title: A randomized clinical trial of anticaries therapies targeted according to risk assessment (caries management by risk assessment).
abstract: This randomized parallel group clinical trial assessed whether combined antibacterial and fluoride therapy benefits the balance between caries pathological and protective factors. Eligible, enrolled adults (n = 231), with 1-7 baseline cavitated teeth, attending a dental school clinic were randomly assigned to a control or intervention group. Salivary mutans streptococci (MS), lactobacilli (LB), fluoride (F) level, and resulting caries risk status (low or high) assays were determined at baseline and every 6 months. After baseline, all cavitated teeth were restored. An examiner masked to group conducted caries exams at baseline and 2 years after completing restorations. The intervention group used fluoride dentifrice (1,100 ppm F as NaF), 0.12% chlorhexidine gluconate rinse based upon bacterial challenge (MS and LB), and 0.05% NaF rinse based upon salivary F. For the primary outcome, mean caries increment, no statistically significant difference was observed (24% difference between control and intervention groups, p = 0.101). However, the supplemental adjusted zero-inflated Poisson caries increment (change in DMFS) model showed the intervention group had a statistically significantly 24% lower mean than the control group (p = 0.020). Overall, caries risk reduced significantly in intervention versus control over 2 years (baseline adjusted generalized linear mixed models odds ratio, aOR = 3.45; 95% CI: 1.67, 7.13). Change in MS bacterial challenge differed significantly between groups (aOR = 6.70; 95% CI: 2.96, 15.13) but not for LB or F. Targeted antibacterial and fluoride therapy based on salivary microbial and fluoride levels favorably altered the balance between pathological and protective caries risk factors.
authors.affiliation: University of California, San Francisco, CA 94143, USA. jdbf@ucsf.edu
authors.forename: J D B
authors.initials: JD
authors.lastname: Featherstone
authors.forename: J M
authors.initials: JM
authors.lastname: White
authors.forename: C I
authors.initials: CI
authors.lastname: Hoover
authors.forename: M
authors.initials: M
authors.lastname: Rapozo-Hilo
authors.forename: J A
authors.initials: JA
authors.lastname: Weintraub
authors.forename: R S
authors.initials: RS
authors.lastname: Wilson
authors.forename: L
authors.initials: L
authors.lastname: Zhan
authors.forename: S A
authors.initials: SA
authors.lastname: Gansky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002327:Cariostatic Agents / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004245:DMF Index; D003731:Dental Caries / Q000517:prevention & control*; D005260:Female; D005459:Fluorides / Q000032:analysis; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000737:chemistry / Q000627:therapeutic use; D018570:Risk Assessment; D012463:Saliva / Q000737:chemistry / Q000382:microbiology; D012969:Sodium Fluoride / Q000627:therapeutic use*; D013295:Streptococcus mutans / Q000302:isolation & purification; D014100:Toothpastes / Q000737:chemistry / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D002327:Cariostatic Agents; D009067:Mouthwashes; D014100:Toothpastes; D012969:Sodium Fluoride; C010882:chlorhexidine gluconate; D005459:Fluorides; D002710:Chlorhexidine