Caries risk assessment

1. CARIES RISK
ASSESSMENT
PRESENTEd by ElENA ToRN
CouRSE: dENTAl HygIENE
FouNdATIoN II

2. Dental Caries
• Infectious
• Communicable
• Transmissible

3. Why caries risk assessment is
important?
• Prediction of disease
• Prevention of disease
• Elimination of disease
• Reversion of the
lesion
• Allows to avoid
unnecessary trauma,
pain, fear, expense

4. Main etiological factors identified by
the survey
• Oral self care
methods
• Dietary habits
• Medical history
aspects
• Fluoride exposure
• Hereditary factors

5. Low caries risk category
• No caries lesion in past 3 years
• OSC: regular, at least 2x day brushing and
flossing
• No habit of snacking or sipping on
sweetened juices
• Optimal exposure to fluoride
• Presence of sealants
• No family history of caries

6. Moderate risk category
• 1 carious lesion restored in past year
• Irregular OSC: brushing 1-2 times per day,
no flossing
• Occasional snacking and sipping on sweet
beverages
• Sealants done
• Inadequate fluoride use

7. High caries risk
• 2 or more caries
lesions in past year
• Poor OSC habits
• Constant snacking
habits
• Orthodontic treatment
• No sealants done
• No use of fluoride
• Family history of
caries

8. Subject A
• Female, 40 years old, Caucasian
• Fair OSC, but no flossing
• Occasional snacking
• I cavity in past year, none-in previous
• Has sealants
• Regular exposure to fluoride, not fluoridated
community
• Family history of caries
Moderate risk category

9. Subject B
• Male, 53 years, Caucasian
• Brushing 1-2 times a day, no flossing
• Regular snacking, drinking of sweet drinks
• Irradiation treatment 8 years ago
• 1 cavity in past year, and 1- in previous
• In-office fluoride treatment-twice a year, lives in
fluoridated community
High risk category

10. Subject C
• Male, 14 years, Caucasian
• Irregular OSC, no flossing
• Constant snacking on candies, and drinking of
juice
• 9 cavities
• Irregular fluoride exposure, not fluoridated
community
• Positive caries family history
High risk category

11. Subject D
• Female, 11 years, Caucasian
• Fair OSC, occasional flossing
• Detrimental snacking habits
• Adequate fluoride exposure
• No cavities in past year, 2- in previous
• Sealants done
• Current orthodontic treatment
• Positive family history of caries
High risk category

12. Subject E
• Female, 19 years, Caucasian
• Good brushing habits, no flossing
• Adequate fluoride exposure
• No snacking habits
• No family history of caries
• No cavities in 3-4 years
Low risk category

13. Possible behavior modifications
• Sugar consumption:
1. Frequency
2. Food form
3. Acid content
4. Oral clearance
• Regular flossing

14. Possible behavior modifications
• Fluoride exposure
Community water
Home care:
0.05%-daily or 0.2% weekly
Professionally applied
fluorides:
2% NaF, 1.23% APF, 8.0%
SnF
5.0% NaF varnish (43.9%
caries reduction)
NB! 76.3% caries reduction
for sealants

15. Possible behavior modifications
Antibacterial rinses:
Chlorhexidine gluconate
0.12%-against S.mutans
10 ml for 1min, daily for
2-week period, every 2-
3 months
Xylitol-chewing gum or
lozenges
Sodium bicarbonate-
neutralizes acids

16. Professional prevention of caries
development
• Sealants produce caries reduction of 33%
• Fluoride varnish containing antimicrobial
• 5% NaF 3 times x week resulted in 46-67%
caries reduction
• Argon laser irradiation
• Client education and motivation

17. Interesting fact/ revolutionary idea
• Rodent studies conducted in 1950s revealed S
mutans as a primary etiologic factor
• Undetected S. mutans in infected clients due to
excellent oral hygiene
• Latest studies prove that S.mutans can exist on
teeth without causing caries
• “The biofilm concept suggests that S. mutans
may not be the principle etiological agent of
caries,…(caries is) a complex disease caused
by a physiological disequilibrium between tooth
mineral and biofilm.” (Oral Care Report-Nov 1,
2006)

18. REFERENCES
• Anusavice K.J. (2005). Present and future approaches for the control of caries. The
journal of Dental Education, 69(5): 538-554.
• Bravo M., Montero J., Bravo J.J., Baca P., Llodra J.C. (2005). Sealant and fluoride
varnish in carries: a randomized trial. J Dent Res 84(12): 1138-1143.
• Carberry F.J., Hazelwood A.E. (2001). Compendium of continuing education in oral hygiene, 8:
10-17.
• Darby M.L. (2006). Comprehensive Review of Dental Hygiene. (p. 649). Elsevier: Mosby
• Marinho V., Sheiham A., (2004). Report on the Cochrane fluoride reviews informing about the
importance of effective use of topical fluorides. Web site
• http://mednet3.who.int/EML/expcom/expcom14/sodium_fluoride/ORH_statement_application.pdf
• Pimlott J.F. (1999). Professionally applied topical fluorides: providing optimal patient care using
an evidence-based approach. Probe Scientific Journal 33(6): 175-179.
• www.ibiblio.org
• canales.laverdad.es
• www.lib.umich.edu
• www.geocities.com
• www.sudarlacamiseta.com
• Changing concepts on dental caries (2006). Oral Care Report, 16, pp.6,10.