In a study of 460 patients at high risk of dental damage separated into two groups, those who used cavity-prevention products dramatically reduced their risk of cavities compared to the control group, according to researchers at the University of California, San Francisco.
The system of prevention is known by the acronym CAMBRA, for Caries Management By Risk Assessment. It included giving the patients prescription fluoride toothpaste, chlorhexidine antibacterial rinse, xylitol mints and fluoride varnish. The release fell short in describing the potential cost saving and addressing any potential for harms.
Dental problems are a plague to people of all income ranges and ages. The cost of dental care, where insurance is inadequate or out-of-reach, is a particular burden for low income people. If specific preventive measures are proven to significantly reduce cavities it could benefit many.
While the news release says the research is aimed at lowering costs and reducing the burden for low income patients, we are not given any numbers that describes the value of the intervention.
The release only gets as detailed on cost as the excerpts below:
The findings, which support earlier research demonstrating positive results of the assessment and treatment method in a university setting, have the potential to transform dental care for high-risk patients at a lower cost to both patients and dental clinics and practices. Results appear online Jan. 22, 2018, in Advances in Dental Research.
The authors said now that this has been shown to be effective in a non-academic clinical setting, there also is potential for insurance companies to reimburse CAMBRA and other preventive therapies for adults, thereby lowering patient costs while increasing profits for dental practices.
The release also doesn’t address the cost of prescription fluoride toothpaste which may actually result in higher costs overall. The number needed to treat was 4, meaning that you would have to treat 4 people for one additional person to get benefit. This results in the cost of therapy being multiplied by 4 to get the effect found in the study.
The release described benefits this way:
Among 242 patients (137 intervention, 105 control) initially identified as high risk for caries, only a quarter of the patients remained at high risk in the CAMBRA group at 24 months, while just over half (54 percent) of the control group did. Of the 192 low-risk participants (93 intervention, 99 control), most participants remained low risk.
As noted under Evidence criteria below, the release listed as a limitation the fact that only about one-third of the patients who started the study completed the 24 month checkup.
There is no mention of harms.
We are given enough information to judge the quality of the evidence; it was a randomized study with an experimental and a control group.
The release also deserves praise for noting study limitations, including the high study attrition rate (65 percent of volunteers dropped out before their 24 month follow-up).
The study quality seems to have been very good considering the difficulty in performing this type of community based study. The blinding was adequate and although the published study states that the blinding was “double” (patient and investigator), it also appears that the treating dentists (participating treaters) were also blinded to the group that the patient was assigned. This could have been mentioned, too, and would have strengthened the release.
There is no disease mongering.
The funding sources are listed, and there are no apparent conflicts.
In the strictest possible way, the release does not directly talk about all the different ways of preventing dental caries. But we were glad that the release discussed the improvements that happened for some patients in the control group who received fewer products. We are glad the release talks about possibly following up on this, in case the lesser products could still benefit many patients.
The researchers said the risk reduction among the control group may have been caused by the fluoride toothpaste enhancing tooth repair, as well as the mouth rinse enhancing saliva flow and having bactericidal effects. While not as significant as the CAMBRA group in this study, the risk level of these patients dropped more dramatically over time than for those in the 2012 UCSF CAMBRA study.
It was surprising to see the benefits gained by the control group,” Rechmann said. “More research is needed to see if the products and treatment administered to this group function in the way we speculate, and if so, they might be made easily available to dental patients. Doing so can change the whole picture of caries control.
This CAMBRA method is available at about half of US schools and colleges of dentistry according to the release. However, the prescription fluoride toothpaste is available from most pharmacies.
The release clearly explains that this research began in 2002, and small incremental steps in its validation have been published over many years. This is one more step.
There is no unjustifiable language.