Documented caries treatment and prevention among highly caries-active adults: a retrospective observational study of public dental records.

backgroundEvidence-based caries management emphasises identification of disease drivers and causal, preventive, and behaviour-oriented care. However, limited evidence is available on how such care is documented for adults with high caries activity in routine public dental care. This study examined documentation of caries treatment and preventive measures consistent with evidence-based caries management, and whether documented care addressed underlying causes of caries disease.

methodsThis retrospective observational record-review study included 418 adults aged 25-65 years from 19 Public Dental Service clinics in Region Västra Götaland, Sweden. High caries activity was defined as ≥ 4 manifest caries lesions at a complete oral examination in 2015 or 2016. Documented caries-related treatment, preventive measures, causal investigations, and counselling content were extracted from electronic dental records between the index examination and the subsequent complete oral examination. Descriptive statistics summarised documentation patterns. Sex-related differences were analysed using Fisher's exact test and Mann-Whitney U-test, and associations with age and sex were explored using logistic regression.

resultsThe sample comprised 185 women (44.2%) and 233 men (55.7%). Overall, 330 patients (78.9%) had at least one documented preventive and/or treatment measure, whereas 88 patients (21.1%) had none. Oral hygiene advice (43.5%; 95% CI 38.7-48.4) and fluoride advice (40.9%; 95% CI 36.2-45.8) were the most frequently documented preventive measures. Dietary enquiry was documented more often than dietary advice (34.4% vs. 16.3%). Professionally applied fluoride treatment was documented for 15.6%. No record contained documentation indicating a theory-based behaviour change approach or salivary secretion measurement. In exploratory analyses, no statistically significant sex-related difference was observed, whereas increasing age was associated with a higher likelihood of documentation.

conclusionsAmong highly caries-active adults in routine public dental care, documentation showed partial alignment with guideline-relevant preventive domains but limited evidence of causal, intensified, and behaviour-oriented caries management. The findings indicate a documentation and implementation gap in adult caries care and provide a baseline for evaluating guideline-aligned preventive practice.