Preferences for caries prevention agents in adult patients: findings from the dental practice-based research network

Evaluation of caries risk assessment practices among dental practitioners in Guangzhou, China: a cross-sectional study

Introduction

This cross-sectional study aimed to investigate dental practitioners' knowledge and practices regarding Caries risk assessment (CRA) in routine clinical practice in Guangzhou, China.

Methods

An online questionnaire was disseminated to dental practitioners to gather socio-demographic information, factors associated with CRA, the implementation of preventive treatment, and the level of awareness regarding personalized preventive treatment in relation to CRA. Statistical analyses included descriptive statistics, Chi-square tests, ANOVA, MANCOVA, linear regression, and scatter plots.

Results and discussion

Out of the 695 dental practitioners who were contacted, 206 dentists participated in the online survey. However, out of the total number of dentists, 198 were successfully recruited, while the remaining 8 dentists had incomplete data in their questionnaires. 92.4% of dentists provided in-office fluoride treatments, and 73.2% held a strong belief in the correlation between current oral hygiene and tooth cavities. 23.7% of dentists evaluated caries risk on an individual basis, and a significant 41.9% never utilized a particular type of CRA. 53.5% of dentists recommended non-prescription fluoride rinses, whereas 51% advocated prescription fluoride treatments. Significant statistical relationships were found between the use of in-office fluoride and the effectiveness of restorative treatment (P < 0.05). Additionally, a significant association was discovered between the use of a specific form for CRA and the kind of dental school (P < 0.05). The study suggests that a significant number of dental practitioners in Guangzhou, China, do not utilize dedicated assessment forms for CRA in their routine professional activities. These findings highlight the im-portance of encouraging dentists to utilize CRA systems to effectively identify patients who are at risk of acquiring dental caries.

What preventive strategies do dentists prescribe for dental caries prevention? - A KAP survey

Background

Dentists play an important role in caries prevention by delivering preventive care, educating patients, and buying related products; it is critical to recognize what they know and believe about caries prevention, as well as how they use caries prevention interventions.

Materials and Methods

A descriptive cross-sectional study was conducted in South India between January 2021 and February 2021 to determine the dentists' knowledge, attitude, and practice of prescribing preventive strategies and remineralizing agents for caries prevention. A questionnaire including 11 self-administered, prestructured questions was made and distributed through electronic media. Chi-square test was done. The test significance value was taken as 0.05.

Results

A total of 252 dental practitioners participated in the study. The majority of general dentists and specialists followed all the measures such as pit and fissure sealants, fluoride application, counseling patients about oral hygiene maintenance, and regular recall after 6 months to 1 year (P > 0.05). Fluoridated remineralization strategy was found to be the most prescribed (69%) strategy for caries prevention. A significant number of dentists think fluoridated mineralization strategies will remain prevalent (P < 0.05). Younger dentists find practicing preventive dentistry more feasible compared to dentists with greater years of experience (P < 0.05).

Conclusion

Dentists across the country are well aware, have sufficient knowledge, and prescribe preventive strategies such as fluoride application, pit and fissure sealants, regular oral health checkups, and counsel the patients about the importance of oral health but there is a lack of implementation of these preventive strategies in everyday practice.

Clinical success of fluoride-releasing fissure sealant in permanent first molars: 5-year retrospective atudy

Background/Aim: It is important to prevent caries on permanent first molars. Fissure sealants are very effective in protecting fissures from caries. The study aimed to determine the clinical success of fluoride-releasing fissure sealants in permanent first molars in the long term. Material and Methods: 64 children with 256 healthy erupted first permanent molars and followed for 5 years, comprised the study. Children who received a fluoride-releasing fissure sealant and came regularly to controls throughout 5 years were evaluated by retention rate and development of new caries and compared with a control group. Results: The complete retention rate of fluoride-releasing fissure sealants was 48.5% and 10.7 % of the sealed teeth had caries after 5 years. 25% of the teeth without fissure sealant were decayed after five years. There was no significant difference between the rate of retention of fissure sealants and the frequency of tooth brushing after 1 year. There was no significant difference between the rate of retention of fissure sealants and oral hygiene status of children after 1 year. Conclusions: The fluoride-releasing fissure sealants were effective for the prevention of caries on pit and fissures of permanent molars and long-term clinical success was satisfying.

