One-Year Analysis of High Caries Risk Patient Management

Objectives: The American Dental Association (ADA) recommends 1.1% fluoride prescription toothpaste and professionally applied fluoride varnish (FV) for caries management and prevention in high caries risk adult patients. Schools of dentistry tend to attract high caries risk patients. In 2013, we determined the University of Michigan School of Dentistry Vertical Integrated Clinics (UMSOD -VICS) restored 8269 new carious surfaces and extracted 7880 teeth. We hypothesize that some high caries risk patients at the UMSOD-VICS may not have received the benefits of additional fluoride therapies. To improve caries management and prevention in high caries risk patients, and to promote evidence-based dentistry in practice, we investigated the use of fluoride prescription toothpastes and FV in the UMSOD-VICS.
Methods: For 20% of the high caries risk adult patients in 2013 (277 patients), we obtained the number of 1.1% fluoride toothpaste prescriptions and FV applications from the patient electronic record system (Axium). This project has been reviewed by the University of Michigan IRB and has been exempted from IRB regulation (HUM00096048).
Results: The chi-squared test showed that only 18% of the high caries risk adult patients received 1.1% NaF prescription toothpastes (p<0.05). Furthermore, only 7% of the high caries risk patients received FV (p<0.05).
Conclusions: We concluded that in 2013 a significant number of the high caries risk adult patients at the UMSOD-VICS did not receive one or two of the ADA-recommended fluoride therapies. We did not find any records of patients declining the fluoride products. Therefore, we propose to create an alert system on Axium to remind practitioners to provide additional fluoride strategies for risk patients. After the implementation of the alert system, we will conduct five-year follow-up studies to assess our ultimate goal of having more than 95% of high caries risk adult patients, managed by ADA evidence-based fluoride guidelines.