Caries-Lesion and Caries-Risk Diagnosis and Management Criteria in Colombian-Clinical Charts

Objectives: Colombia has been working towards the adoption/implementation of the undergraduates' cariology curriculum and its translation into practice and the health system. The aim of this study was to describe the criteria used nationally in the clinical charts for caries-lesion and caries-risk assessment/diagnosis and their clinical management and compare between dental schools (DS) and oral-health care providers (OHCP).
Methods: A 92-item questionnaire –based on ICCMS™– was designed including: 1-Caries risk assessment, 2-Caries staging/activity, 3-Personalised patient/tooth-level care plan (Diagnostic synthesis), and 4-Appropriate tooth-preserving/patient-level caries prevention and control interventions (Management). Forty institutions were invited (DS-28, OHCP-12). Percentage yes/no answer distribution was described and differences between institution types explored (prtest; p<0.05).
Results: Twenty-seven institutions (DS-18; OHCP-9) answered 29 questionnaires (DS-20; OHCP-9). Items where ≥1/3 answered “not registering it” were: 1-Caries risk assessment: -F-toothpaste use: 48.3% (DS: 35%; OHCP: 77.8%; p=0.03); -Radiotherapy/hyposalivation/recreational-drugs use and hyposalivation assessment/saliva tests: 69.5% (DS: 64.2%; OHCP: 81.5%; p>0.05); 2-Caries staging/activity: -Radiographic assessment of initial/moderate coronal and of root caries: 48.3% (DS: 41.7%; OHCP: 63%; p>0.05); -Clinical assessment of root- caries and exposed surfaces: 39.7% (DS: 40%; OHCP: 38.9%; p>0.05); -Plaque-retentive restorations: 34.5% (DS: 25%; OHCP: 55.6%; p=0.03); 3-Diagnostic synthesis: -Caries likelihood: 58.6% (DS: 45%; OHCP: 88.8%; p=0.02); -Caries lesions severity and activity: 41.4% (DS: 20%; OHCP: 88.9%; p=0.01); 4-Management: -F-toothpaste/mouthwash home-use instructions: 43.1% (DS:30%: 72.2%; p=0.03); -Prophylaxis: 34.5% (DS:20%; 66.7%; p=0.02); -Sugar-consumption counseling: 75.9% (DS:75%: 75.8%; p>0.05); -Hyposalivation and Recreational-drug-use management: 79.3% (DS:80%: 77.8%; p>0.05); -Management revision intervals and Risk reassessment plan: 46.6% (DS:37.5%: 55.6%; p>0.05).
Conclusions: There is a high opportunity to improve clinical charting in Colombia of both assessment and management of caries risk and caries lesions for best clinical practice caries management.