Caries Risk Assessment Flashcards
How is risk assessed in caries?
Caries are managed by a risk assessment which takes an evidence based approach to prevent or treat the cause of dental caries at any early stages rather than waiting for irreversible damage.
What are indicators of dental caries?
White spot lesions
Restorations placed in the last 3 years
Proximal caries confined to enamel
Cavitation of caries into dentine
What are the risk factors for dental caries?
Cariogenic bacteria
Absence of saliva
Lifestyle habits that contribute to the disease
What does the caries risk management form used at UWA dental school ask about?
Modifying risk factors
Diet analysis
Fluoride history
Caries experience
Plaque score
Salivary and bacterial clinical tests
What kinds of medications cause xerostomia?
Prescribed meds
Over the counter meds
Recreational drugs
What kinds of systemic disease cause dry mouth?
Primarily from diseases such as autoimmune disorders
Secondary by means of the disease management
What are some caries modifying factors?
Lifestyle factors including sugar intake, oral hygiene, smoking, and fluoride.
Prostheses increase plaque accumulation and make cleaning more difficult.
Fluoride history (Water supply as well as toothpaste)
PAST EXPERIENCE WITH CARIES IS THE BIGGEST INDICATOR
What increases caries prevalence?
Sugary food
Snacking
Milk bottle feeding at night
Carbonated drinks
Where can carious lesions arise?
Pit and fissure lesions
Smooth surface lesions
Carious lesion site can be hidden or exposed. Hidden caries are harder to detect and require additional diagnostic imaging.
What is dental plaque?
Dental plaque has been defined as the nonmineralized microbial accumulation that adheres tenaciously to tooth surface, restorations and prosthetic appliances, shows structural organization with predominance of filamentous forms, is composed of an organic matrix derived
from salivary glycoproteins and extracellular microbial products, and cannot be removed by rinsing or water
spray
What oral hygiene indices are used?
Oral hygieve index (greene and vermiliion)
Simplified Oral Hygiene Index, OHI-S
Silness-Loe Index
Quigely Hein index
Plaque control record (Plaque score)
What are the 5 key roles of saliva?
Lubrication and protection
Buffering action and clearance
Maintenance of tooth integrity
Antibacterial activity
Taste and digestion
What are the 5 steps of saliva testing?
Step 1: Resting saliva hydration
Step 2: Resting saliva viscosity (watery vs bubbly)
Step 3: Resting saliva pH (Red = acidic, yellow = moderate, and healthy saliva = green)
Step 4: Stimulated saliva quantity (<3.5ml = red, 3.5 - 5.0ml = yellow, and >5.0ml = green)
Step 5: Stimulated saliva buffering capacity
How is the strep mutans test done?
Chew the wax, collect saliva
Add 1 drop of reagent
Add 4 drops of reagent 2, shake until saliva sample becomes green
Dispense 3 scales of saliva in the sample window of the test device and wait 15 minutes
After 15 minutes observe the control line C and result in Test window T (positive result - either a faint or clear red line appearing means there are over 500000, negative result - no red line appearing means there are less than 500000 of 5 minutes)
What is the caries balance between?
Pathological factors and protective factors.
Pathological factors include acid producing bacteria, frequent eating/drinking of fermentable carbohydrates, sub-normal saliva flow and function.
Protective factors: Saliva flow and components, fluoride (remineralization with calcium and phosphate), and antibacterials
What is the evidence for effectiveness of caries management by risk assessment?
Randomised controlled trial conducted from 1999 to 2005.
Examined the concept of the caries balance and whether altering that balance could reduce new dental caries.
Adults aged 18 to 65 y who had 1 to 7 cavities.
Control group was patients who continues with conventional treatment.
Test group had an intervention that consistsed of a combination of fluoride mouth rinse, fluoride toothpaste, and 0.12% chlorhexidine gluconate mouth rinse.
RESULTS:
A statistically significant reduction in 2 year caries increment in initially high-caries-risk patients provided with the combined therapeutic intervention.
Placing restorations did not significantly affect mean bacteria levels in the mouth, either initially or over a 2 year follow-up period after restorative work was complete.
In the control group ~70% of the subjects returned with new cavities.
Which bacteria in the mouth were related to a high number of decayed surfaces? What does this tell us about treating caries?
High numbers of decayed surfaces at baseline were correlated to high levels of mutans streptococci and lactobacilli.
Caries reduction was mediated by combined action of changes in salivary bacterial levels and fluoride concentration, as well as additional unmeasured factors.
How should low caries risk patients be managed?
Low risk: Recall exams every 6 months, radiograph examinations as necessary, saliva tests at baseline, twice daily toothbrushing using fluoride toothpaste.
How should caries moderate risk patients be managed?
Recall exams every 6 months, radiograph examinations as necessary, saliva tests at baseline and recall exam, twice daily toothbrushing using fluoride toothpaste and fluoride varnish application, dental sealant for children under 6 years old.
How should caries high risk patients be managed?
Recall every 3 months, radiograph examinations as necessary, saliva tests at baseline and recall exam, twice daily toothbrushing using fluoride toothpaste and fluoride varnish application, antimicrobial mouthwash for one week every month, dental sealant is recommended.
How should caries extreme risk patients be managed?
Recall exams every 3 months
Radiograph examinations as necessary
Saliva tests at baseline and recall exam
Twice daily toothbrushing using fluoride toothpaste and fluoride varnish application
Antimicrobial mouthwash for one week every month
Acid neutralising mouthwash
Dental sealant is recommended
How should a patient with the following characteristics be treated: 18 year old, loves energy drinks, snacks more than 2 times a day, brushes once a day, and has a dental cavity?
- Take dental and medical history.
- Conduct clinical examination.
- Detect caries lesions early enough to reverse or prevent progression.
- Assess the caries risk as low, high, moderate, or extreme using data from 1, 2, and 3 and a short questionnaire.
- Produce a treatment plan that includes chemical therapy appropriate to the caries risk level.
- Use chemical therapy that includes fluoride and/or antibacterial agents based on risk level.
- Use minimally invasive restorative procedures to conserve tooth structure and function.
- Recall and review at intervals appropriate to the caries risk status.
- Reassess caries risk level at recall and modify the treatment plan as necessary
