Disconnect between Science and Practice: Management of High Caries Risk

Objectives: Based on scientific evidence, professional dental organizations have developed guidelines for dental caries prevention and treatment. These guidelines recommend viewing dental caries as a disease managed by risk assessment. We surveyed general dentists' knowledge, attitudes, and behaviors related to management of adults at high risk for dental caries.

Methods: From 2005-2006, a 60-item caries management survey, embedded in a larger survey of preventive practices, was mailed to a random sample of 410 general dentists who were Delta Dental Providers in CA, PA, or WV. Frequency tables with odds ratios (ORs) and 95% confidence intervals (CIs) assessed factors related to management of caries by risk assessment.

Results: Of 410 surveys mailed, 265 (65%) were returned. Most respondents were White (79%), male (86%) and had practiced at least 15 years (74%); 94% agreed intervening when high caries risk is identified as important. Among the respondents who reported doing the following often/always, 98% recommend fluoride dentifrices; 96% advise patients about caries risk; 86% provide information about the caries process; 82% recommend home fluoride rinse; 58% provide dietary counseling; 50% recommend antimicrobials; less than 1% measure salivary bacteria levels; and 34% apply in-office fluoride varnish. Among those who reported knowing how to assess high caries activity, 81% routinely documented caries risk vs. 38% for those not knowing (OR=7.2; 95% CI: 2.5-20.7; p<0.001). Of those who felt quite effective in addressing high caries activity, 70% routinely applied professional topical fluorides vs. 47% (OR=2.6; 95% CI: 1.3-5.5; p=0.011)for those who reported feeling ineffective; and among those who felt effective, 40% applied sealants vs. 21% (OR=2.6; 95% CI: 1.1-6.1;p=0.036) for those who felt ineffective.

Conclusion: Dentists are willing and interested in managing patients at high-risk for caries. They also feel knowledgeable and effective to address the treatment of high caries risk patients. However, problems with information transfer may exist, as some services provided are not consistent with professional recommendations.

Research supported by USDHHS/NIDA&NIDCR R01DEO1569-04 and by Delta Dental of California