Clinical success of fluoride-releasing fissure sealant in permanent first molars: 5-year retrospective study

Background/Aim: It is important to prevent caries on permanent first molars. Fissure sealants are very effective in protecting fissures from caries. The study aimed to determine the clinical success of fluoride-releasing fissure sealants in permanent first molars in the long term. Material and Methods: 64 children with 256 healthy erupted first permanent molars and followed for 5 years, comprised the study. Children who received a fluoride-releasing fissure sealant and came regularly to controls throughout 5 years were evaluated by retention rate and development of new caries and compared with a control group. Results: The complete retention rate of fluoride-releasing fissure sealants was 48.5% and 10.7 % of the sealed teeth had caries after 5 years. 25% of the teeth without fissure sealant were decayed after five years. There was no significant difference between the rate of retention of fissure sealants and the frequency of tooth brushing after 1 year. There was no significant difference between the rate of retention of fissure sealants and oral hygiene status of children after 1 year. Conclusions: The fluoride-releasing fissure sealants were effective for the prevention of caries on pit and fissures of permanent molars and long-term clinical success was satisfying.

Influences on dentists' adoption of nonsurgical caries management techniques: A qualitative study

BACKGROUND

Nonsurgical caries management techniques (NSCMT) offer a simple, conservative approach to treating caries. Despite evidence supporting and potential advantages of NSCMT, dentists can be reluctant to adopt these techniques. To better understand this phenomenon, the authors interviewed dentists who primarily treat children regarding their thoughts, attitudes, and adoption of 3 NSCMT.

METHODS

The 3 NSCMT were fluoride varnish, silver diamine fluoride, and Hall stainless steel crowns. The authors interviewed dentists in North Carolina whose practices were restricted mostly to children. A nonprobabilistic maximum-variation design was used in the sampling. Using a semistructured interview guide, the authors recorded the interviews digitally and analyzed them thematically. The authors stratified the analysis according to years of practice, geographic location, and type of practice. Reporting was based on emerging and recurring themes and insightful quotes.

RESULTS

Factors most likely to promote the adoption of NSCMT were related to clinical practice, family preference, patient safety, and provider philosophy. Barriers to adoption included previous practitioner negative experiences using the techniques, high-risk caries population, and perceived likelihood of negative outcomes. Characteristics of the practice environment, patient population, communication with families, and financial considerations were influential in the clinician's determination as to whether to use these techniques.

CONCLUSIONS

These findings provide valuable insight into practitioners' influences, motivations, and clinical decision making in the adoption and use of management and treatment approaches for carious lesions in the pediatric population.

PRACTICE IMPLICATIONS

The primary factors and barriers identified in this study are possible targets for education and quality improvement programs aimed at increasing NSCMT use.

[Categorizing methods used in participatory research]

Hintergrund

In der Forschung gewinnen partizipative Ansätze an Bedeutung. Der Einsatz partizipativer Methoden erfolgt meist ohne eine methodologische Auseinandersetzung oder den Bezug auf eine gemeinsame Systematik.

Ziel der Arbeit

Auf der Grundlage eines Scoping-Reviews wird eine Systematisierung partizipativer Methoden vorgeschlagen. Damit wird ein Beitrag zum Diskurs über partizipative Methoden geleistet, die gesundheitliche Chancengleichheit fördern.

Material und Methoden

Nach einer Literaturrecherche wurden 44 Treffer eingeschlossen. Die Suche sowohl nach deutsch- als auch englischsprachiger Literatur basierte auf diversen Datenbanken (PubMed, PsycInfo, SocIndex, Livivo, Cochrane, Fachportal Pädagogik), einer Handsuche und einer Suche nach dem Schneeballprinzip.

