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[Agency] AHRQ-Indian Health Service [Project Title] Fluoride Effectiveness in Prevention of Dental Caries in High Caries Risk Adults [Institution] BOSTON UNIVERSITY MEDICAL CAMPUS [Amount] $0 [Summary] The proposed work addresses several of the Institute of Medicine's (IOM's) national priorities in clinical effectiveness research: disparities in oral health and health care. Combining extant dental data with other components of the rich VA patient databases, we will be able to examine the effectiveness of fluoride in preventing caries in patients with five of the 14 priority conditions specified by AHRQ: medically compromised veterans with dementia, depression and bipolar disorder, diabetes, HIV-Aids and persons with alcohol dependence. Recent data suggest that dental caries is as much of a problem in adults as children (Dye, et al., 2007). However, significant knowledge gaps remain in our knowledge base regarding prevention of caries in adults (Griffin et al., 2007). Using an extant, rich electronic data base from a health care system providing dental treatment to over 342,000 veterans annually, this proposed retrospective, longitudinal study takes maximum advantage of a unique opportunity to examine the following specific aims in a population of medically complex veterans. Aim 1. Examine the effectiveness of prescription-strength, self-applied fluoride and professionally applied fluoride in the prevention of caries in medically compromised veterans who are at high risk for caries. Veterans will be defined as at risk for caries if they have had two or more restorations in the previous year. Aim 2. While recent evidence suggests that fluoride is effective in preventing caries in adults, and multiple exposures to fluoride reduces caries risk in children (Weintraub, 2006), limited data exist showing that multiple exposures or modalities are more effective than a single modality in adults. Thus, we have a unique opportunity to examine whether multiple exposures to fluoride will be more effective than a single exposure. Aim 3. Over the past year, the Department of Veterans Affairs introduced a quality measure (the fluoride monitor) that examines, on a quarterly basis, the percent of veterans at high risk for caries who receive fluoride treatments. This project will examine the effectiveness of the introduction of this fluoride monitor in reducing the rate of restorations in medically compromised veterans at high risk for caries. [Completion/ Closing Date] 10/02/2010 [Link] link [Category] 
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