Caries Risk Assessment

Question 1

Dental Caries
(3)

Answer 1

 Multifactorial disease
 Bacterial infection, followed by acid attack
 Trends

Question 2

 Multifactorial disease

Answer 2

 Can be altered by secondary
factors: f luoride, saliva f low,
etc.

Question 3

 Bacterial infection, followed
by acid attack
(2)

Answer 3

 Remin/demin
 Controlled by multiple risk
factors

Question 4

 Trends
 Decline:
 Increase:

Answer 4

fluoride
fermentable
carbohydrate

Question 5

Caries occurs in areas where

Answer 5

plaque accumulates, undisturbed

Question 6

 Each site has a unique
environment that influences
plaque composition, access by
(3)

Answer 6

dietary factors, saliva and anti-
caries factors

Question 7

Site-specific Modifying Factors
(5)

Answer 7

 Pre/post-eruption fluoride exposure
 Patient’s oral hygiene practices
 Biofilm (composition varies person to person, site to
site)
 Saliva flow rate and composition
 Dietary habits

Question 8

Changes in our Understanding
(3)

Answer 8

 Treatable vs controllable
 Fluoride results in slower
progression
 Caries process is dynamic. It can be
arrested or reversed.

Question 9

Caries Prevention Strategies
(6)

Answer 9

Fluoride (highly effective in all forms)
Sealants (highly effective if applied correctly)
Salivary stimulation
Diet modification
Antimicrobial
Non- f luoride remineralizing strategies

Question 10

Fluoride (highly effective in all forms)
(3)

Answer 10

 Water fluoridation
 Professionally applied
 Home delivery

Question 11

Salivary stimulation
(1)

Answer 11

 Chewing gum

Question 12

Diet modification
(2)

Answer 12

 Behavioral
 Protective food additives

Question 13

Antimicrobial
(2)

Answer 13

 Non-specific
 Targeted

Question 14

Casein phosphopeptide stabilized amorphous calcium
phosphate (Recaldent; CPP-ACP)
 Claim:
(2)

Answer 14

 CPP stabilize high concentrations of
calcium and phosphate ions, together
with f luoride ions, at the tooth
surface by binding to pellicle and
plaque
 The ions are supposedly freely bio-
available and can diffuse into enamel
subsurface lesions, thus promoting
re-mineralization

Question 15

Evidence suggests that, under highly favorable
conditions,

Answer 15

Recaldent re-mineralizes artificial lesions
to a modest extent.

Question 16

There is need for

Answer 16

independent, randomized,
controlled studies, under clinically relevant
conditions

Question 17

Bottom line
 “The clinical benefits of CPP-ACP with and without
fluoride in paste form are not yet substantiated by
credible scientific evidence, and thus

Answer 17

it cannot be
recommended at this time. Topically applied fluoride
remains the standard for anti-caries effectiveness…”

Question 18

ADA Center for Evidence Based
Dentistry:
 *There is insufficient evidence from clinical trials
that use of agents containing

Answer 18

calcium and/or
phosphates with or without casein derivatives lowers
incidence of either coronal or root caries.

Question 19

Allergies
(2)

Answer 19

 These products are derived from milk products.
 Patients with dairy allergies should avoid using them.

Question 20

CAMBRA

Answer 20

CAries Management By Risk Assessment

Question 21

determining caries risk
(3)

Answer 21

Caries disease indicators
Caries risk factors
Caries protective factors

Question 22

Caries disease indicators
(3)

Answer 22

□Active caries
□Restorations within 3 years
□Areas of demineralization, including interproximal

Question 23

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Caries risk factors
(9)

Answer 23

□Multiple multi-surface restorations
□Frequent snacking/sugared drinks
□Reduced saliva
□Exposed roots
□Visible, heavy plaque
□Deep pits and fissures
□Ortho
□Recreational drug use
□Physical or mental limitations

Question 24

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Caries protective factors
(10)

Answer 24

□Regular dental care
□Regular professional fluoride treatments/varnish
□Sealants
□Fluoridated water
□Fluoridated toothpaste
□OTC fluoride mouthrinse (daily)
□Rx fluoride daily (5000 ppm)
□Xylitol gum
□Xylitol products
□Adequate saliva flow

