Practical approach to evidence-based management of caries.
This paper discusses evidence-based management of dental caries with regard to: (1) need to adopt new office methods, (2) potential barriers to change, and (3) possible practical solutions to aid change. The need for classifying individual patients into low-, medium-, and high-risk caries groups is justified from a review of the epidemiological characteristics of caries. In addition, a deficiency is identified in traditional caries recording methods since they are unable to grade the severity and activity of individual lesions. The traditional basis of six-monthly recall examinations for all patients is shown from the literature to have no scientific support. It is suggested a three-twelve month recall interval be used, depending on a patient's risk group classification. Some barriers to change are identified as: (1) the collection of more comprehensive history and clinical caries data, (2) the complexity of evidence-based decision-making, and (3) dentists' difficulty in standardizing decision-making. A new pictorial classification for caries severity and activity is described. A demonstration decision-support system is presented in terms of assisting collection of data, automatic identification of risk factors, patient risk classification, and generation of a suggested treatment plan. Evidence-based management may result in change of professional manpower levels.
Benn
D K
DK
Department of Operative Dentistry, University of Florida College of Dentistry, Gainesville 32610-0414, USA.
Clark
T D
TD
Dankel
D D
DD
Kostewicz
S H
SH
D003731:Dental Caries / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D003936:Diagnosis, Computer-Assisted; D019317:Evidence-Based Medicine / Q000379:methods* / Q000639:trends; D006801:Humans; D019239:Practice Patterns, Dentists' / Q000639:trends; D011861:Radiography, Dental; D012985:Software Design