L13 Risk Assessment for Caries/Perio

Question 1

What is a risk assessment?

Answer 1

The process of determining that a specified negative event will occur to you or other people, so that you can minimise the chance of risk occuring.

Question 2

What is our role as clinicians in terms of risk assessment?

Answer 2

We should:

• Identify the assocaited risk factors
• Determine how to control such risk factors

Question 3

What is included on the risk assessment page of the adult dental assessment form?

Answer 3

• Caries
• Periodontal
• TSL
• Soft tissues
• Endodontic

All categorised as high, moderate or low.

Question 4

What factors should be taken into consideration in a risk assessment for caries?

Answer 4

• OHI (collected in dental history)
• Diet (type of food and frequency)
• Oral environment (e.g. xerostomia)
• Age

Question 5

How are caries classified by site?

Answer 5

• Pits and fissures
• Smooth surface (interproximal and cervical)
• Exposed root surface

Question 6

How are caries classified by rate of attack?

Answer 6

• Rapidly progressive (acute or rampant)
• Slowly progressive
• Arrested

Question 7

What can be the effects of lateral spread of caries through dentine at the ADJ?

Answer 7

• Undermined enamel
• Fractures
• Further cavitation

Question 8

What are specific risk factors for root caries?

Answer 8

• Cariogenic diet
• Gingival recession/exposure of root surface
• Poor oral hygiene
• Decreased salivary flow
• Age of patient/increased age
• Lower socio-economic group

Question 9

What are methods of caries prevention?

Answer 9

• OHI
• Diet advice
• Fluoride varnish
• High strength fluoride toothpaste (2800 or 5000ppm)
• Fissure sealants

Question 10

How can we assess a patient’s current oral hygiene, diet and fluoride use?

Answer 10

• Plaque scores
• Diet sheet
• Dental history
• Presence or absence of new active caries since last checkup

Question 11

What are local risk factors for periodontal disease and what 3 categories are they divided into?

Answer 11

Anatomical:
- Calculus
- Enamel pearls
- Root grooves
- Furcations
Tooth position:
- Malalignment
- Crowding
- Tipping
- Migration
Iatrogenic:
- Overhanging restorations and margins
- Partial dentures
- Orthodontic appliances

Question 12

What are systemic risk factors for periodontal disease and what 2 categories are they divided into?

Answer 12

Modifiable:

• OHI
• Smoking
• Diabetes (how well controlled)
• Stress
• Obesity
• Immunodeficiency
• Medications
• Poor nutrition
• Osteoporosis

Non-modifiable:

• Age
• Genetics
• Hormonal influences (e.g. pregnancy)

Question 13

How can we modify overhanging restorations?

Answer 13

Make them cleansable:

- Modify with a bur or interproximal strip (Soflex)

Question 14

What advice can be given to pevent periodontal disease?

Answer 14

• OHI, demonstrate interproximal cleaning
• Smoking cessation
• Make sure diabetes is well controlled