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CARIES RISKASSESSMENT ANDMANAGEMENT FOR THEPROSTHODONTICPATIENT5조 60. Kanguk Joo
Purpose of this article To review how caries risk assessment of theprosthodontic patient can result in meaningfulcaries management and a more favorableprosthodontic outcome. To outline considerations on caries riskassessment for improved caries managementin the prosthodontic patient.
Preventive treatment plan Involve the patient in disease control The importance of a caries reduction programduring and following prosthodontic treatmentshould be thoroughly discussed with the patientprior to initiating treatment. Fluoride in various forms In prosthodontic patients with gingival recessionwith other risk factors for caries, a fluoride varnishon root surfaces three times annually is warranted.
Preventive treatment plan Chlorhexidine Because of staining and impact ontaste, chlorhexidine use should be limited toseven consecutive days a month. Recommendeddosage is 10 ml of a 0.12% rinse for 1 minute atnight at least 1 hour after brushing withfluoridated toothpaste and after removing anyprosthesis.
Preventive treatment plan Xylitol Although the independent variables of unit dose,frequency of chewing, and time chewing have notbeen thoroughly evaluated, patients at high riskfor caries should chew xylitol-containing gumtwice daily for 15 minutes with a total xylitol doseof 7 to 10 g per day.
Preventive treatment plan Combination of xylitol and chlorhexidine Elderly partially and completely edentulouspatients with caries and denture stomatitis and/orangular cheilitis would benefit from chewing gumcontaining both xylitol and chlorhexidine. Sincethe product studied by Simons et al is notcurrently available in the United States, the use ofxylitol gum daily and 10 ml of a 0.12% rinse ofchlorhexidine 1 day a week is a viable alternative.
Preventive treatment plan Amorphous calcium phosphate Although studies of CCP-ACP are somewhatcontroversial, there appears sufficient evidence ofcaries reduction potential to recommend its use,especially in patients with root exposure.Application follows the use of fluoridatedtoothpaste twice a day using a cotton swab, afinger, or a custom tray.
Preventive treatment plan Stimulation of salivary flow Patients with diminished saliva flow should becounseled managing the condition, including theadvantages of a low-sugar diet and on possiblerelief provided by the products discussed above.Sipping frequently on water that contains twoteaspoons of baking soda in 8 oz of water willhelp hydrate the mouth and neutralize bacterialacids generated in the plaque.
Conclusion Management of caries risk may include patientbehavioral modification, chemical control ofthe biofilm, stimulation of salivary flow, and/orthe supplement of constituents to favorremineralization over demineralization. Successful management of the patient’s cariesrisk will ultimately result in more enduringprosthodontic outcomes.