Caries risk assessment and Prevention Planning Flashcards
What is caries
multifactorial, dynamic process caused primarily by
the complex interaction of cariogenic bacteria with
fermentable carbohydrates on a tooth surface over time
Caries occurs when
the net demineralising flux prevails
over the net remineralisation flux
Caries risk factors are
Anything that affects this balance
Caries balance- pathological factors that result in demineralisation ie caries?
Acid producing bacteria
Sub normal saliva flow and/function
Frequent eating/drinking of fermentable carbohydrates
Poor oral hygiene
Caries balance-
Protective factors resulting in remineralisation ie no caries?
Saliva flow and components
Remineralisation (fluoride, calcium, phosphate)
Antibacterials (flouruide, chlorhexadine, xytilol)
Good oral hygiene
What is the caries risk in NI?
Decay in primary and permenant teeth
Children’s dental health
survey (CDHS), UK 2013
Obvious decay at
5 years
NI 40 percent
Obvious decay at
15 years
England 31% 32% 44%
Northern Ireland 40% 57% 72%
What is the caries risk in NI?
Decay in primary and permenant teeth
Children’s dental health
survey (CDHS), UK 2013
Obvious decay at
12 years
57 percent
What is the caries risk in NI?
Decay in primary and permenant teeth
Children’s dental health
survey (CDHS), UK 2013
Obvious decay at
15 years
72 percent
What percentage of
12 year olds
15 year olds
reported experiencing difficulty eating
in the past three months.
22 percent of 12 year olds
19 percent of 15 year olds
What percentage of 12 year olds and 15 year olds reported to be embarrassed to smile or laugh due to the condition of their teeth?
35 percent of 12 year olds
28 percent of 15 year olds
What percentage of parents of 15 year olds reported that their child’s oral health has impacted on family life in the past 6 months?
35 percent
What percentage of parents off 15 year olds took time of work because of their child’s oral health in that period?
23 percent
When does the first caries risk assessment occur?
By 1 year of age or when first tooth erupts
Children can be classified as … caries risk
Low or high
Caries risk assessment is
And it predicts
Comprehensive assessment using medical dental and social status for risk of caries development
Also predicts the rate of disease progression
What are some Some Evidence Based Risk Indicators
SDCEP, 2018
*Previous Caries experience (any decayed, missing or filled teeth)
*Visible plaque on maxillary incisors is excellent predictor in young children
*Caries in primary teeth increases caries risk in permanent teeth
*Resident in an area of deprivation
*Caries/restorations in anterior teeth
. Healthcare worker’s opinion
When should caries risk assessment be carried out?
*Should be done regularly as can change/ is non static
*Caries risk assessment is undertaken as part of the
history and examination and
*Determination of caries risk assessment should be
undertaken before formulating a treatment plan
Caries risk assessment factors to consider… History?
. Diet
*Drinks- Use of sweetened drinks regularly/bottle in bed
*Previous and current caries experience
*Significant Medical History e.g. Special needs, chronic ill
health (increased risk of developing disease or increased
risks associated with management of disease), regular
sugar containing medication.
*Salivary flow, xerostomia, previous radiation
*Poor oral hygiene
*Fluoride usage
*Family caries
experience (consider parents, siblings)
*SES and mother’s education
*Regular dental attendance
Caries risk assessment factors to consider - dental
*Visible plaque
*Gingivitis
*Hypomineralisation/ hypoplasia of enamel
*Deep pits/ fissures
*Defective restorations
Caries risk assessment factors to consider
Other
Radiographic caries
High caries risk
CO
Toothache, yellow teeth
Low caries risk
CO
No concerns
High caries risk
HPC
Low caries risk
Nocturnal pain
——
High caries risk
PMH
Sugar containing medications
Medications causing xerestomia
Autism
Low caries risk
PMH
Healthy child
PDH
High caries risk
Previous fillings
No LA ie temporary fillings
PDH
Low caries risk
Regular dental visits
SHx
Age
Drinks bottles
snacking/ diet
Brushing
High caries risk
3 years old
Bottle milk to bed, juice, no H20
Frequent snacks, poor eater
Brushing themselves
SHx
Age
Drinks bottles
snacking/ diet
Brushing
Low caries risk
6 years old
Water/milk main drink
3 meals, 2 snacks
Brushes twice a day, parent, F toothpaste
Family Hx
High caries risk
Single mother
Siblings have had teeth out
Family Hx
Low caries risk
Siblings have no Hx of GA extractions
Dental Hx
High caries risk
Poor oral hygiene
Cavities
Temporary fillings/fillings
Hypomineralisation/hypoplastic enamel
Dental Hx
Low caries risk
Good oral hygiene
Has fissure sealants
For young children what exam may you have to perform?
Knee to knee exam
Treatment Planning in Paediatric Dentistry:
Principles
. Must be individualised
*Should foster a positive dental attitude
*Whilst aiming for adulthood with optimal dental health
. Realistic and flexible and achievable
Each treatment plan should compromise:
. Relief of pain
. Prevention *
. Behaviour management/ acclimatisation
. Operative procedures …
. Recall and reinforcement of preventative advice*
Each treatment plan should compromise… operative procedures…
*Consider stabilization
*Logical treatment progression building on each
previous visit
*Prioritise 6’s
Caries caries risk should be considered when planning what things?
- Radiographic Investigations Frequency
- Preventive care/ Interventions
- Operative treatment
- Recall Interval
Radiographic investigations frequency-
High caries risk?
*6-12 monthly BWs until no new or active
lesions are apparent
Low caries risk?
*BW radiographs taken at 12-18 month intervals in
primary
2 year intervals in permanent
When are baseline BWs taken?
For this patient-
*5 year old, No parental concerns, no clinical decay,
brother had dental decay
From 4 years old, when contacts close
Prevention of caries document?
Toolkit for delivering better oral health- must learn !
See summary guidance for primary care needs
Under 3, 3-6 years, 0-6 year etc.
The tables
(3rd year lectures)
Advice for babies - bottle?
If on a bottle at night only drink water
Never put juice, sweetened milk/soya milk in bottle- cultural variations
Stop bottle by 1 y/o
Advice for babies- brushing
*X2 daily brushing with smear > 1000 ppm F tooth paste
Advice for babies-
Food and drink
Reduce frequency of sugary foods and drinks
Advice for babies-
Free flowing cup
Free flowing cup by 3 months
Operative treatment- caries risk may affect
Possible need for stabilisation stage
What is the material choice in proximal lesions?
–Pulp Rx/conventional PMC
–Hall Crown
–Composite
–RMGIC
—Extraction
Recall interval for children?
3, 6 or 12 months
What else does NICE 2004 say about recall intervals?
These should be considered at every assessment and agreed with carer
Remember that the rate of caries progression can be more rapid in children