Ergebnisse und Diskussion

Die Systematisierung kombiniert phasen- und formatbasierte Logiken. Als zentrale Prinzipien in den Definitionen einer partizipativen Methodologie und von partizipativen Methoden werden die Mehrdimensionalität und Phasenintegration berücksichtigt. Daraus abgeleitet werden die Hauptunterscheidung von prozessgestaltenden und forschenden Methoden. Schwerpunkte zeigen sich bei den Erhebungsmethoden und Reflexionsverfahren. Lücken im deutschsprachigen Raum sind bei Methoden gemeinsamer Entscheidungsfindungen, der Auswertung und Verwendung erkennbar.

Fazit

Die Ergebnisse helfen bei der Einordnung verschiedener Ansätze und ihres Grades an Partizipation. Für Forschung und Lehre wird die Aufmerksamkeit auf das Spektrum forschender und prozessgestaltender partizipativer Methoden gelenkt, die es einzusetzen, zu beschreiben und zu vermitteln gilt.

METHODS FOR CARIES PREVENTION IN ADULTS AMONG DENTISTS FROM A BRAZILIAN COMMUNITY: Adult' caries prevention among Brazilian dentists

Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists.

OBJECTIVE

To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community.

METHODS

Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05).

RESULTS

In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents.

CONCLUSION

Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.

Assessment of Knowledge, Attitude, and Practice among Private Dental Practitioners toward Preventive Measures of Pediatric Patients in Durg-Bhilai City

INTRODUCTION

The old saying "prevention is better than cure" holds true when applied to preventive dental care. It is vitally important for the general health and well-being of the individual to take the necessary steps to prevent the occurrence of major dental problems. American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of initiating professional oral health intervention in infancy and continuing through adolescence and beyond.

MATERIALS AND METHODS

Around 109 available private general dental practitioners of Durg-Bhilai city (within city limits) made up the (convenient) sampling frame of the study. These entire dentists were identified and contacted. But, out of 109 dentists, only 92 were surveyed. BDS graduates and MDS (other than pedodontists) were included in the study. Dentists who were not willing to participate were excluded from the study. The sample size was calculated based on the total number of dentists practicing in Durg-Bhilai city limits.

CONCLUSION

A statistically significant correlation was found in-between the knowledge and practice score (0.368), knowledge and attitude (0.269); attitude and practice (-0.257).

HOW TO CITE THIS ARTICLE

Tiwari J, Pattanshetti K, Doifode D, et al. Assessment of Knowledge, Attitude, and Practice among Private Dental Practitioners toward Preventive Measures of Pediatric Patients in Durg-Bhilai City. Int J Clin Pediatr Dent 2020;13(S-1):S78-S81.

The anticaries effects of pit and fissure sealant in the first permanent molars of school-age children from Guangzhou: a population-based cohort study

BACKGROUND

Analyses of the effects of pit and fissure sealant have been based on small samples and lack large-scale field evaluation data in China. The aim of this study was to understand the effect of pit and fissure sealant in preventing caries in the first permanent molars (FPMs) of children in Guangzhou.

METHODS

We conducted a population-based cohort study using the database of the pit and fissure sealant program of Guangzhou. The carious status and sealant retention of the FPMs were assessed in 4,822 school children who received pit and fissure sealant 3 years prior to the study. The control group included 4,396 children who had indications for receiving pit and fissure sealant but were not treated and were matched according to sex, age and school.

RESULTS

In the sealant group, the rate of sealant retention in the FPMs was 72.2%. Children in the sealant group had a 37% decreased risk of dental caries compared with the control group (adjusted HR = 0.63 [95% confidence interval (CI), 0.57-0.69], P < 0.001). Compared to no sealant use, the use of pit and fissure sealants reduced the risk of developing dental caries by 44% after 3 years in the FPMs of children from rural areas, reflecting a greater reduction than that among urban children (35%) during the same period (urban: adjusted hazard ratio (HR) = 0.65 [95% CI, 0.58-0.72]; rural: adjusted HR = 0.56 [95% CI, 0.45-0.70], P < 0.001). The mean number of decayed, missing, or filled permanent teeth (DMFT) in the control group was higher than that in the sealant group, and the difference was statistically significant regardless of sex.

