Long-term adoption of caries management by risk assessment among dental students in a university clinic.
The aim of this study was to evaluate the long-term adoption of a risk-based caries management program at a university dental clinic. The authors extracted data from electronic records of adult non-edentulous patients who underwent a comprehensive oral evaluation in the university predoctoral clinic from July 2007 through June 2014 (N=21,984). Consistency with caries management guidelines was measured as the percentage of patients with caries risk designation (low, moderate, high, or extreme) and the percentage of patients provided non-operative anti-caries agents within each designated caries risk category. Additionally, patient and provider characteristics associated with risk assessment completion and with provision of anti-caries therapy were identified. Results showed that the percentage of patients with documented caries risk grew steadily from 62.3% in 2007-08 to 92.8% in 2013-14. Overall, receipt of non-operative anti-caries agents increased with rising caries risk, from low (6.9%), moderate (14.1%), high (36.4%), to extreme (51.4%), but percentages were stable over the study period. Younger patients were more likely to have a completed risk assessment, and among high- and extreme-risk patients, delivery of anti-caries therapy was more common among patients who were younger, identified as Asian or Caucasian, received public dental benefits, or were seen by a student in the four-year DDS program or in the final year of training. These results demonstrate that extensive compliance in documenting caries risk was achieved within a decade of implementing risk-based clinical guidelines at this dental school clinic. Caries risk was the most strongly associated of several factors related to delivery of non-operative therapy. The eventual success of this program suggests that, in dental education, transition to a risk-based, prevention-focused curriculum may require a long-term commitment.
Dr. Chaffee is Assistant Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; Dr. Featherstone is Professor and Dean, School of Dentistry, University of California, San Francisco. benjamin.chaffee@ucsf.edu.
Benjamin W
BW
Chaffee
Dr. Chaffee is Assistant Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; Dr. Featherstone is Professor and Dean, School of Dentistry, University of California, San Francisco.
John D B
JD
Featherstone
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002327:Cariostatic Agents / Q000627:therapeutic use; D003731:Dental Caries / Q000517:prevention & control / Q000628:therapy*; D003733:Dental Caries Susceptibility; D003740:Dental Clinics; D004497:Education, Dental; D057286:Electronic Health Records; D019983:Guideline Adherence; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D044469:Racial Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D012575:Schools, Dental; D013335:Students, Dental; D016896:Treatment Outcome; D055815:Young Adult
D002327:Cariostatic Agents
CAMBRA; caries management; caries risk assessment; clinic management; clinical education; dental education; dental school clinic; preventive care