Dental Tribune Middle East

New study to explore caries risk management in dental clinical practice

By Dr Jean Noël Vergnes et al.
January 08, 2021

The Caries Risk Management (CARMEN) project is an ongoing observational longitudinal study that is being carried out among dentists in four European countries: Bulgaria, Greece, Poland and Portugal. As there is only limited data available on the implementation of caries risk management guidelines in dental practices in Europe, the project aims to describe dental professionals’ adherence to these guidelines and assess the impact of their strategies on caries experience in patients. Here, the researchers present the cohort formation of their study.

Caries risk management: Practice of dentists and influence of guidelines and protocols―cohort formation


While there has been epidemiological progress in the reduction of dental caries over the past 30 years, it remains a significant health problem. Although guidelines for early identification of high-risk caries patients and preventive strategies for high-risk populations have been developed, there is little data on the practices of dental professionals in Europe in this regard.


Here, we describe dental professionals’ adherence to caries risk management guidelines in order to subsequently assess the impact of their strategies, in a later part of the greater study.


An international, epidemiological, observational, retrospective and prospective longitudinal cohort study conducted with dental clinicians in four European countries―Bulgaria, Greece, Poland and Portugal―was initiated in 2019. Here, we present the initial cohort formation data collected on the caries risk management practices reported by participating dentists, and the dental condition of the patients who consented to inclusion in the study.


Fig. 1: Comparison of dentists with university education on caries risk management compared with those with none in relation to their adherence to caries risk management guidelines.

Fifty-one dental clinicians agreed to take part in the study (19 from Bulgaria, eight from Greece, 14 from Poland and ten from Portugal), most of whom (63%) were female. The dental professionals’ mean age was 44 years (± 12 years), and they had been in practice for a mean of 19 years. Most were specialised—paediatric dentistry (15.7%), dental surgery (15.7%) and restorative dentistry/endodontics (15.7%)—whereas 13.7% were not. Overall, 48% had received specific education on caries risk management at university, although there was some variation between the countries: 78.6% in Poland, 60.0% in Portugal, 28.6% in Greece and 26.3% in Bulgaria. Almost all the participants reported that they undertook continuing dental education, but only 72% considered themselves to be up to date on the topic of caries risk management.

Having received specific education on caries risk management at university was found to be highly correlated with the application of guidelines in routine practice (95% of those educated on caries risk management at university adhered to caries risk management recommendations, compared with 60% who did so and who had not received education on caries risk management at university; Fig. 1). Overall, more than half of the participants routinely carried out a systematic caries risk assessment; however, differences were observed between the countries: 100% of the participants in Greece, 77.8% in Portugal, 47.4% in Bulgaria and 35.7% in Poland. The caries risk assessments were mainly based on an oral examination (98.0%), a medical interview (79.6%), a nutritional assessment (71.4%), a radiographic examination (67.3%), topical fluoridation (51.0%) and fluoride intake (40.8%). Biological tests and caries risk assessment scales and software were not employed often.

Fig. 2: Association of patients’ socio-economic status with caries risk and presence of carious lesions.

The patient cohort was made up of 1,009 patients (366 from Bulgaria, 281 from Greece, 276 from Poland and 86 from Portugal), the majority of whom (56%) were female, and their mean age was 35.4 years (± 19.7 years). Almost 80% had experienced recent caries, despite over 90% of the patients reporting that they brushed their teeth daily and 80% stating that they used fluoride toothpaste. Active carious lesions and the risk of caries appear to have a converse association with socio-economic status. Active carious lesions were observed in 33.5%, 48.2% and 61.2% of patients of high, medium and low socio-economic status, respectively. Similarly, a high caries risk was reported by the dentists for 36.6%, 48.5% and 70.0% of patients of high, medium and low socio-economic status, respectively (Fig. 2).

The patients’ condition at the inclusion visit included visible plaque on the teeth in 53.2% of cases, the presence of active carious lesions in 44.1% of cases, and deep pits and fissures in 38.2% of the patients. These figures were higher for patients in Portugal (67.4%, 77.9% and 53.5%, respectively). During the inclusion visit, direct restoration was the most frequent care provided (provided to almost half of patients).

During the visit, most of the patients received advice on oral hygiene or diet, but there was variation between the countries: 98.9% in Bulgaria, 92.2% in Greece, 78.3% in Poland and 64.0% in Portugal. For the dentists from Bulgaria, 68.3% reported that more than half of the patients had a positive attitude towards their care and a willingness to cooperate. This was the case for 59.1% of the dentists from Poland, 46.3% from Greece and 29.1% from Portugal.  


The research team is composed of dental experts from Bulgaria, Greece, Poland and Portugal, and members of Pierre Fabre. (Image: Pierre Fabre)

This is the first international large-scale cohort study conducted to describe dentists’ reported practices relating to caries risk management guidelines and the impacts on their attitudes to patient care. Significant diversity can be observed in caries risk management and counselling provided by dental clinicians between the four European countries. A retrospective investigation of patients’ dental history in the last three years is currently in progress, and the forthcoming prospective follow-up will help more accurately determine the impact of dental professionals’ adherence to caries risk management recommendations.

Editorial note: The Caries Risk Management (CARMEN) study is expected to run until the end of 2022, and the final results are expected to be published two or three years later. The preliminary results have not yet been peer reviewed or published in a scientific journal. The study is being sponsored by Pierre Fabre Oral Care, supplier of oral hygiene and care products for dental professionals and patients.  

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