Risk Assessment Flashcards
What are the factors necessary for caries?
tooth
substrate (carbohydrate)
plaque (bacteria)
Which child patients are at higher risk of dental caries?
- children presenting with tooth decay
- children who have had dental caries in their primary dentition and first permanent molars
- been admitted to hospital for removal of their teeth;
- certain children who are medically compromised or have a disability.
Which adult patients are at a higher risk of dental caries?
people with medically compromising conditions or disabilities
older adults, particularly as they become physically or cognitively impaired
Why does risk identification based on a single risk or protective factor have limitations?
due to the multifactorial nature of caries
What are general caries risk factors?
social
general health
What are the local caries risk factors?
Oral Hygiene
Diet
Fluoride Experience
Past Caries Experience
Orthodontic Treatment
What is caries risk assessment?
individually tailored
basis of case management & treatment planning in the short & long term
ongoing re-assessment
What are the 7 elements of caries risk determination?
Clinical Evidence
Dietary Habits
Social History
Fluoride use
Plaque control
Saliva
Medical History
What is the role of diet in caries development?
> 3 sugar intakes per day
High frequency more of an issue than volume of sugar
Highly processed/refined carbohydrate more cariogenic than natural sugars (e.g. sucrose more cariogenic than glucose and fructose)
Natural sugars still cause harm e.g lactose in Early Childhood Caries
What should be used to analysed diet?
four day diet diary including one/two days at the weekend
What examination provides clinical evidence?
physical
What are clinical factors that increase risk of caries?
Caries Experience
dmft > 5 (primary dentition), DMFT > 5 (permanent dentition)
caries in 6’s at 6 years
3 year caries increment > year
Orthodontics
Fixed appliance therapy
Prosthetics
Fixed or removable
What are the social history factors that could impact caries risk?
SIMD category (social index multiple depravation)
Education
Unemployment
Work stressors
Single parent families
Violence
Inequalities and access to healthcare
Dependents
What is the role of fluroide in caries development?
Infrequent use of F- toothpaste
No F- in Water supply
Professionally applied fluoride
What does fluoride do?
forms caries resistant flurorapitite
antimicrobial effect
reduces ability of bacteria to stick to the surface of the teeth
What is the role of plaque control in caries development?
- Poor technique
- Irregular brushing
- Unassisted (very young/very old, those with manual dexterity issues)
- Access to toothbrush/toothpaste
- Difficulty due to changes (mixed dentition/orthodontics/gaps/recession)
What is the role of saliva in caires development?
Amount
Flow
Buffering Capacity
pH
Viscosity
What is the role of medication on caries development?
Xerostomia (desired effect/side effect e.g. scopolamine patches/asthma inhalers)
Other drug side effects making OH difficult e.g.Mucositits
Free sugars to make medicine more palatable (lactulose)
Frequency of sugar containing medicine
Recreational drug use/rehabilitation from
drug addiction
Social convention of how we act towards people who are ill- bring them sweets!
What are the social factors that impact child caries?
Mother’s education secondary only
Poor dental attender
Family Unit: single parent, social class, unemployment
What are the health factors that impact child caries?
Poor health/chronic sick
Sugar-based medications
What are social/behaviourial factors that affect infant caries?
mother’s caries rate
prolonged nursing habits
bottle/ pacifier at bedtime
cariogenic snacking
No tooth cleaning
Little Fluoride exposure
When should you start brushing infant teeth?
as soon as they erupt
What are factors associated with a typical high risk adult?
Level of education
Attends only when they identify a problem
Social difficulties
“Sweet tooth” with poor OH
Secondary caries
Medication that impacts oral health
What are the eight elements of the preventative program?
Radiographs
Toothbrushing instruction
Strength of F in toothpaste
F varnish
F supplementation
Diet advice
Fissure sealants
Sugar free medicine
