Applying evidence-based dentistry to caries management in dental practice: a computerized approach

It has been suggested that dentists manage patients' treatment according to their risk of developing caries, as determined on the basis of scientific findings-an example of applying evidence-based dentistry, or EBD, to caries management. This article evaluates the barriers to adopting EBD and suggests possible outcomes for dentists and patients if new EBD caries strategies are adopted.

The author estimated the complexity of adopting EBD for a general dentist by means of flowchart analysis. He considered the ease of collecting comprehensive patient screening data, identifying risk factors and classifying risk. He examined the adequacy of conventional caries charting methods for representing the different stages and behavior of carious lesions, as well as the difficulty of producing treatment plans according to different caries risk levels. He also modeled the possible financial and organizational results of applying EBD caries management methods and increasing the use of hygienists.

Traditional caries management strategies required only one flowchart page, while EBD needed 16 pages. Two full-time hygienists and 25 percent of a dentist's time, managing only patients at low risk of developing caries, could generate the equivalent gross income of a full-time dentist working conventionally. Adding a third hygienist and devoting 75 percent of a dentist's time to managing the remaining patients (those at medium or high risk of developing caries and periodontal disease) could gross a similar amount again.

Changing from traditional to risk-based management of caries requires complex decision making that is unlikely to occur with paper chart methods. Computers are ideal for collecting patient screening data and automating the treatment planning process to reduce the complexity of clinical management. Conventional methods of charting caries are not suited for evidence-based caries risk management.

One dentist who uses risk-based management of caries and makes efficient use of three hygienists may see a doubling of income and a fourfold increase in the practice's patient population.