Caries Risk Assessment Flashcards
Dental Caries
(3)
Multifactorial disease
Bacterial infection, followed by acid attack
Trends
Multifactorial disease
Can be altered by secondary
factors: f luoride, saliva f low,
etc.
Bacterial infection, followed
by acid attack
(2)
Remin/demin
Controlled by multiple risk
factors
Trends
Decline:
Increase:
fluoride
fermentable
carbohydrate
Caries occurs in areas where
plaque accumulates, undisturbed
Each site has a unique
environment that influences
plaque composition, access by
(3)
dietary factors, saliva and anti-
caries factors
Site-specific Modifying Factors
(5)
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
Changes in our Understanding
(3)
Treatable vs controllable
Fluoride results in slower
progression
Caries process is dynamic. It can be
arrested or reversed.
Caries Prevention Strategies
(6)
Fluoride (highly effective in all forms)
Sealants (highly effective if applied correctly)
Salivary stimulation
Diet modification
Antimicrobial
Non- f luoride remineralizing strategies
Fluoride (highly effective in all forms)
(3)
Water fluoridation
Professionally applied
Home delivery
Salivary stimulation
(1)
Chewing gum
Diet modification
(2)
Behavioral
Protective food additives
Antimicrobial
(2)
Non-specific
Targeted
Casein phosphopeptide stabilized amorphous calcium
phosphate (Recaldent; CPP-ACP)
Claim:
(2)
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
Evidence suggests that, under highly favorable
conditions,
Recaldent re-mineralizes artificial lesions
to a modest extent.
There is need for
independent, randomized,
controlled studies, under clinically relevant
conditions
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
it cannot be
recommended at this time. Topically applied fluoride
remains the standard for anti-caries effectiveness…”
ADA Center for Evidence Based
Dentistry:
*There is insufficient evidence from clinical trials
that use of agents containing
calcium and/or
phosphates with or without casein derivatives lowers
incidence of either coronal or root caries.
Allergies
(2)
These products are derived from milk products.
Patients with dairy allergies should avoid using them.
CAMBRA
CAries Management By Risk Assessment
determining caries risk
(3)
Caries disease indicators
Caries risk factors
Caries protective factors
Caries disease indicators
(3)
□Active caries
□Restorations within 3 years
□Areas of demineralization, including interproximal
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Caries risk factors
(9)
□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
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Caries protective factors
(10)
□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
Caries risk
□Low
□Moderate
□High
(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)
Saliva
(4)
Cleansing
action
Re-
mineralization
and repair of
enamel
Dilution of
plaque acids
Antimicrobial
Properties
Saliva testing for caries
Salivary bacterial count
(3)
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)
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Saliva Flow/Buffering Capacity
(4)
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
skipped
Aids
(6)
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)
skipped
Diet assessment
(4)
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)
Overall objectives:
(2)
identify specific dietary behaviors that affect caries
risk (identify the high-risk behaviors)
Enable clinician to open conversation regarding
dietary habits
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Diet Diary
(3)
Record 24 hr period –week-long
Explain purpose
Review form/app that you will send home with
patient
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Review form/app that you will send home with
patient
(5)
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
Key areas to observe:
(2)
Number of meals/snacks
< 6/day (desired)
> 6/day = increased risk
Meal/Snack structure
Structured (desirable)
Unstructured/grazing = increased risk
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Considerations:
(5)
Garnishes
Sports drinks
Chewing gum: sugarless or other?
Canned fruit: packed in water or heavy syrup?
Coffee/tea: with sugar?
Sugared Beverages-what to observe
Quantity
(3)
< 12 ounces/day (desirable)
12-20 ounces/day = moderate risk
> 20 ounces/day = high risk
Sugared Beverages-what to observe
Timing
(3)
With meals (desirable)
With snacks = moderate risk
Between meal snacks* = high risk
Sugared Beverages-what to observe
Frequency
(3)
1 exposure/day = low risk
2-3 exposures/day = moderate risk
> 4 exposures/day* = high risk
Sugared Beverages-what to observe
Length of exposure
(3)
< 15 minutes = (desirable)
15-30 minutes = moderate
> 30 minutes = high
Sugared Beverages-what to observe
Drinking style
(3)
Straw = (desirable)
Open container = moderate
Swishing around in mouth = high
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Strategies for making Recommendations
(5)
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
skipped
Provide how-to advice
(2)
Include how-to advice; strategies to achieve outcome
Provide educational resources
