A Randomized Clinical Trial of Anticaries Therapies Targeted according to Risk Assessment (Caries Management by Risk Assessment)

被引:66
作者
Featherstone, J. D. B. [1 ]
White, J. M. [1 ]
Hoover, C. I. [1 ]
Rapozo-Hilo, M. [1 ]
Weintraub, J. A. [1 ]
Wilson, R. S. [1 ]
Zhan, L. [1 ]
Gansky, S. A. [1 ]
机构
[1] Univ Calif San Francisco, San Francisco, CA 94143 USA
关键词
Dental caries; Dentistry; Fluoride; Mutans streptococci; Oral health; Randomized clinical trial; UNITED-STATES; DENTAL-CARIES; FLUORIDE; CHILDREN; DENTITION;
D O I
10.1159/000337241
中图分类号
R78 [口腔科学];
学科分类号
1003 ;
摘要
This randomized parallel group clinical trial assessed whether combined antibacterial and fluoride therapy benefits the balance between caries pathological and protective factors. Eligible, enrolled adults (n = 231), with 1-7 baseline cavitated teeth, attending a dental school clinic were randomly assigned to a control or intervention group. Salivary mutans streptococci (MS), lactobacilli (LB), fluoride (F) level, and resulting caries risk status (low or high) assays were determined at baseline and every 6 months. After baseline, all cavitated teeth were restored. An examiner masked to group conducted caries exams at baseline and 2 years after completing restorations. The intervention group used fluoride dentifrice (1,100 ppm F as NaF), 0.12% chlorhexidine gluconate rinse based upon bacterial challenge (MS and LB), and 0.05% NaF rinse based upon salivary F. For the primary outcome, mean caries increment, no statistically significant difference was observed (24% difference between control and intervention groups, p = 0.101). However, the supplemental adjusted zero-inflated Poisson caries increment (change in DMFS) model showed the intervention group had a statistically significantly 24% lower mean than the control group (p = 0.020). Overall, caries risk reduced significantly in intervention versus control over 2 years (baseline adjusted generalized linear mixed models odds ratio, aOR = 3.45; 95% CI: 1.67, 7.13). Change in MS bacterial challenge differed significantly between groups (aOR = 6.70; 95% CI: 2.96, 15.13) but not for LB or F. Targeted antibacterial and fluoride therapy based on salivary microbial and fluoride levels favorably altered the balance between pathological and protective caries risk factors. Copyright (c) 2012 S. Karger AG, Basel
引用
收藏
页码:118 / 129
页数:12
相关论文
共 30 条
[1]  
[Anonymous], 1999, DESIGN ANAL CLIN EXP, DOI DOI 10.1002/9781118032923
[2]  
[Anonymous], 1998, Fundamentals of clinical trials
[3]   Validation of a simple approach to caries risk assessment [J].
Bader, JD ;
Perrin, NA ;
Maupomé, G ;
Rindal, B ;
Rush, WA .
JOURNAL OF PUBLIC HEALTH DENTISTRY, 2005, 65 (02) :76-81
[4]   A systematic review of selected caries prevention and management methods [J].
Bader, JD ;
Shugars, DA ;
Bonito, AJ .
COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, 2001, 29 (06) :399-411
[5]   RETENTION OF TOPICAL FLUORIDE IN THE MOUTHS OF XEROSTOMIC SUBJECTS [J].
BILLINGS, RJ ;
MEYEROWITZ, C ;
FEATHERSTONE, JDB ;
ESPELAND, MA ;
FU, J ;
COOPER, LF ;
PROSKIN, HM .
CARIES RESEARCH, 1988, 22 (05) :306-310
[6]   The zero-inflated Poisson model and the decayed, missing and filled teeth index in dental epidemiology [J].
Böhning, D ;
Dietz, E ;
Schlattmann, P ;
Mendonça, L ;
Kirchner, U .
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES A-STATISTICS IN SOCIETY, 1999, 162 :195-209
[7]   DENTAL-CARIES - PRINCIPAL CAUSE OF TOOTH EXTRACTION IN A SAMPLE OF UNITED-STATES MALE-ADULTS [J].
CHAUNCEY, HH ;
GLASS, RL ;
ALMAN, JE .
CARIES RESEARCH, 1989, 23 (03) :200-205
[8]  
Domejean-Orliaguet Sophie, 2006, J Dent Educ, V70, P1346
[9]  
Dye BA, 2004, VITAL HLTH STAT, V11, P1
[10]  
Featherstone J.D., 2007, J Calif Dent Assoc, V35, P703