Long-Term Improvements in Caries Management by Risk Assessment Among Students

Objectives: The number of dental schools that emphasize risk-based caries management in clinical teaching has expanded greatly. However, student conformity in following guidelines during patient care is rarely reported over the long-term. Our objective was to evaluate the long-term implementation of a risk-based caries management program at a university dental clinic.
Methods: We extracted data from electronic records of adult non-edentulous patients who underwent a comprehensive oral evaluation at the University of California San Francisco 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 by the percentage of patients provided non-operative anti-caries agents within each designated caries-risk category. Additionally, we identified patient and provider characteristics associated with risk assessment completion and with provision/acceptance of anti-caries therapy.
Results: The percentage of patients with documented caries risk grew steadily from 62.3% in 2007-2008 to 92.8% in 2013-2014 (p-for-linear-trend<0.001). 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 doctoral program or in the final year of training (all p<0.001, chi-square test).
Conclusions: Extensive student compliance in documenting caries risk was not achieved immediately but was reached within a decade of implementing risk-based clinical guidelines. Caries risk was the most strongly associated of several factors related to delivery of non-operative therapy. In dental education, transition to a risk-based, prevention-focused curriculum may require a long-term commitment.