Application of the high-risk strategy to control dental caries

The aim of this prospective study was to determine whether a child population with low overall caries frequency benefits when prevention is targeted to high-risk individuals.

Data from clinical examinations and salivary tests were used to assess caries risk in 12-year-olds (n=1465). Children who were regarded as being at high risk of developing caries were randomized into two groups. Half (HRI group) were offered intensive prevention (counseling, F-varnish applications, F-lozenges, sealants, chlorhexidine), and the other half (HRB group) were provided the same basic prevention given to low-risk children (counseling, one F-varnish application/year). A random sample of the low-risk children (LRB) was followed up for the same 3-year period as the high-risk children. The number of children completing the study was 216 in the LRB group, 199 in the HRI group and 174 in the HRB group.

The mean (SD) 3-year DMFS increment was 2.0 (2.4), 4.4 (4.7) and 5.1 (5.0) in the LRB, HRI and HRB groups, respectively. Comparison between the LRB and HRB groups revealed that risk assessment was fairly successful in terms of mean DMFS increment. However, 63% of the children in the LRB group developed at least one new lesion (max. 12).

The negligible difference between the HRI and HRB groups implies that intensifying prevention produced practically no additional benefit. By offering all children only basic prevention, virtually the same preventive effect could have been obtained with substantially less effort and lower costs.