CONCLUSIONS

Pit and fissure sealant has a significant preventive effect against dental caries in the FPMs, especially for children in rural areas; thus, this sealant represents an effective technique for preventing and controlling dental caries.

Evidence-Based Dentistry Caries Risk Assessment and Disease Management

The objective of this article was to provide a summary of evidence-based recommendations for the assessment of caries risk and management of dental caries. The goal is to help clinicians manage the caries disease process using personalized interventions supported by the best available evidence, taking into account the clinician's expertise and the patient's needs and preferences, to maintain health and preserve tooth structure.

Production of arabitol from enzymatic hydrolysate of soybean flour by Debaryomyces hansenii fermentation

Arabitol is a low-calorie sugar alcohol with anti-cariogenic properties. Enzymatic hydrolysate of soybean flour is a new renewable biorefinery feedstock containing hexose, pentose, and organic nitrogen sources. Arabitol production by Debaryomyces hansenii using soybean flour hydrolysate was investigated. Effects of medium composition, operating conditions, and culture stage (growing or stationary phase) were studied. Production was also compared at different culture volumes to understand the effect of dissolved oxygen concentration (DO). Main factors examined for medium composition effects were the carbon to nitrogen concentration ratio (C/N), inorganic (ammonium) to organic nitrogen ratio (I/O-N), and sugar composition. Arabitol yield increased with increasing C/N ratio and a high I/O-N (0.8-1.0), suggesting higher yield at stationary phase of low pH (3.5-4.5). Catabolite repression was observed, with the following order of consumption: glucose > fructose > galactose > xylose > arabinose. Arabitol production also favored hexoses and, among hexoses, glucose. DO condition was of critical importance to arabitol production and cell metabolism. The yeast consumed pentoses (xylose and arabinose) only at more favorable DO conditions. Finally, arabitol was produced in fermentors using mixed hydrolysates of soy flour and hulls. The process gave an arabitol yield of 54%, volumetric productivity of 0.90 g/L-h, and specific productivity of 0.031 g/g-h.

Patient-reported negative experiences related to caries and its treatment among Swedish adult patients

Background

It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment.

Methods

A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients’ dental records. Exploratory factor analysis was conducted on items related to patients’ perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared.

Results

The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients.

Conclusions

Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0384-3) contains supplementary material, which is available to authorized users.

Professional Variability in Decision Making in Modern Dentistry: A Pilot Study

Dental treatment planning is usually expected to take account of the individual patient's clinical risks and benefits. Ideally, the therapeutic choice for each and every patient should be based on adequate clinical diagnostics and risk assessment that facilitates stabilization of the patient's clinical condition as well as prevents further oral impairment. However, identification of the most suitable approach tends to become more and more challenging as the number of therapeutic alternatives continues to increase due to medical innovation. In this study, the challenge of decision making in modern dentistry is illustrated using the example of bounded edentulous spaces. Many therapeutic alternatives exist for such clinical scenarios, including a noninvasive monitoring approach, minimally invasive tooth recontouring, orthodontic and prosthodontic treatment, and implant placement. The findings of this pilot study highlight the utmost relevance of incorporating individual patients' needs and risks into clinical treatment planning and providing appropriate guidelines.

Baseline Caries Risk Assessment Using CAMBRA May Predict Caries Only in High and Extreme Caries Risk Groups

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Baseline caries risk assessment as a predictor of caries incidence. Chaffee BW, Cheng J, Featherstone JD.J Dent 2015;43(5):518-24.

