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

描述（由申请人提供）：提议的工作涉及医学研究所（IOM）在临床有效性研究方面的几个国家优先事项：口腔健康和卫生保健的差异。将现有牙科数据与丰富的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种优先条件中的5种患者龋牙方面的有效性：患有痴呆症，抑郁症和双相情感障碍，糖尿病，艾滋病毒艾滋病和酒精依赖者的医疗受损退伍军人。最近的数据表明，龋齿在成人和儿童中都是同样严重的问题（Dye等，2007）。然而，在预防成人龋齿方面，我们的知识库仍存在重大知识缺口（Griffin et al., 2007）。利用现有的、丰富的电子数据库，该数据库来自每年为超过342,000名退伍军人提供牙科治疗的医疗保健系统，本回顾性、纵向研究最大限度地利用了一个独特的机会，在医疗复杂的退伍军人群体中检查以下具体目标。目的1。检查处方强度氟化物、自行应用氟化物和专业应用氟化物在预防龋齿高风险医疗受损退伍军人龋齿方面的有效性。如果退伍军人在前一年做过两次或两次以上的牙齿修复手术，他们将被定义为有患龋齿的风险。目标2。虽然最近的证据表明，氟化物可有效预防成人龋齿，多次接触氟化物可降低儿童龋齿风险（Weintraub， 2006年），但现有的有限数据表明，在成人中，多次接触或多种方式比单一方式更有效。因此，我们有一个独特的机会来检查多次接触氟化物是否比一次接触更有效。目标3。在过去的一年里，退伍军人事务部引入了一项质量测量（氟化物监测），每季度检查接受氟化物治疗的患龋风险高的退伍军人的百分比。该项目将检查采用这种氟化物监测仪在降低患龋齿风险高的医疗受损退伍军人牙齿修复率方面的有效性。

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.