The Caries Management System: are preventive effects sustained postclinical trial?
Version of Record online: 7 DEC 2015
© 2015 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Community Dentistry and Oral Epidemiology
Volume 44, Issue 2, pages 188–197, April 2016
How to Cite
The Caries Management System: are preventive effects sustained postclinical trial?. Community Dent Oral Epidemiol 2016; 44: 188–197. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., , .
- Issue online: 3 MAR 2016
- Version of Record online: 7 DEC 2015
- Manuscript Accepted: 26 OCT 2015
- Manuscript Received: 7 JUL 2015
- Oral Health Foundation
- University of Sydney
- National Health and Medical Research Council. Grant Numbers: 402466, 632715
- Dental Board of New South Wales
- Australian Dental Research Foundation
- Australian Dental Association (NSW) and Colgate Oral Care
- dental services research;
- non-surgical treatment;
- preventive dentistry;
- risk assessment
To report, at two and 4 years post-trial, on the potential legacy of a 3-year randomized controlled clinical trial (RCT) of the Caries Management System (CMS) at private general dental practices. The CMS was designed to reduce caries risk and need for restorative care.
Nineteen dental practices located in city, urban, and rural locations in both fluoridated and nonfluoridated communities participated in the RCT. Eight practices were lost to follow-up post-trial; however, baseline mean DMFT balance between CMS and control practices was maintained. At the control practices, caries management following usual practice continued to be delivered. The patient outcome measure was the cumulative increment in the DMFT index score, and the practice outcome measures included the practice-mean and practice-median increments of patient DMFT index scores. In covariable analysis (patient-level unit of analysis), as the patients were clustered by practices, mean DMFT increments were determined through multilevel modeling analysis. Practice-mean DMFT increments (practice-level unit of analysis) and practice-median DMFT increments (also practice level) were determined through general linear modeling analysis of covariance. In addition, a multiple variable logistic regression analysis of caries risk status was conducted.
The overall 4-year post-trial result (years 4–7) for CMS patients was a DMFT increment of 2.44 compared with 3.39 for control patients (P < 0.01), a difference equivalent to 28%. From the clinical trial baseline to the end of the post-trial follow-up period, the CMS and control increments were 6.13 and 8.66, respectively, a difference of 29% (P < 0.0001). Over the post-trial period, the CMS and control practice-mean DMFT increments were 2.16 and 3.10 (P = 0.055) and the respective increments from baseline to year 7 were 4.38 and 6.55 (P = 0.029), difference of 33%. The practice-median DMFT increments during the 4-year post-trial period for CMS and control practices were 1.25 and 2.36 (P = 0.039), and the respective increments during the period from baseline to year 7 were 2.87 and 5.36 (P < 0.01), difference of 47%. Minimally elevated odds of being high risk were associated with baseline DMFT (OR = 1.17). Patients attending the CMS practices had lower odds of being high risk than those attending control practices (OR = 0.23, 95% CI = 0.06, 0.88).
In practices where adherence to the CMS protocols was maintained during the 4-year post-trial follow-up period, patients continued to benefit from a reduced risk of caries and, therefore, experienced lower needs for restorative treatment.