Caries Management By Risk Assessment and the Effect On Caries Diagnosis and Oral Health Behaviors

Abstract

Objective: To determine whether a caries management by risk assessment tool improves oral health behaviors and results in less caries diagnoses over time. Methods: A sample consisting of 207 patient records from the School of Dentistry (SOD) dental hygiene clinic were screened for inclusion and exclusion criteria. Inclusion criteria for the control group included patients eighteen years of age or older with their first visit to SOD dental hygiene clinic between years 2010-2011, no record of CAMBRA completion, and two or more dental hygiene clinic visits. Inclusion criteria for the intervention group included patients eighteen years of age or older with their first visit to the SOD’s dental hygiene clinic between 2012-2016, two or more completions of CAMBRA, and two or more dental hygiene clinic visits. Using the CAMBRA form, the following changes in protective factors and risk factors for the experimental group were recorded using a standard form: visible heavy plaque on teeth, drinks water from fluoridated municipal supply, use of fluoride toothpaste at least once a day, use of fluoride toothpaste at least 2xday, use of fluoride mouth rinse (0.05%NaF) daily, use of 5000 ppm F fluoride toothpaste daily, and chlorhexidine prescribed/used one week each of last 6 months. Results: A total of 207 patient records comprised the study sample. One hundred subjects were in the control group and one hundred and seven were in the intervention group. In both the control and intervention groups, at least 50% of the subjects presented with active caries at visit one. The total number of visits ranged from two to eleven. Plaque scores were significantly higher in the control group at the last visit (p-value=0.0442). Subjects in the intervention group, who completed CAMBRA, had lower plaque scores indicating improved self-care behaviors. However, differences in new caries diagnoses at the last visit were not statistically significant between groups. Although statistical significance was not attained, the percentage of subjects with a new caries diagnosis at the last visit was lower for the intervention group (intervention=18.69%, control=29%). Subjects in the intervention group increased the number of protective factors over the course of their visits, except for the use of a prescribed chlorhexidine rinse. The most common reported protective factor was the use of fluoride toothpaste daily. Over the course of five visits, there was an increase in total protective factors for subjects in the intervention group. Conclusion: The results of this study showed subjects with a CAMBRA improved their self-care behaviors and had lower plaque index scores. Differences in new caries diagnosis were not statistically significant between control and intervention, but the percentage of subjects with a new caries diagnosis at the last visit was lower for the intervention group. The results of this study support existing evidence, as the use of caries management by risk assessment appears to offer a preventive approach to oral health care delivery.