Management of high caries risk and high caries activity patients: rampant caries control program (RCCP)

The purpose of this article is to describe the Rampant Caries Control Program established in the operative dentistry third-year clinic at the University of Iowa College of Dentistry. This program represents a new approach to the management of high caries risk and high caries activity patients who come to the school. The patients are referred initially to the third-year operative clinic only for disease control (phase I) to help them decrease the caries risk and activity. The disease control phase has three important components: 1) caries risk assessment evaluation and reevaluation throughout their treatment, in which individual risk factors are identified and recommendations are made; 2) caries removal and placement of transitional restorations using fluoride release restorative materials (glass ionomers); and 3) chemotherapeutic agents and preventive treatment in which a therapeutic regimen for prevention and nonsurgical treatment is established according to each patient's individual risk factors. About 50 percent of patients have dropped from the program, 36 percent currently are under disease control treatment, and 14 percent have finished the disease control phase of the program. After the disease is controlled through modification of risk factors and activity, the patients can be referred for reevaluation prior to beginning the rehabilitation phase.