Fluoride Effectiveness in Prevention of Dental Caries in High Caries Risk Adults

描述（由申请人提供）：拟议的工作解决了医学研究所（IOM）在临床有效性研究中的几个国家优先事项：口腔健康和医疗保健的差异。将现有的牙科数据与丰富的VA患者数据库的其他组成部分相结合，我们将能够检查氟化物在预防AHRQ指定的14个优先条件中的5个的患者龋齿中的有效性：患有痴呆症，抑郁症和双相情感障碍的医学受损退伍军人，糖尿病，艾滋病和酒精依赖者。 最近的数据表明，龋齿在成人和儿童中同样是一个问题（Dye等人，2007年）。然而，在我们关于成人龋齿预防的知识库中仍然存在显著的知识缺口（Griffin等人，2007年）。使用现存的，丰富的电子数据库，从医疗保健系统提供牙科治疗，每年超过342，000退伍军人，这项建议的回顾性，纵向研究最大限度地利用了一个独特的机会，以检查以下特定的目标，在医学复杂的退伍军人的人口。目标1。检查处方强度，自我应用的氟化物和专业应用的氟化物在预防龋齿的医学妥协的退伍军人谁是龋齿的高风险的有效性。退伍军人将被定义为在龋齿的风险，如果他们有两个或两个以上的龋齿在前一年。目标2.虽然最近的证据表明，氟化物可有效预防成人龋齿，多次暴露于氟化物可降低儿童龋齿风险（Weintraub，2006），但有限的数据表明，多次暴露或方式比单一方式更有效。因此，我们有一个独特的机会来研究多次暴露于氟化物是否比单次暴露更有效。目标3。在过去的一年里，退伍军人事务部推出了一项质量措施（氟化物监测器），每季度检查一次接受氟化物治疗的龋齿高危退伍军人的百分比。该项目将研究引入这种氟化物监测器在降低龋齿高危医学受损退伍军人的龋齿发生率方面的有效性。 公共卫生相关性：尽管在过去的50年里，口腔健康和牙齿护理的获得取得了巨大的进步，但蛀牙仍然是医学复杂的老年人的一个问题。7600万婴儿潮一代的老龄化，他们比以往任何时候都保留了更多的牙齿，使这成为一个引人注目的问题。本研究的目的是检查处方强度，自我应用，刷氟化物和在办公室氟化物治疗在预防龋齿在现实世界中的医疗妥协的老年人在蛀牙的高风险设置的影响。

DESCRIPTION (provided by applicant): The proposed work addresses several of the Institute of Medicine's (IOM's) national priorities in clinical effectiveness research: disparities in oral health and health care. Combining extant dental data with other components of the rich VA patient databases, we will be able to examine the effectiveness of fluoride in preventing caries in patients with five of the 14 priority conditions specified by AHRQ: medically compromised veterans with dementia, depression and bipolar disorder, diabetes, HIV-Aids and persons with alcohol dependence. Recent data suggest that dental caries is as much of a problem in adults as children (Dye, et al., 2007). However, significant knowledge gaps remain in our knowledge base regarding prevention of caries in adults (Griffin et al., 2007). Using an extant, rich electronic data base from a health care system providing dental treatment to over 342,000 veterans annually, this proposed retrospective, longitudinal study takes maximum advantage of a unique opportunity to examine the following specific aims in a population of medically complex veterans. Aim 1. Examine the effectiveness of prescription-strength, self-applied fluoride and professionally applied fluoride in the prevention of caries in medically compromised veterans who are at high risk for caries. Veterans will be defined as at risk for caries if they have had two or more restorations in the previous year. Aim 2. While recent evidence suggests that fluoride is effective in preventing caries in adults, and multiple exposures to fluoride reduces caries risk in children (Weintraub, 2006), limited data exist showing that multiple exposures or modalities are more effective than a single modality in adults. Thus, we have a unique opportunity to examine whether multiple exposures to fluoride will be more effective than a single exposure. Aim 3. Over the past year, the Department of Veterans Affairs introduced a quality measure (the fluoride monitor) that examines, on a quarterly basis, the percent of veterans at high risk for caries who receive fluoride treatments. This project will examine the effectiveness of the introduction of this fluoride monitor in reducing the rate of restorations in medically compromised veterans at high risk for caries. PUBLIC HEALTH RELEVANCE: Despite dramatic gains in oral health and access to dental care during the past 50 years, dental decay remains a problem in medically complex older adults. The aging of the 76 million baby boomers, who are retaining more teeth than ever before, makes this a compelling problem. The purpose of this study is to examine the effects of prescription strength, self-applied, brush on fluorides and in-office fluoride treatments in preventing decay in a real-world setting of medically compromised older adults at high risk for dental decay.