Title: Subjective Caries Risk Assessment in VA Dentistry
M. Marianne Jurasic (Presenter)
Gretchen Gibson, Veterans Health Care System of the Ozarks
Michelle Orner, Center for Healthcare Organization and Implementation Research
Carolyn Wehler, Boston University
Judith Jones, University of Detroit Mercy School of Dentistry
Objectives: In a national system of dental care, determine whether a subjective caries risk assessment (CRA) as documented in an electronic health record (EHR) identifies the need for future caries-related treatment.
Methods: This is a retrospective analysis of longitudinal data (10/01/09-08/31/17) contained within the VA EHR. Inclusion criteria are new dentate patients with at least 3-years of follow-up. Study participants were enrolled at their initial comprehensive exam. Their first follow-up exam was identified and the subjective CRA (low, moderate, high) associated with this exam was recorded. After all caries-related treatment associated with this CRA were completed (in 12 months or less), patients were monitored for another twelve months (observation period) and caries-related restorative and surgical treatment was documented. Age, gender, race/ethnicity, and proportion of patients in each CRA group were counted. Teeth/person and percent of patients receiving caries-related treatment by CRA group were calculated. Unadjusted logistic regression modelled caries-related treatment, with subjective CRA as predictor.
Results: The study population includes 58,076 patients; 60.8±12.4 years=mean age; 92.3%=male; 74.4%=White/Caucasian; 20.3%=Black/African American; 6.8%=Hispanic. Proportion of Veterans in each CRA group were: 54.1%=Low; 32.5%=moderate; 13.4%=high. Veterans in the low CRA group had 0.21 teeth/person receive caries-related treatment, versus 0.38 teeth/person in the moderate CRA group, versus 0.45 teeth/person in the high CRA group. Unadjusted logistic regression modelling caries-related treatment with subjective CRA as the predictor showed those in the moderate versus low group were 60% more likely to receive caries-related treatment, while those in the high versus low CRA group were 155% more likely to receive caries-related treatment.
Conclusions: A subjective CRA was able to identify the need for future caries-related treatment; patients in the high CRA group had twice as many teeth/person receive caries-related treatment compared to patients in the low CRA group.