ICCMS™ vs. Colombian-Adjusted Health-System Caries-Management Schemes: Schoolchildren-Multicenter RCT One-Year Effectiveness

Objectives: The ICDAS derived International-Caries-Classification-and-Management-System (ICCMS™) (2012) focuses in maintaining health/preserving tooth structure.
Aim: To compare in a Colombian schoolchildren’s multicentre RCT the 1-year effectiveness of the ICCMS™ (A) with the Colombian-adjusted NHS (B) caries-management schemes in terms of mean number of initial caries lesions, caries-risk likelihood and parents/clinicians caries-management satisfaction.
Methods: With parents’ informed consents 240 7-yr. olds from 6 Colombian-dental schools’ clinics participated (IRB-008-201_2014). They were assessed by 6 trained blinded examiners for: ICCMS™ caries experience (dmf/DMF) including Initial (I: ICDAS 1-2), besides Moderate/Extensive (M/E: ICDAS 3-6) caries lesions (d_IMEmfs/D_IMEMFS); ICCMS™ caries-risk likelihood (low/moderate/high). Children were randomly allocated to scheme A/B. Scheme-A managed prevention according to caries-risk likelihood differentiating home/clinical approaches and recalls, and all caries active lesions received non-operative/tooth-preserving-operative treatment. In scheme-B all children received standardised prevention and 6-month recalls, and only cavitated/dentine caries lesions received treatment (operative). After 1 year clinical exams were repeated. Clinicians and parents answered validated caries-management questionnaires.
Results: Baseline prevalence of d_MEmf/D_MEMF was 78.85% (A) and 77.23% (B), increasing to 93.27% and 95.05%, respectively, with d_IMEmf/D_IMEMF. Mean surfaces of d_MEmfs/D_MEMFS were almost 4 (A: 3.98±3.89; B: 3.95±3.57) and of d_Is/D_IS of almost 10 (A: 9.42±8.72; B: 9.90±7.93). Most children were categorized as high caries-risk likelihood (A: 62.05%; B: 57.43%). No significant baseline/1-year differences were found between schemes (p>0.05). At 1-year follow-up (n=205) mean d_Is/D_IS decreased significantly (A: 6.79±4.85; B: 7.33±5.25) (Mann Whitney; p<0.05), and most children were now in moderate caries-risk likelihood (A: 53.85%; B: 52.48%) (χ²; p<0.05). Parents and clinicians reported a higher caries-management satisfaction for scheme A (χ²; p<0.05).
Conclusions: Implementing caries management schemes A/B significantly reduced caries initial lesions and caries-risk likelihood after one year with higher parents’ and clinicians’ caries-management satisfaction for the ICCMS™ scheme.