This document discusses caries risk assessment in dentistry. It defines risk assessment as using factors to determine a patient's likelihood of developing dental diseases. Caries risk assessment can help predict who will develop caries, increase examination suspicion for high-risk patients, identify patients early in the disease process, and determine who will benefit from prevention. The treatment plan and decisions should be based on a careful caries diagnosis, risk assessment, and classification of the patient's treatment needs. Caries risk assessment tests saliva and plaque for bacteria levels, pH, and defense factors to predict future caries development and inform prevention.

1. Caries Risk Assessment

2. Risk Assessment
The use of knowledge of factors associated
with diseases to determine individual that
are more or less likely to develop diseases

3. Uses of Risk Assessment in the Field of
Dentistry
• Prediction of who will or will not get dental diseases
• Increase level of suspicion of examination among high risk
patient
• Identifying patient at early stage of disease
• Identifying patient that will benefit from prevention

4. Drill or not drill

5. • Traditional management of caries in most
dental practice presently constitute
overtreatment.
• More than 50% of cases of replacement of
restoration are due to secondary caries.

6. •Dentist should be taught to consider caries as an
infective disease, considering risk assessment,
prevention and non surgical management
before planning traditional surgical management
in the clinical situation

7. The treatment plan for each patient
must be individualized and based on:
•Careful diagnosis of dental caries
•Caries risk assessment
•Precise classification of the patient into a
specific treatment need category

8. Treatment decisions according to
caries diagnosis and risk assessment
TREATMENT DECISION CRITERIA
No care advised
)NCA(
No caries diagnosed + low caries risk
Preventive care advised
)PCA(
No caries diagnosed + High caries risk
OR
Initial caries diagnosed + low caries risk
Operative care advised
)OCA(
Caries diagnosed + high caries risk

9. Definition of Caries risk assessment
•Caries risk assessment is a procedure to predict future
caries development before the clinical onset of the
disease.

10. Importance of caries risk assessment
• If patient is wrongly labeled as high risk so initial lesion that
may be reversed may be restored
unnecessarily( overtreatment)
• If patient is wrongly labeled as low risk so initial lesion may
be left leading to endodontic treatment or extraction

11. Caries predictors

12. 1-Past caries experience
• The presence of caries in the mother increases a young child’s risk.
• Children with spot lesions should be considered at high risk for caries since
these are precipitated lesions that are indicative of caries activity
• Caries prevalence in primary teeth can help predict future caries in permanent
teeth.
• Early restoration of a first permanent molar is a powerful indicator of the
later need for restorations in all other molar teeth
• In adults, there is an association between gingival recession and the risk of
developing root caries.

13. 2- Bacteria
• Caries is a microbial disease in which the etiologic agents are normal
constituents of the oral flora that cause problems when their
pathogenicity and proportions change in response to environmental
Conditions.
• Streptococcus mutans is strong predictor in primary dentition and
adults
• Lactobacilli is better predictor in older age

14. 3- Salivary parameters
The characteristics of saliva have a direct impact on the oral environment
and on the growth and survival of cariogenic bacteria.
1- Salivary flow rate
It is the most important parameter since all other salivary parameter depend
on flow rate
2- Salivary Buffer Capacity
Has negative association with caries attack
3- salivary fluoride content
Increase resistant of tooth to dental caries but its predictive value is
questionable
4-Salivary antimicrobial agents
Has no strong association with caries activity

15. Caries Activity Test for Dental Office

16. Advantages of Caries Activity tests
• Patient evaluation of caries risk & develop a preventive program
matching with the severity of risk assessment (determine prospective
workload)
• Establish initial baseline level of cariogenic pathogens
• Evaluation of patient compliance with dietary and oral hygiene
instruction.