REVIEWERS

Marisol Tellez, BDS, MPH, PhD, Vinodh Bhoopathi, BDS, MPH, DScD, Sungwoo Lim, MS, DrPH PURPOSE/QUESTION: To determine, with each increasing category of baseline caries risk as assessed by Caries Management by Risk Assessment (CAMBRA) in a patient, whether a greater or higher number of new decay/restored teeth can be predicted at a subsequent 6-month periodic oral evaluation.

SOURCE OF FUNDING

National Center for Advancing Translational Sciences, National Institutes of Health (KL2TR000143) TYPE OF STUDY/DESIGN: Retrospective cohort study

LEVEL OF EVIDENCE

Level 2: Limited-quality, patientoriented evidence

STRENGTH OF RECOMMENDATION GRADE

Not applicable.

Evidence-practice gap for in-office fluoride application in a dental practice-based research network

OBJECTIVE

The aims of this study were to examine dentists' recommendations for in-office fluoride to patients and identify dentists' characteristics associated with these recommendations.

STUDY DESIGN AND SETTING

The study was conducted using a cross-sectional questionnaire survey in Japan. The survey queried dentists (n = 282) in outpatient dental practices affiliated with the Dental Practice-based Research Network Japan (JDPBRN). This network aims to assist dentists in investigating research questions and sharing their experience and expertise.

RESULTS

The responses were obtained by 189 dentists (67 percent). Among valid response, 54 percent of dentists (n = 98) recommend in-office fluoride to more than 50 percent of their patients aged 6-18 years and 15 percent (n = 29) recommended this care to more than 50 percent of their patients aged over 18 years. Multiple logistic regression analysis suggested that factors associated with the percentage of patients who are recommended in-office fluoride included patient's interest in caries prevention and dentist's belief in the effectiveness of caries risk assessment.

CONCLUSIONS

Dentist practice patterns for recommending in-office fluoride vary widely. Recommendation was significantly related to having a higher percentage of patients interested in caries prevention and to the dentist's belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01680848).

Preventive care delivered within Public Dental Service after caries risk assessment of young adults

OBJECTIVES

To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period.

METHODS

The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics. The baseline caries risk assessment was carried out by the patient's regular team in four classes according to a predetermined model, and the team was responsible for all treatment decisions. Based on the variables 'oral health information', 'additional fluoride' and 'professional tooth cleaning', a cumulative score was constructed and dichotomized to 'basic prevention' and 'additional prevention'.

RESULTS

More additional preventive care was provided to the patients in the 'low-risk' and 'some risk' categories than to those classified as 'high' or 'very high' risk (OR = 2.0, 95% CI 1.4-3.0; P < 0.05). Professional tooth cleaning and additional fluorides were most frequently employed in the 'low-risk' and 'some risk' categories, respectively. Around 15% of the patients in the high-risk categories did not receive additional preventive measures over the 3-year period. There was an insignificant tendency that patients with additional prevention developed less caries than those that received basic prevention in all risk categories except for the 'very high-risk' group.

CONCLUSION

The caries risk assessment process was not accompanied by a corresponding targeted individual preventive care in a cohort of young adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention.

Factors that drive dentists towards or away from dental caries preventive measures: systematic review and metasummary

BACKGROUND

Dental caries is a serious public health concern. The high cost of dental treatment can be avoided by effective preventive measures, which are dependent on dentists' adherence. This study aimed to evaluate the factors that drive dentists towards or away from dental caries preventive measures.

METHODS AND FINDINGS

This systematic review was registered in PROSPERO (CRD42012002235). Several databases as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines, yielding 18,276 titles and abstracts, which were assessed to determine study eligibility. Seven qualitative studies and 41 surveys (36,501 participants) remained after data extraction and interpretation. A total of 43 findings were abstracted from the reports and were grouped together into 6 categories that were judged to be topically similar: education and training, personal beliefs, work conditions, remuneration, gender, place of residence and patients. The main findings for adherence based on their calculated frequency effect sizes (ES) were teamwork (21%) and post-graduation (12%), while for non-adherence were biologicism (27%), and remuneration for preventive procedures (25%). Intensity ES were also calculated and demonstrated low prevalence of the findings. Quality assessment of the studies demonstrated that the methodological quality, particularly of surveys, varied widely among studies.

