Dental News - Study shows positive influence on dental caries using a multilevel approach

Dental Tribune International

Thu. 15. February 2018

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SAN FRANCISCO, U.S.: According to a new study, a multilevel approach that includes a dental caries risk assessment, aggressive preventive measures and conservative restorations can dramatically reduce caries incidence. The findings, which support earlier research demonstrating positive results of the assessment and treatment method in a university setting, show that the protocol has the potential to transform dental care for high-risk patients.

“We put the 2012 UCSF [Caries Management by Risk Assessment] clinical study into the real world and showed it works,” said lead author Dr. Peter Rechmann, Professor of Preventive and Restorative Dental Sciences at the University of California, San Francisco (UCSF) School of Dentistry. “The patients at high caries risk who used prescription products went down significantly over time in their risk level. Those in the control group also reduced their risk to a lesser degree, simply by using over-the-counter products that also protect teeth and affect the bacteria.”

Caries Management by Risk Assessment (CAMBRA) is a method that was originally developed in 2003 by a team led by then Dean of the UCSF School of Dentistry Prof. John Featherstone. The method adopts a multilevel approach in which dentists collect patients’ dental and medical histories, conduct clinical examinations to assess caries, and utilize behavioral approaches and chemical treatments to optimize protective factors.

For their two-year study, Rechmann and his colleagues recruited 30 dentists to take part, 18 from private practices and three from community clinics. The study involved 460 patients aged between 12 and 65, split into two groups: the CAMBRA group and control group, with 239 and 221 participants, respectively. In the CAMBRA group, high-risk patients received prescription fluoride toothpaste, a chlorhexidine antibacterial rinse, xylitol mints and a fluoride varnish. The control group received regular fluoride toothpaste, an assumed inactive mouthrinse, sorbitol candies and a nonfluoride varnish.

In follow-up visits at six, 12, 18 and 24 months, new carious lesions or changes in caries risk level were recorded. According to the results, a significantly greater percentage of high-risk participants were classified as lower risk after receiving CAMBRA preventive therapies. Dental caries was low in both groups.

Among 242 patients (137 intervention, 105 control) initially identified as high risk for caries, only a quarter of the patients remained at high risk in the CAMBRA group at 24 months, and just over half (54 percent) in the control group. Of the 192 low-risk participants (93 intervention, 99 control), most participants remained low risk. The researchers believe this points to the assessment correctly identifying those at risk for caries.

The study, titled “Changes in caries risk in a practice-based randomized controlled trial,” was published in the February issue of the Advances in Dental Research journal.

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