17. Type of caries activity tests
1- Microbiological tests
A- streptococcus mutans B- lactobacilli
2- Saliva and plaque PH measurements
3- Defense factors
A- salivary flow rate B- buffering capacity

18. 1- Microbiological Tests
A- Streptococcus mutans
•Initial colonizer
•Initiation of dental caries
•Acidogenic
•Aciduric
•Store polysaccharide

19. Importance of streptococcus mutans
determination
A threshold value of 2.5 x 106
CFU ml High caries risk
2 year children with high SM Caries active at 4 years

20. 1- Streptococcus mutans count
•Used for research work not for dental office
•A chewing paraffin wax or rubber band
•Saliva placed on Mitis Salivarius bacitracin agar
medium
•Medium incubation (37c – 2 days) & count

21. 2- Dip slide method
• Paraffin stimulated saliva is allowed to flow
on dip slide coated with Mitis Salivarius agar
• Slide is then placed into sterile tube
• Incubated at (37c – 2 days)
• Comparing with model chart
• SM count are either low , moderate or high

22. B- LACTOBACILLI
• Coronal & secondary caries
• Active caries high count
• Caries free no or very low count
• Caries free + high count lactobacilli caries develop within one
year
• Effect of carbohydrate

23. 1- Lactobacilli count
• Used for research work not for dental office
• A chewing paraffin wax or rubber band
• Saliva placed on Rogosa medium
• Medium incubation (37c – 4days) & count

24. • Paraffin stimulated saliva is allowed to flow on dip slide coated with
Rogosa.
• Slide is then placed into sterile tube
• Incubated at (37c – 4days)
• Comparing with model chart
• Low ≤ 10000 , moderate 10000 -100000 or high ≥100000
2- Dip slide method

25. 2- Saliva and plaque PH
measurements
Topical pH indicator.
•0.1% solution methyl red is applied topically on the suspected site. The sites that turn red are
recorded.
•This method is very simple, inexpensive and can be used at chair side.
•The methyl red changed from yellow at pH 6.0 to orange at 5.2 and to red below the pH 5.0
pH paper
•dribble saliva into container
• insert pH paper
• read after 10 s

26. 3- Defense factors (Salivary defense)
Role of saliva in caries prevention
•Mechanical cleansing of debris and plaque bacteria
•Enhance re mineralization and inhibit demineralization
•Buffering and neutralizing of acid
•Antibacterial activity

27. A- Salivary flow rate test
Unstimulated Saliva
(ml/minute)
more than 0.25 normal
0.1 - 0.25 low
less than 0.1 very low
Stimulated Saliva
(ml/minute)
more than 1.0 normal
0.7 - 1.0 low
less than 0.7 very low
Inverse relation to dental caries
radiation caries

28. • It is recommended that the tests are performed at least one
hour after the person has eaten something (drinking water is
allowed), or taken snuff.
• It is important that the person is relaxed and calm.
• If the person has any disease, it should be considered if the
disease affects the secretion rate, and if it is a temporary
condition or a long-lasting disease.

29. B- Buffer Capacity Test
• Inverse relation to dental caries
• Dentobuff Strip System
• For chair-side use.
• A test pad contains dry acids and color
indicators.
• When saliva is added, the acids are dissolved
and pH drops. If saliva can buffer, pH will raise.
• The color indicators show the final pH.
Dentobuff® Strip
final pH
value
buffer
capacity
. blue 6.0 or more high
. green 4.5 - 5.5 medium
. yellow 4.0 or less low

30. Caries Risk Assessment Tool
Inexpensive and non-invasive method to
determine an individual’s liability to future dental
caries, and relates to treatment and preventive
therapy

33. Caries Management by Risk
Assessment CAMBRA

36. Cariogram
• Cariogram is a new way in which to illustrate the interaction between
caries related factors.
• Advantage of cariogram
• The Cariogram shows if the patient over all is at high, intermediate or
at low risk for caries.
• Shows for every individual examined, which etiological factors are
considered responsible for the caries risk.
• The results also indicate where targeted actions to improve the
situation will have the best effect