Audit of patient outcomes - Caries Management Clinic, Westmead Hospital, Australia

Background information: An analysis of patient folders at the Westmead Centre for Oral Health revealed that caries management was based on restorative care and not on the control of the disease itself. The Caries Management Clinic was established for patients at high risk of caries aiming to reduce caries incidence to close to zero, that is, to prevent the new lesions on (1) existing sound surfaces, (2) along the susceptible restoration margins, and (3) to remineralize existing cavitated and non-cavitated lesions. Objective: The aim of this investigation was to audit the clinical outcomes of patients attending the Caries Management Clinic. The focus of this presentation is on the outcome of 20 patients who attended the clinic every 2 weeks since April 2005. Methods: The protocols we used are designed to (1) improve oral hygiene, (2) reduce bacterial infection using chlorhexidine, (3) reduce added sugar in the diet, and to (4) remineralize non-cavitated tooth surfaces using frequent applications of fluoride varnish, home use of fluoride rinse, and 5000 ppm toothpaste. Results: After 6 months, (1) 69% of 146 non-cavitated carious surfaces at baseline have remineralized, (2) 99% of sound surfaces remained sound, and (3) 23 new lesions were observed in 6 of the 20 patients (c=292, p= 0.00001).There was a 42% increase in gingival sites having Gingival Index scores of zero, and a 21% decrease in sites having Gingival Index scores of 2 compared to baseline (c=137.67, p= 0.00001). Conclusion: A combination of intensive coaching in oral hygiene maintenance, special home care, intensive monitoring, and frequent professional applications of topical fluoride was able to reduce caries incidence and progression.