Caries Management by Risk Assessment: Results from a Practice-Based Research Network Study

Abstract

Thirty dentists with clinical practices outside of a university setting were trained and calibrated successfully in DMFS and ICDAS-scoring. This randomized, controlled, parallel-arm, double-blind 2-year clinical trial with individual-level caries risk assignment of 460 patients to standard of care as control versus active CAMBRA treatment as intervention demonstrated that caries risk level, as well as caries disease indicators, were significantly reduced in the CAMBRA intervention group compared to the controls at all recall time points.

Figure 1.

Percentage of patients with new cavities at follow up separated into low, moderate, high, and extreme high caries risk level at baseline (patients had not received the appropriate preventive measures); generated from Domejean S, White JM, Featherstone JD. Validation of the CDA CAMBRA caries risk assessment--a six-year retrospective study. J. Calif. Dent. Assoc. 2011;39(10):709–715.

Figure 2.

Number of new decayed/filled teeth of patients who received none, a single-time, and twice or more often anti-caries preventives; a 20% reduction in new decayed/filled teeth over 18 months in the group receiving twice of more anti-caries preventives was shown. (adapted from BMC Oral Health. 2015;15(1):111)

Figure 3.

ICDAS scoring criteria for healthy (score 0), non-cavitated lesions (score 1 and 2) and first representation of a cavitated lesion (score 3) (adapted from BMC Oral Health. 2018;18(2))

Figure 4.

Number of eligible patients at baseline, separated into caries risk levels and assignment to control and intervention group treatment.

Figure 5.

Change in caries risk levels for patients assessed as high caries risk at baseline; showing the percentage of patients staying at high risk over time for the intervention and the control group. (* marks statistically significant difference at specific recall time point; overall significance P<0.001)

Figure 6.

Percentage of participants classified as low caries risk at baseline, showing increased caries risk level to moderate or high caries risk, over time for intervention and control group (* marks statistically significant difference at specific recall time point).

Figure 7.

Percentage of patients with initial high risk at baseline developing any of the 4 clinical outcomes/disease indicators (cavities on radiographic into dentin, proximal enamel lesions on radiographs, active white spot lesions on smooth surfaces, restorations within prior year). *Percentages statistically significant different (cluster-adjusted P < 0.05) newly developed disease indicators (* marks statistically significant difference at specific recall time point).