Implementing the Caries Management System - Results after 12 months

Objectives: The main objective of this study was to audit the implementation in the student clinic of a new caries management system that aimed to maximise opportunities for arresting and remineralizing lesions and to minimise the need for restorative care. Material and methods: Qualitative methods, including observation (researcher field notes describing students' activity) and interview (semi-structured interviews with BDent3 students) were used as unobtrusive tools to assess the process of implement- ing the program. A quantitative analysis of patient files, as completed by students, in relation to diagnosis and treatment planning was conducted. Results: Less than one quarter of BDent 3 students in 2004 followed the protocols correctly. BDent3 students experienced difficulty in detecting both inner and outer enamel lesions, and in relation to low risk patients, were inclined to restore some of them instead of attempting to arrest them. Student treatment planning decisions were better in relation to the dentinal lesions. For high risk patients, students tended to focus on restorative care and to neglect the arrest and remineralision of most non-cavitated lesions. Problems cited by students were lack of time and too much paper work. Discussion: The implementation of the program was hampered due to the difficulty of ensuring that all clinical supervisors were familiar with the system requirements, and consequent lack of support by them. There was a perception by some students that implementation was voluntary. Conclusion: Success in implementing major changes to the curriculum depends on teamwork and keeping in close contact with clinical supervisors. An ongoing monitoring of the system, especially in relation to high risk patients is seen as a priority to improve the quality of the care provided.