Improving predoctoral education related to caries risk assessment in adults

Objectives: This project examined patterns of adult patient management using a caries risk assessment (CRA) protocol at East Carolina University, School of Dental Medicine. Usage of the CRA protocol from 2014 to 2019 was assessed. Non-operative anti-caries treatments were measured against caries risk status (high, moderate, low, or none). Steps to improve the appropriate management of patients based on caries risk are presented to align with accreditation standards for predoctoral education programs.

Methods: The CRA protocol is based on the Caries Management by Risk Assessment approach. Risk-based patterns for two non-operative interventions were examined: (1) prescriptions for 0.12% chlorhexidine gluconate (CHX) mouth rinse and (2) prescriptions for 5000 ppm fluoride toothpaste (PreviDent 5000 [PreviDent]). Statistical analyses included chi-square tests and logistic regression.

Results: Over the study period only 16.4% of adult patients had completed the CRA form. Among 29,411 patients from nine community sites, treatment rates for PreviDent were 18.7% among high-risk patients, 11.6% for moderate-risk adults, and 6.4% for low-risk adults (p < 0.01). Treatment rates for CHX were 23.0%, 22.6%, and 17.1%, respectively (p < 0.05). Patients without a CRA status were least likely to receive any anti-caries treatments, indicating that CRA status affects clinical, non-operative care.

Conclusions: Patterns for prescription of PreviDent and CHX are consistent with CRA status. Future efforts to improve usage of the CRA protocol using faculty calibration, tracking with quality improvement tools, and reassessment. Training in the community-based educational setting is enhanced through data-based tracking to assure evidence-based decision making.