The Monitor Practice Program: Two Year Efficacy Results

Objective: To assess the efficacy of an intensive, preventive-based, non-invasive approach to the management of dental caries within a randomised controlled trial, as a prelude to a formal cost-effectiveness analysis. Methods: The primary efficacy measure was the two-year DMFS increment. Changes in risk status, fluoride history, number of emergency visits and toothaches, along with demographic variables such as age, gender, health problems, and the location of the dental practice attended were measured. Regression analysis was undertaken to adjust for potential confounding variables. Results: Nine-hundred and two patients were recruited within 22 dental practices between May 2005 and March 2006. Baseline DMFS did not differ significantly between the control and study groups (p=0.83). Age (p<0.001), health status (p=0.005), baseline risk (p<0.001), and fluoride history (p<0.001) were all independent significant predictors of two-year DMFS increment. Gender approached significance (p=0.08). There was no statistically significant differences between the groups in the incidence of toothaches (p=0.1) or number of treatment visits required (p=0.35). There was a highly significant difference in the two-year incremental DMFS score in favour of the study group (mean difference 2.2; p<0.001). After adjusting for confounding variables the difference in the DMFS increment between the control and study groups remained significant (mean difference 1.7; p<0.001). Conclusion: The results indicate efficacy of the preventive program under review. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations, on a relatively short-term basis (2yrs). While encouraging, it will be essential that these results are followed over a longer period of time in order to determine whether the benefits are maintained.

Support Acknowledged: NH&MRC (402466), Australian Dental Research Fund, Oral Health Foundation