Skip to main content
Top
Published in: BMC Oral Health 1/2015

Open Access 01-12-2015 | Research article

Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study

Authors: Benjamin W. Chaffee, Jing Cheng, John DB Featherstone

Published in: BMC Oral Health | Issue 1/2015

Login to get access

Abstract

Background

Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized.

Methods

This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time.

Results

Approximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95 % CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95 % CI: -0.65, -0.08).

Conclusions

These results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.
Appendix
Available only for authorised users
Literature
2.
go back to reference Fellows JL, Gordan VV, Gilbert GH, Rindal DB, Qvist V, Litaker MS, et al. Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth: multiple-regression modeling of observational clinical data from the National Dental PBRN. Am J Dent. 2014;27:91–9.PubMedPubMedCentral Fellows JL, Gordan VV, Gilbert GH, Rindal DB, Qvist V, Litaker MS, et al. Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth: multiple-regression modeling of observational clinical data from the National Dental PBRN. Am J Dent. 2014;27:91–9.PubMedPubMedCentral
3.
go back to reference Gomez J, Ellwood RP, Martignon S, Pretty IA. Dentists’ perspectives on caries-related treatment decisions. Community Dent Health. 2014;31:91–8.PubMed Gomez J, Ellwood RP, Martignon S, Pretty IA. Dentists’ perspectives on caries-related treatment decisions. Community Dent Health. 2014;31:91–8.PubMed
4.
go back to reference Kakudate N, Sumida F, Matsumoto Y, Yokoyama Y, Gilbert GH, Gordan VV. Patient age and dentists’ decisions about occlusal caries treatment thresholds. Oper Dent. 2014;39:473–80.CrossRefPubMedPubMedCentral Kakudate N, Sumida F, Matsumoto Y, Yokoyama Y, Gilbert GH, Gordan VV. Patient age and dentists’ decisions about occlusal caries treatment thresholds. Oper Dent. 2014;39:473–80.CrossRefPubMedPubMedCentral
5.
6.
go back to reference Featherstone JD, Doméjean-Orliaguet S, Jenson L, Wolff M, Young DA. Caries risk assessment in practice for age 6 through adult. J Calif Dent Assoc. 2007;35:703–7. 710–3.PubMed Featherstone JD, Doméjean-Orliaguet S, Jenson L, Wolff M, Young DA. Caries risk assessment in practice for age 6 through adult. J Calif Dent Assoc. 2007;35:703–7. 710–3.PubMed
7.
go back to reference Evans RW, Dennison PJ. The caries management system: an evidence-based preventive strategy for dental practitioners. Application for children and adolescents. Aust Dent J. 2009;54:381–9.CrossRefPubMed Evans RW, Dennison PJ. The caries management system: an evidence-based preventive strategy for dental practitioners. Application for children and adolescents. Aust Dent J. 2009;54:381–9.CrossRefPubMed
8.
go back to reference Wright JT. Current evidence for remineralizing therapeutics in caries management. J Dent Hyg. 2012;86:35–6.PubMed Wright JT. Current evidence for remineralizing therapeutics in caries management. J Dent Hyg. 2012;86:35–6.PubMed
9.
go back to reference Hallett KB. The application of caries risk assessment in minimum intervention dentistry. Aust Dent J. 2013;58 Suppl 1:26–34.CrossRefPubMed Hallett KB. The application of caries risk assessment in minimum intervention dentistry. Aust Dent J. 2013;58 Suppl 1:26–34.CrossRefPubMed
10.
go back to reference Jenson L, Budenz AW, Featherstone JD, Ramos-Gomez FJ, Spolsky VW, Young DA. Clinical protocols for caries management by risk assessment. J Calif Dent Assoc. 2007;35:714–23.PubMed Jenson L, Budenz AW, Featherstone JD, Ramos-Gomez FJ, Spolsky VW, Young DA. Clinical protocols for caries management by risk assessment. J Calif Dent Assoc. 2007;35:714–23.PubMed
11.
go back to reference Featherstone JD, White JM, Hoover CI, Rapozo-Hilo M, Weintraub JA, Wilson RS, et al. A randomized clinical trial of anticaries therapies targeted according to risk assessment (caries management by risk assessment). Caries Res. 2012;46:118–29.CrossRefPubMedPubMedCentral Featherstone JD, White JM, Hoover CI, Rapozo-Hilo M, Weintraub JA, Wilson RS, et al. A randomized clinical trial of anticaries therapies targeted according to risk assessment (caries management by risk assessment). Caries Res. 2012;46:118–29.CrossRefPubMedPubMedCentral
12.
13.
go back to reference Liu K, Acharya A, Alai S, Schleyer TK. Using electronic dental record data for research: a data-mapping study. J Dent Res. 2013;92 Suppl 7:90S–6S.CrossRefPubMed Liu K, Acharya A, Alai S, Schleyer TK. Using electronic dental record data for research: a data-mapping study. J Dent Res. 2013;92 Suppl 7:90S–6S.CrossRefPubMed
14.
go back to reference Söderström U, Johansson I, Sunnegårdh-Grönberg K. A retrospective analysis of caries treatment and development in relation to assessed caries risk in an adult population in Sweden. BMC Oral Health. 2014;14:126.CrossRefPubMedPubMedCentral Söderström U, Johansson I, Sunnegårdh-Grönberg K. A retrospective analysis of caries treatment and development in relation to assessed caries risk in an adult population in Sweden. BMC Oral Health. 2014;14:126.CrossRefPubMedPubMedCentral
15.
