CARIES MANAGEMENT BY RISK ASSESSMENT

描述：（来自申请人摘要）龋齿及其后遗症仍然存在 美国牙科治疗和牙齿脱落的主要原因。 龋齿的分布并不均匀; 80%的龋齿总负担， 儿童占人口的25%。 这种偏态分布 需要有方法来识别那些风险最大的人， 采取适当的干预措施。 最近的进展导致了 采用诊断、预防和治疗技术 有望持久治愈这种疾病 整体 本研究的目的是提供临床证据， 以科学为基础的龋齿风险评估， 积极的预防和治疗措施，以恢复平衡 病理因素和保护因素之间的关系， 预防龋齿将导致很少或没有进一步的龋齿增加 与常规治疗相比。 具体目标是：（1） 进行为期2.5年的随机对照临床试验， “干预”组（148例），其龋病将根据 根据他们的低或高龋齿风险状态（通过唾液评估）， 微生物和化学测定）与对照组（148例患者）比较 接受“常规”修复治疗， 风险状态要检验的假设是， （主要是氯己定氟化物、密封剂）和保守 根据龋齿风险状况进行恢复性治疗， 减少龋齿修复治疗的需要超过两年（加） 与常规牙科治疗相比。 研究受试者为成年人 至少有一处明显龋损的患者， 加州大学旧金山分校的综合护理诊所 (2)确定龋齿增量 比例和数量的新的牙齿脱落由于龋齿， 变形链球菌（MS）、乳酸杆菌（LB）和氟化物（F） 唾液，和两分法龋齿的风险类别，在这两个测试 （干预组）和对照组患者。 如果这项研究成功， 将显著改变龋齿管理的教学和实践。

DESCRIPTION: (From applicant abstract) Caries and its sequelae remain the major reasons for dental treatment and tooth loss in the USA. Caries is not uniformly distributed; 80% of the total caries burden in children is found in 25% of the population. This skewed distribution of disease calls for methods to identify those at greatest risk and apply appropriate interventions. Recent advances have led to the introduction of diagnostic, preventive and therapeutic technologies which hold the promise of enduring cure of the disease. The overall objective of this study is to provide clinical evidence that the use of scientifically based caries risk assessment in conjunction with aggressive preventive and therapeutic measures to restore the balance between pathological and protective factors, and conservative restorations will result in little or no further caries increment compared to conventional treatment. The specific aims are: (1) To conduct a 2.5 year randomized, controlled clinical trial, to compare an "intervention" group (148 patients), whose caries will be managed based upon their low or high caries risk status (assessed by salivary microbiological and chemical assays) to a control group (148 patients) that receives "conventional" restorative treatment without knowledge of risk status The hypothesis to be tested is that caries management (primarily chlorhexidine fluorides, sealants) and conservative restorative treatment based on caries-risk status will significantly reduce the need for caries restorative treatment over two (plus) years compared to usual dental treatment. Study participants will be adult patients with at least one frank carious lesion who enter the comprehensive care clinic at UCSF. (2) To determine caries increment proportion and number of new restorations due to caries, changes in mutans streptococci (MS), lactobacilli (LB), and fluoride (F) in whole saliva, and dichotomized caries risk category in both the test (intervention) and control group patients. If successful this study will markedly change the teaching and practice of caries management.