title: Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study.
abstract: BACKGROUND
  Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized.
  
  
  METHODS
  This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time.
  
  
  RESULTS
  Approximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95% CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95% CI: -0.65, -0.08).
  
  
  CONCLUSIONS
  These results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.
authors.affiliation: Center to Address Disparities in Children's Oral Health, UCSF School of Dentistry, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA. benjamin.chaffee@ucsf.edu.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Chaffee
authors.affiliation: Center to Address Disparities in Children's Oral Health, UCSF School of Dentistry, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA. jing.cheng@ucsf.edu.
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.affiliation: UCSF School of Dentistry, 513 Parnassus Ave, Room S630, San Francisco, CA, 94143-0430, USA. john.featherstone@ucsf.edu.
authors.forename: John D B
authors.initials: JD
authors.lastname: Featherstone
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 / Q000627:therapeutic use; D015331:Cohort Studies; D004245:DMF Index; D003731:Dental Caries / Q000517:prevention & control / Q000628:therapy*; D003733:Dental Caries Susceptibility; D057286:Electronic Health Records; D005260:Female; D005459:Fluorides / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D014100:Toothpastes / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States; D014993:Xylitol / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D002327:Cariostatic Agents; D009067:Mouthwashes; D014100:Toothpastes; D005459:Fluorides; D002710:Chlorhexidine; D014993:Xylitol