2. Definition of risk assessment.
• Risk assessment are procedures used in medical
practice normally to have sufficient data to
accurately quantitate a person’s disease
susceptibility and allow for preventive measures.
• Caries-risk assessment models involve a
combination of factors including diet, fluoride
exposure, a susceptible host, and micro flora that
interplay with a variety of social, cultural, and
behavioral factors
3. Risk assessment in children
• Every child should begin to receive oral health
risk assessments by 6 months of age by a
qualified pediatrician or a qualified pediatric
health care professional. Children at high risk
should be referred to a dentist as early as 6
months of age and no later than 6 months
after the first tooth erupts or 12 months of
age.
4. Infants at risk involve:
• Children with special health care needs.
• Children of mothers with a high caries rate.
• Children with demonstrable caries, plaque,
demineralization, and/or staining.
• Children who sleep with a bottle throughout the
night.
• Later-order offspring.
• Children in families of low socioeconomic status.
5. History taking in assessing risk in
infants
• Questions directed at: dietary practices,
fluoride exposure, oral hygiene, utilization of
dental services, and the number and location
of the mother’s dental fillings can give a
relative indication of the mother’s baseline
decay potential.
6. • Frequent sugar intake, low fluoride exposure,
poor oral hygiene practices, infrequent
utilization of dental services and/or active
decay and/or multiple dental fillings in
multiple quadrants of the mouth indicates a
high caries risk in the mother
8. Assessing environmental risk factors
• LOW RISK:
• Adequate fluoride exposure (supplements, water,
dentifrice, etc.)
• Primarily consumes sugary or starchy foods/drinks only
at mealtimes
• No family history of carious lesions in past 24 months
• MODERATE RISK:Patients who exhibit any of the
following conditions may be considered at Moderate
Risk.
• Multiple conditions increase risk.
9. • No fluoride exposure (supplements, water, dentifrice,
etc.)
• Family history of carious lesions in past 7-23 months
• Has some special health care needs that inhibit
adequate oral home care (in patients over 14 years of
age)
• Has eating disorder
• Uses tobacco products
• Takes medication that reduces salivary flow
• Abuses drugs or alcohol
10. HIGH RISK
• Patients who exhibit multiple Moderate Risk factors
may be considered at High Risk.
• Additionally, any one of the following conditions may
place the patient at high risk.
• • Frequently consumes sugary or starchy foods/drinks
between meals
• • Had carious lesions in past 6 months
• • Has some special health care needs that inhibit
adequate oral home care (in patients 6-14 years of age)
• • Received chemo/radiation therapy
11. Clinical risk assessment
• LOW RISK:• No carious lesions or restorations in past
36 months
• • No visible plaque
• • No unusual tooth morphology that compromises oral
hygiene
• • No interproximal restorations
• • No exposed roots
• • No open margins or bad contacts in existing
restorations
• • No orthodontic appliances
• • No dry mouth
12. MODERATE RISK
• Patients who exhibit any of the following conditions may be
considered at
• Moderate Risk. Multiple conditions increase risk.
• • One or two carious lesions or restorations in past 36
months
• • Visible plaque
• • Unusual tooth morphology that compromises oral
hygiene
• • Interproximal restorations
• • Exposed roots
• • Open margins or bad contacts in existing restorations
• • Orthodontic appliances
13. HIGH RISK
• Patients who exhibit multiple Moderate Risk
factors may be considered at High Risk.
• Additionally, any one of the following
conditions may place the patient at high risk.
• • Three or more carious lesions, restorations
or missing teeth in past 36 months
• • Severe dry mouth
14. PROTOCAL OF MANAGING PATIENTS
AT RISK ACCORDING TO ADA.
• LOW RISK: Encourage patients to maintain
current lifestyle and oral hygiene habits. Offer
suggestions for improvement where applicable,
such as more frequent flossing or eating less
frequently.
• • Schedule recall appointments every 6-12
months.
• • Bitewing radiographs should be taken every 24-
36 months (18-24 months for age 2-5 years).
15. • • Sealants are optional as well as products
containing xylitol or calcium phosphate
• • The use of fluoride products twice daily is
adequate to maintain the patients’ oral
health.
16. MODERATE RISK
• More effort is required to maintain oral health
with patients in this category. The patients may
need instruction on proper oral hygiene habits.
• • Schedule recall appointments every 4-6
months.
• • Bitewing radiographs should be taken every 18-
24 months (12-18 months for age 2-5 years).
• • In office preventive treatments should include a
topical fluoride application at every recall.
17. • • Sealants should be applied to surfaces that are
at risk in children and are optional for adults.
Other coatings/barriers may also be applied (e.g.
resin modified glass ionomers).
• • A saliva test may be considered if there is a
suspicion of high bacterial challenge or as a
baseline for new patients.
• • Restore any cavitated lesions.
• Direct patients to use a fluoride rinse once per
day after brushing in addition to the use of
toothpaste twice daily
18. HIGH RISK
• This group of patients present the biggest
challenge for maintaining good oral health. They
are at high risk for future decay. They may not
have good home hygiene habits and can benefit
from instruction on proper home.
• Schedule recall appointments every 3-4 months.
• Bitewing radiographs should be taken every 6-18
months (6-12 months for age 2-5 years) or until
no cavitated lesions are present.
• • In office preventive treatments should include a
topical fluoride application at every recall.
19. • Sealants should be applied to surfaces that are at
risk in children and are optional for adults.
• A saliva test and bacterial culture should be
performed initially and at every recall
appointment to assess treatment efficacy and
patient compliance.
• Direct patients to brush with a 1.1% NaF
dentifrice twice daily.
• Direct patients to use 10ml of chlorhexidine
gluconate 0.12% rinse for one minute daily, one
week per month.
20. • A 0.2% NaF rinse once daily or a 0.05% NaF rinse
twice daily can be considered.
• Gels or dentifrices containing calcium phosphate,
mints or gum containing xylitol and pH modifying
products are optional. These therapies should be
considered if a high bacterial challenge is
identified, excessive root exposure or sensitivity
is present or saliva flow is inadequate.
• Restore any cavitated lesions
21. Guide lines for preventing caries in
infants
• Oral hygiene—the parent should be instructed
to brush thoroughly twice daily (morning and
evening) and to floss at least once every day.
• Diet—the parent should be instructed to
consume fruit juices only at meals and to
avoid all carbonated beverages during the first
30 months of the infant’s life
22. • Fluoride—the parent should be instructed to
use a fluoride toothpaste approved by the
American Dental Association and rinse every
night with an alcohol-free over-the-counter
mouth rinse with 0.05% sodium fluoride.
• Caries removal—parents should be referred to
a dentist for an examination and restoration of
all active decay as soon as feasible.
23. • Delay of colonization—mothers should be
educated to prevent early colonization of
dental flora in their infants by avoiding sharing
of utensils (ie, shared spoons, cleaning a
dropped pacifier with their saliva, etc).
• Xylitol chewing gums—recent evidence
suggests that the use of xylitol chewing gum
(4 pieces per day by mother) had a significant
impact on decreasing the child’s caries rates
