease process. The CAMBRA approach has been firmly adopted in the university clinic in which this study was based.
Relatively few studies have evaluated the effectiveness of non-operative anti-caries management among adults at high caries risk. A recent randomized controlled trial reported that combined antibacterial and fluoride preventive therapy could lower caries risk and suggested a reduction in 2-year caries increment among initially high-risk patients. The widespread implementation of electronic health records represents an opportunity to evaluate the effectiveness of personalized treatments in real practice. 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, but in the other, fluoride therapy was not associated with significantly lower caries increment.
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: specifically, whether caries increment would be reduced among high-risk patients who received non-operative anti-caries agents. We hypothesized that among initially high-risk individuals, caries increment will be lowest among those patients who received non-operative anti-caries agents repeatedly over time.