CONCLUSIONS

Despite the questionable quality of the included reports, the evidence that emerged seems to indicate that further education and training coupled with a fairer pay scheme would be a reasonable approach to change the balance in favor of the provision of dental caries preventive measures by dentists. The results of this review could be of value in the planning and decision making processes aimed at encouraging changes in professional dental practice that could result in the improvement of the oral health care provided to the population in general.

Effect of changing the kilovoltage peak on radiographic caries assessment in digital and conventional radiography

Purpose

This study aimed to investigate the effect of changing the kilovoltage peak (kVp) on the radiographic assessment of dental caries.

Materials and Methods

Seventy-five extracted posterior teeth with proximal caries or apparently sound proximal surfaces were radiographed with conventional E-speed films and a photostimulable phosphor system using 60 kVp and 70 kVp for the caries assessment. The images were evaluated by three oral radiologists and compared with the results of the stereomicroscope analysis.

Results

No statistically significant difference was found between 60 kVp and 70 kVp for the caries detection, determination of caries extension into dentin, and caries severity in either the conventional or the digital images. Good to very good inter-observer and intra-observer agreements were found for both kilovoltage values on the conventional and digital images.

Conclusion

Changing the kilovoltage between 60 kVp and 70 kVp had no obvious effect on the detection of proximal caries or determination of its extension or severity.

Minimal intervention dentistry: part 2. Caries risk assessment in adults

Risk-based, patient-centred decision-making, supported by best available evidence is an essential component for the correct prevention, control and management of dental caries. This article reviews the importance of caries risk assessment in adults as a prerequisite for appropriate caries preventive and treatment intervention decisions. A clinical case will be used to demonstrate how risk assessment can be easily incorporated in everyday clinical practice, using information readily available in the dental-medical history and clinical examination.

Risk factors of caries progression in a Hispanic school-aged population

The purpose of this Institutional Review Board-approved study was to identify risk factors of caries lesion progression in children enrolled in rural schools in Puerto Rico. A convenience sample of 408 children (5-13 yrs old) was examined at baseline and at 12 and 24 mos with the International Caries Detection and Assessment System (ICDAS). A total of 395 caregivers completed a 25-item questionnaire including socio-demographic, dietary, protective factors, disease experience, and access to care. Caries progression was significant (89% and 91% at 12 and 24 mos, respectively). Multiple-variable models for predicting children with lesion progression and numbers of lesions progressing were calculated for 2 outcome variables (any-progression vs. progression-toward-cavitation). Models developed had areas under the receiver operating characteristic (ROC) curve ranging between 0.70 and 0.79 and were very similar regardless of the outcome (progression criteria), prediction time (12-24 mos), or inclusion (or not) of previous caries experience. Significant predictors of disease progression collected through a parent-completed questionnaire included questions related to caries experience in the child or caregiver, and the caregiver's rating of the child's oral health.

Design of the xylitol for adult caries trial (X-ACT)

Background

Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations.

Methods/Design

X-ACT is a three-year, multi-center, placebo controlled, double-blind, randomized clinical trial that tests the effects of daily use of xylitol lozenges versus placebo lozenges on the prevention of adult caries. The trial has randomized 691 participants (ages 21-80) to the two arms. The primary outcome is the increment of cavitated lesions.

Discussion

This trial should help resolve the overall issue of the effectiveness of xylitol in preventing caries by contributing evidence with a low risk of bias. Just as importantly, the trial will provide much-needed information about the effectiveness of a promising caries prevention agent in adults. An effective xylitol-based caries prevention intervention would represent an easily disseminated method to extend caries prevention to individuals not receiving caries preventive treatment in the dental office.

Trial Registration

ClinicalTrials.Gov NCT00393055