Caries Experience of High Risk Individuals

Objective: Caries risk assessment is being implemented in many dental settings to target preventive and therapeutic interventions to those at greatest risk. Little is known about the utilization and caries experience of those classified as high-risk. The purpose of this paper is to describe the subsequent caries and dental utilization of a population assessed at high caries risk. The caries risk assessment instrument described in this paper has been implemented in a large prepaid dental program. Methods: The study includes three-years of post-risk assessment caries activity and preventive treatment for a population of 3,918 individuals who received a high-risk classification during 1997. For some comparisons this group was compared to the individuals classified at moderate risk. Individuals were tracked for either three years or until termination of dental eligibility. Measures were adjusted for censoring. Results: Individuals at high risk have a consistent semi-annual caries rate of 334 per 1000 enrolled after the first year post-classification. Caries-active high-risk individuals have a 671 filled teeth per 1000 enrollees during subsequent six month time periods. Only 35% of those classified as high risk received at least one fluoride treatment. Compared to individuals assessed at moderate risk, high-risk individuals are both more likely to experience caries (O.R.=1.35) and to have more teeth receiving restorations. Conclusions: This study confirms that risk assessment is effective at identifying high risk individuals. The consistent subsequent caries rate raises the important question of which specific interventions can reduce caries risk in high-risk populations.