Question 25

Caries risk
□Low
□Moderate
□High

Answer 25

(no disease indicators, <2 risk factors, has protective factors)
(no disease indicators, > 2 risk factors (but no caries)
(cavitated lesion(s)/disease indicators OR > 3 risk factors)

Question 26

Saliva
(4)

Answer 26

Cleansing
action
Re-
mineralization
and repair of
enamel
Dilution of
plaque acids
Antimicrobial
Properties

Question 27

Saliva testing for caries
 Salivary bacterial count
(3)

Answer 27

 Detect levels of Strep mutans and lactobacilli
 (Most) require 48-hour incubation period and follow-up
appointment to discuss results
 Chairside tests available (15 minute result)

Question 28

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Saliva Flow/Buffering Capacity
(4)

Answer 28

 Insufficient salivary flow can lead to demineralization
and dental caries
 Influenced by time of day, diet, age, disease, and
medications
 Testing flow rate can aid in caries susceptibility and in
diagnosing salivary gland dysfunction
 Buffer capacity measures response to acid challenge

Question 29

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Aids
(6)

Answer 29

 Saliva substitutes (Biotene products,
Oasis, Hydris)
 Prescription level fluoride (ie.
Prevident 5000 plus)
 Sugar free chewing gum (xylitol?)
 Baking soda
 Meticulous plaque control
 Professional fluoride ‘Homemade
recipe’ (1 cup water, lemon juice,
glycerine)

Question 30

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Diet assessment
(4)

Answer 30

 Provide opportunity for patient to objectively
observe their dietary habits.
 Gain overall picture of types of food in patient’s diet
 To study food habits: ie. frequency and regularity of
foods eaten. (record frequency of cariogenic foods)
 Determine consistency of diet (fibrous vs sticky)

Question 31

Overall objectives:
(2)

Answer 31

 identify specific dietary behaviors that affect caries
risk (identify the high-risk behaviors)
 Enable clinician to open conversation regarding
dietary habits

Question 32

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Diet Diary
(3)

Answer 32

 Record 24 hr period –week-long
 Explain purpose
 Review form/app that you will send home with
patient

Question 33

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Review form/app that you will send home with
patient
(5)

Answer 33

 Encourage to fill out soon after eating
 Record everything eaten, including beverages and
in-between meal snacks.
 Encourage patient to be detailed
 Encourage patient to be truthful
 Consider having patient include when he/she
brushes/f losses

Question 34

Key areas to observe:
(2)

Answer 34

 Number of meals/snacks
 < 6/day (desired)
 > 6/day = increased risk

 Meal/Snack structure
 Structured (desirable)
 Unstructured/grazing = increased risk

Question 35

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Considerations:
(5)

Answer 35

 Garnishes
 Sports drinks
 Chewing gum: sugarless or other?
 Canned fruit: packed in water or heavy syrup?
 Coffee/tea: with sugar?

Question 36

Sugared Beverages-what to observe
 Quantity
(3)

Answer 36

 < 12 ounces/day (desirable)
 12-20 ounces/day = moderate risk
 > 20 ounces/day = high risk

Question 37

Sugared Beverages-what to observe
 Timing
(3)

Answer 37

 With meals (desirable)
 With snacks = moderate risk
 Between meal snacks* = high risk

Question 38

Sugared Beverages-what to observe
 Frequency
(3)

Answer 38

 1 exposure/day = low risk
 2-3 exposures/day = moderate risk
 > 4 exposures/day* = high risk

Question 39

Sugared Beverages-what to observe
Length of exposure
(3)

Answer 39

 < 15 minutes = (desirable)
 15-30 minutes = moderate
 > 30 minutes = high

Question 40

Sugared Beverages-what to observe
Drinking style
(3)

Answer 40

 Straw = (desirable)
 Open container = moderate
 Swishing around in mouth = high

Question 41

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Strategies for making Recommendations
(5)

Answer 41

 Delivery matters—and will improve pt’sreceptiveness
 Determine pt’sunderstanding of diet/disease
 Determine pt’smotivation
 Provide how-to advice
 Engage the patient to increase compliance

Question 42

skipped
 Provide how-to advice
(2)

Answer 42

 Include how-to advice; strategies to achieve outcome
 Provide educational resources