Clinical Caries Prevention in the Curriculum Framework for Health Professions

Clinical Prevention and Population Health, a Curriculum Framework for all the Health Professions (Am J. Prev. Med 27:471-6, 2004) responds to calls by the Institute of Medicine and Healthy People 2010 for restructuring health professional education and practice. It has four Components: 1-Evidence Base of Practice; 2-Clinical Preventive Services incl. Health Promotion; 3-Health Systems and Health Policy; and 4. Community Aspects of Practice. COMPONENT 2, paralleling the structure of the U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/uspstf/uspstopics.htm) has four DOMAINS, applied to caries prevention for individuals in this paper. 1. Screening, testing and risk assessment, 2. Counseling patients in culturally appropriate health behavioral change, 3. Immunization renamed Clinical Procedures for dental applications, and 4. Chemoprevention, self-applied. Screening, social health and preventive history taking, testing and recording are used for an assessment of degree of future caries risk, based on etiological factors determined to be present or absent. Testing includes caries detection and recording at early/ late stages, dietary assessment, salivary function, and indicator bacterial load,all as appropriate.The Domains of clinical preventive services, and recall interval to reassess risk/disease, can then be planned at an intensity according to risk, ie, Counseling about diet and oral preventive practices, incl. plaque control; Chemoprevention - appropriate personal use of fluorides, salivary stimulants, and antimicrobials; and professional Clinical Procedures – topical fluorides, pit and fissure sealants, and remineralization therapy. These clinical preventive services for dental caries have been tabulated and are detailed in a forthcoming textbook. Prevention of other oral diseases awaits application within the Framework.