Efficacy of an adenosine triphosphate meter for evaluating caries risk in clinical dental practice

Abstract Background Adenosine triphosphate bioluminescence (ATP-B) readings have been proposed as markers of caries risk. ATP readings may indicate bacteria or oral streptococci activity in microbial plaque. The authors of this study aimed to evaluate whether readings using a commercial ATP meter (CariScreen Testing Meter, Oral BioTech) are significantly different for patients with low, moderate, and high caries risk in the Caries Management by Risk Assessment Practice-Based Research Network study. Methods Twenty practice-based research network dentists enrolled 460 patients; 271 returned for 2 or more semiannual follow-up visits over 2 years. Dentists were trained and calibrated to perform ATP-B testing and caries risk assessment (CRA) using established protocols. ATP-B readings were compared via CRA category (low, moderate, high). Generalized estimating equations were used to compare the risk of experiencing incident clinical outcomes (newly recorded decayed, missing, or restored tooth surfaces and CRA disease indicators) according to ATP-B reading at prior patient visits (≥ 1,500 versus Results Median ATP-B readings did not differ statistically significantly by clinician-assessed caries risk level (low, 2,323; moderate, 2,940; high, 3,217; P = .65). Adjusted for patient demographics and trial intervention assignment, higher readings were not associated with newly developed decayed, missing, or restored tooth surface (relative risk, 1.57; 95% confidence interval, 0.55 to 4.45) or disease indicators (relative risk, 1.08; 95% confidence interval, 0.85 to 1.37) at the following visit, whereas clinician-assessed caries risk level was strongly associated. Conclusions ATP-B readings poorly predicted caries risk and future clinical outcomes. CRA incorporating multiple risk, protective, and disease indicators has superior predictive performance. Practical Implications The findings of this study do not provide evidence supporting the use of ATP-B to predict caries risk.