An Audit of the Caries Management Clinic at the WCOH

Objectives: The aim of this investigation is to audit the clinical outcomes, that is, the expected reductions in tooth decay incidence, in patients attending the Caries Management Clinic, Westmead Centre for Oral Health (WCOH), and to make a formal review of all events at the clinic. An analysis of patient folders at WCOH revealed that the oral health status of many patients under long term care had deteriorated. It was apparent that caries management was based on restorative care and not on the control of the disease itself. Methods: A caries management clinic has been established at the Westmead Centre for Oral Health 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 non-cavitated lesions. 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 5000ppm toothpaste. The focus of this presentation is on the oral hygiene improvement of 20 patients who attended the clinic every 2 weeks since April 2005. Results: Index (GI) scores were taken as the outcome measure of improved oral hygiene. After 3 visits (over 6 weeks) GI scores of 3 had reduced from 90 to 10% and GI scores of 0 had increased from 39 to 61% ( Chi-squared = 24.5, p= 0.00001, df =3).Conclusions: The results indicated that overall oral hygiene improved. It is noted that oral hygiene improvement depends mostly upon each patient life condition. Supported by GC.