Caries risk assessment in an educational environment

This study was designed to assess, retrospectively using dental records, the impact on the management of dental caries of new caries risk assessment (CRA) forms and procedures introduced into a predoctoral dental school clinic. Of 3,659 patients with a new patient visit (NPV) and baseline exam (BE) in the two-year period of July 2003 through June 2005, 69 percent (n= 2,516) had a baseline CRA. "Visible cavitation or caries into dentin by radiograph" was significantly correlated to most items included in the CRA form, for example, "frequent between meal snack of sugars/cooked starch" (p<0.001), "inadequate saliva flow" (p=0.03), and "deep pits and fissures or developmental defects" (p<0.001). Fluoride toothpaste use (odds ratio, OR=0.7) was negatively related to cavitation risk while "readily visible heavy plaque on teeth" (OR=2.0), "frequent between meal snack of sugars/cooked starch" (OR=1.6), "interproximal enamel lesions or radiolucencies" (OR=11.8), and "white spots or occlusal discoloration" (OR=1.50) were positively related. CRA use at follow-up, the use of bacterial tests, antibacterial therapy, and specific patient recommendations were all very low. While the content and usefulness of the CRA procedures were validated, the study highlighted the difficulties of implementing such programs in educational establishments even with an extensive student didactic program and faculty training.