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Caries development is determined by a balance of protective and pathological factors, so the clinician should be able to identify and document those factors, understand their relative weight in disease development or reversal, and make recommendations to patients that will lead to risk reduction. The caries management by risk assessment (CAMBRA) protocol frames these factors into an easy-to-follow template that also guides the clinician in making recommendations. The purposes of this study were to examine implementation of the CAMBRA-based risk assessment program in a predoctoral clinic at one dental school, assess the accuracy of caries risk evaluation by the students, and evaluate the utilization of professionally applied luoride varnish in a moderate-and high-risk patient cohort. After dental clinic patients were screened for previous caries risk status, sixty-eight moderate-or high-risk patients were invited to participate in the study. At the study visit that included four bite-wing radiographs, a new caries risk assessment (CRA) form was completed. Our results showed that students underestimated the risk in 25 percent of the cases; the underestimation occurred especially when visible cavitation or caries into dentin by radiograph was the only risk factor or when caries were not identiied at the initial visit when the CRA form was completed for the irst time despite the presence of other high-risk factors. Students also underestimated both risk and protective factors at the initial evaluation visit compared with the study visit. The results show that students were not rigorous enough in documenting these factors and determining the patient's risk. In order to increase the sensitivity of risk assessment, training and recalibration for students and faculty members should be an ongoing process.
Caries development is determined by a balance of protective and pathological factors, so the clinician should be able to identify and document those factors, understand their relative weight in disease development or reversal, and make recommendations to patients that will lead to risk reduction. The caries management by risk assessment (CAMBRA) protocol frames these factors into an easy-to-follow template that also guides the clinician in making recommendations. The purposes of this study were to examine implementation of the CAMBRA-based risk assessment program in a predoctoral clinic at one dental school, assess the accuracy of caries risk evaluation by the students, and evaluate the utilization of professionally applied luoride varnish in a moderate-and high-risk patient cohort. After dental clinic patients were screened for previous caries risk status, sixty-eight moderate-or high-risk patients were invited to participate in the study. At the study visit that included four bite-wing radiographs, a new caries risk assessment (CRA) form was completed. Our results showed that students underestimated the risk in 25 percent of the cases; the underestimation occurred especially when visible cavitation or caries into dentin by radiograph was the only risk factor or when caries were not identiied at the initial visit when the CRA form was completed for the irst time despite the presence of other high-risk factors. Students also underestimated both risk and protective factors at the initial evaluation visit compared with the study visit. The results show that students were not rigorous enough in documenting these factors and determining the patient's risk. In order to increase the sensitivity of risk assessment, training and recalibration for students and faculty members should be an ongoing process.
Patient recall should be a tool to support prevention, allow early intervention, and ensure long-term dental health. Although the concept of patient-customized recall intervals has increased in popularity, recommendations vary signiicantly. Concepts of risk assessment-derived recalls are described in the literature separately for caries, periodontal disease, and edentulism, but no published guidelines exist for creating patient-centered recall systems that integrate all risks. Further, no recommendations exist regarding oral cancer risk assessment and recall intervals. The evidence shows that recall intervals of less than twelve months do not impact stage and tumor size at diagnosis although increasing this interval may signiicantly affect the outcome. The typical approach to recall scheduling is that the interval before the next oral health review should be chosen when no further treatment is indicated or on completion of a speciic treatment journey. This article advocates a modiied approach that supports individualized risk-based recall schedules not only after active therapy is completed but also during the course of treatment. The design of individualized recall schedules would address a patient's risk for caries and periodontal disease and the need to perform periodic oral cancer screenings. Evidence is also presented regarding the timing of recalls for edentulous patients. This article describes design principles for a Risk Assessment-Based Individualized Treatment (RABIT) system, presents an example of an electronic health record (EHR) recall module implemented at one dental school, and identiies barriers to implementation. As EHRs become more prevalent in dental practice, it is expected that the software industry and the profession will collaborate to include RABIT-like concepts in software management packages.
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