CARIES MANAGEMENT BY RISK ASSESSMENT

描述：(摘自申请者摘要)龋齿及其后遗症仍然存在 在美国，牙齿治疗和牙齿脱落的主要原因。 龋病分布不均匀；占总龋病负担的80% 25%的人口中有儿童。这种不对称的分布 疾病的发生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 介绍诊断、预防和治疗技术 它们拥有持久治愈这种疾病的希望。整体而言 本研究的目的是为临床应用提供证据。 以科学为基础的龋病风险评估与 采取积极的预防和治疗措施以恢复平衡 在病理因素和保护性因素之间，以及保守之间 修复后的龋齿增加很少，甚至不会进一步增加 与常规治疗相比。具体目标是：(1) 进行一项为期2.5年的随机对照临床试验，以比较 “干预组”(148名患者)，其龋齿将在基础上进行管理 根据他们的低或高龋齿风险状态(通过唾液评估 微生物和化学分析)给对照组(148名患者) 在不知情的情况下接受“常规”的恢复性治疗 风险状况需要检验的假设是龋齿管理 (主要是洗必泰、密封胶)和保守型 基于龋齿风险状况的恢复性治疗将显著 在两年(以上)内减少对龋齿恢复性治疗的需求 与通常的牙科治疗相比。研究参与者将是成年人 有至少一个坦率的龋损的患者进入 加州大学旧金山分校的综合护理诊所。(2)确定龋齿增量 因龋齿而新修复体的比例和数量， 变形链球菌(MS)、乳杆菌(Lb)和氟化物(F) 唾液和龋齿风险分类在这两个测试中都有 (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.