Pitts N B, Richards D
Monogr Oral Sci. 2009;21:128-143. doi: 10.1159/000224217. Epub 2009 Jun 3.
This chapter aims to outline a flexible framework which the dental team can use to bring together key elements of information about their patients and their patients' teeth in order to plan appropriate, patient-centred, caries management based on the application of best current evidence and practice. This framework can be enabled by the use of the International Caries Detection and Assessment System (ICDAS) clinical visual scoring systems for caries detection and activity, but also needs additional information about lesions and the patient to plan and then monitor the effectiveness of personalized caries care. The treatment planning process has evolved from restorative treatment decisions being largely made during clinical assessment as an examination of wet teeth proceeds, with limited charting and a minor role for patient factors. Best practice now involves a comprehensive examination being made systematically of clean dry teeth using sharp eyes and blunt probes. The ICDAS-enabled framework provides for information to be collected at the tooth/surface level (clinical visual lesion detection, lesion detection aids and lesion activity assessment) and at the patient level (patient caries risk assessment, dentition and lesion history and patient behavioural assessment). This information is then synthesized to inform integrated, personalized treatment planning which involves the choice of appropriate treatment options (background level care, preventive treatment options, operative treatment options) and then recall, reassessment and monitoring. Examples of international moves towards using integrated, personalized treatment planning for caries control are given, drawing on experiences in the UK, the USA and from the ICDAS Committee.
本章旨在概述一个灵活的框架，牙科团队可利用该框架整合有关患者及其牙齿的关键信息，以便基于当前最佳证据和实践，制定以患者为中心的适当龋病管理计划。国际龋病检测与评估系统（ICDAS）临床视觉评分系统可用于龋病检测和活性评估，从而实现该框架，但制定和监测个性化龋病护理的有效性还需要有关病变和患者的其他信息。治疗计划流程已有所演变，过去在临床评估过程中，随着对湿牙的检查进行，修复治疗决策主要基于此做出，记录有限，患者因素作用较小。如今的最佳实践是使用锐利的眼睛和钝头探针，对清洁干燥的牙齿进行系统全面的检查。基于ICDAS的框架规定在牙齿/表面层面（临床视觉病变检测、病变检测辅助工具和病变活性评估）以及患者层面（患者龋病风险评估、牙列和病变病史以及患者行为评估）收集信息。然后综合这些信息，为综合的、个性化的治疗计划提供依据，该计划包括选择合适的治疗方案（基础护理、预防性治疗方案、手术治疗方案），随后进行复诊、重新评估和监测。文中借鉴了英国、美国以及ICDAS委员会的经验，列举了国际上在龋病控制方面采用综合、个性化治疗计划的实例。