go back to reference Rindal DB, Rush WA, Perrin NA, Maupomé G, Bader JD. Outcomes associated with dentists’ risk assessment. Community Dent Oral Epidemiol. 2006;34:381–6.CrossRefPubMed Rindal DB, Rush WA, Perrin NA, Maupomé G, Bader JD. Outcomes associated with dentists’ risk assessment. Community Dent Oral Epidemiol. 2006;34:381–6.CrossRefPubMed
16.
go back to reference Young DA, Featherstone JD, Roth JR. Curing the silent epidemic: caries management in the 21st century and beyond. J Calif Dent Assoc. 2007;35:681–5.PubMed Young DA, Featherstone JD, Roth JR. Curing the silent epidemic: caries management in the 21st century and beyond. J Calif Dent Assoc. 2007;35:681–5.PubMed
17.
go back to reference Doméjean S, White JM, Featherstone JD. Validation of the CDA CAMBRA caries risk assessment--a six-year retrospective study. J Calif Dent Assoc. 2011;39:709–15.PubMed Doméjean S, White JM, Featherstone JD. Validation of the CDA CAMBRA caries risk assessment--a six-year retrospective study. J Calif Dent Assoc. 2011;39:709–15.PubMed
18.
go back to reference Gao X, Di Wu I, Lo EC, Chu CH, Hsu CY, Wong MC. Validity of caries risk assessment programmes in preschool children. J Dent. 2013;41:787–95.CrossRefPubMed Gao X, Di Wu I, Lo EC, Chu CH, Hsu CY, Wong MC. Validity of caries risk assessment programmes in preschool children. J Dent. 2013;41:787–95.CrossRefPubMed
19.
go back to reference Vansteelandt S, Keiding N. Invited Commentary: G-computation – lost in translation? Am J Epidemiol. 2011;173:739–42.CrossRefPubMed Vansteelandt S, Keiding N. Invited Commentary: G-computation – lost in translation? Am J Epidemiol. 2011;173:739–42.CrossRefPubMed
20.
go back to reference Ahern J, Hubbard A, Galea S. Estimating the effects of potential public health interventions on population disease burden: a step-by-step illustration of causal inference methods. Am J Epidemiol. 2009;169:1140–7.CrossRefPubMedPubMedCentral Ahern J, Hubbard A, Galea S. Estimating the effects of potential public health interventions on population disease burden: a step-by-step illustration of causal inference methods. Am J Epidemiol. 2009;169:1140–7.CrossRefPubMedPubMedCentral
21.
go back to reference Snowden JM, Rose S, Mortimer KM. Implementation of G-computation on a simulated data set: demonstration of a causal inference technique. Am J Epidemiol. 2011;173:731–8.CrossRefPubMedPubMedCentral Snowden JM, Rose S, Mortimer KM. Implementation of G-computation on a simulated data set: demonstration of a causal inference technique. Am J Epidemiol. 2011;173:731–8.CrossRefPubMedPubMedCentral
22.
23.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.CrossRef
24.
go back to reference Slade GD, Bailie RS, Roberts-Thomson K, Leach AJ, Raye I, Endean C, et al. Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial. Community Dent Oral Epidemiol. 2011;39:29–43.CrossRefPubMedPubMedCentral Slade GD, Bailie RS, Roberts-Thomson K, Leach AJ, Raye I, Endean C, et al. Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial. Community Dent Oral Epidemiol. 2011;39:29–43.CrossRefPubMedPubMedCentral
25.
go back to reference Cheng J, Chaffee BW, Cheng NF, Gansky SA, Featherstone JD. Understanding treatment effect mechanisms of the CAMBRA randomized trial in reducing caries increment. J Dent Res. 2015;94:44–51.CrossRefPubMedPubMedCentral Cheng J, Chaffee BW, Cheng NF, Gansky SA, Featherstone JD. Understanding treatment effect mechanisms of the CAMBRA randomized trial in reducing caries increment. J Dent Res. 2015;94:44–51.CrossRefPubMedPubMedCentral
26.
go back to reference Kahn MG, Kaplan D, Sokol RJ, DiLaura RP. Configuration challenges: implementing translational research policies in electronic medical records. Acad Med. 2007;82:661–9.CrossRefPubMedPubMedCentral Kahn MG, Kaplan D, Sokol RJ, DiLaura RP. Configuration challenges: implementing translational research policies in electronic medical records. Acad Med. 2007;82:661–9.CrossRefPubMedPubMedCentral
27.
go back to reference Taubman SL, Robins JM, Mittleman MA, Hernan MA. Intervening on risk factors for coronary heart disease: an application of the parametric g-formula. Int J Epidemiol. 2009;38:1599–611.CrossRefPubMedPubMedCentral Taubman SL, Robins JM, Mittleman MA, Hernan MA. Intervening on risk factors for coronary heart disease: an application of the parametric g-formula. Int J Epidemiol. 2009;38:1599–611.CrossRefPubMedPubMedCentral
28.
go back to reference Westreich D, Cole SR, Young JG, Palella F, Tien PC, Kingsley L, et al. The parametric g-formula to estimate the effect of highly active antiretroviral therapy on incident AIDS or death. Stat Med. 2012;31:2000–9.CrossRefPubMedPubMedCentral Westreich D, Cole SR, Young JG, Palella F, Tien PC, Kingsley L, et al. The parametric g-formula to estimate the effect of highly active antiretroviral therapy on incident AIDS or death. Stat Med. 2012;31:2000–9.CrossRefPubMedPubMedCentral
Metadata
Title
Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study
Authors
Benjamin W. Chaffee
Jing Cheng
John DB Featherstone
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2015
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-015-0097-4

Other articles of this Issue 1/2015

BMC Oral Health 1/2015 Go to the issue