Resident’s Name: Semantha Charles Date: 08/26/2015
Article Title: Assessing patients’ caries risk
Journal: JADA, Vol. 137
Author: Margherita Fontana, DDS, PhD; Domenick T. Zero, DDS, MS
Date: September 2006
Major Topic: how to apply risk assessment models to adult populations
Main Purpose: Changes in the modern management of caries.
Because caries is a multifactorial disease, the incorporation of caries risk assessment into the concept of caries management should include factors that may affect caries development, such as past and current caries, diet, fluoride exposure, presence of cariogenic bacteria, salivary status, general medical history and sociodemographic.
The preventive and restorative caries management plan and frequency of recall visits should depend on a patient’s caries risk.
The risk assessment, any proposed management strategy and outcomes should be recorded formally over time to monitor and measure treatment efficacy.
Caries risk assessment determines the probability of caries incidence (that is, number of new cavities or incipient lesions) in a certain period.
It also involves the probability that there will be a change in the size or activity of lesions in the mouth.
Determining caries activity may be a stronger predictor of caries risk than decayed, filled or missing teeth.
The detection of frank cavitations in teeth requiring restorations has been a hallmark of dentistry. In contrast, modern caries management also focuses on the detection of incipient, noncavitated lesions and the practitioner’s ability to diagnose whether those lesions are active.
An active carious lesion progresses over time and requires management (remineralization or restoration).
An inactive lesion may be visible either clinically or radiologically (like “scar tissue” that reminds us of past damage to the tooth), but it will not progress or change over time.
Arrested or remineralized lesions do not require intervention since they do not represent active disease, unless the lesions are so advanced that they interfere with oral function or esthetics.
Any patient with active disease faces an increased risk of developing the disease in the future.
Patients who do not have active disease or clinical signs of caries are not necessarily at low risk of developing the disease.
For example, life stressors such as leaving home for college for the first time, having orthodontic brackets placed on teeth or experiencing other significant life events can affect caries risk.
Caries risk indicators include:
Bacteria and oral hygiene: The microbial component of caries can be viewed from the perspective of specific microorganisms that contribute to the disease, or whole plaque.
Specific organisms: Available bacterial salivary tests could be used to determine cariogenic bacteria in the mouth and perhaps motivate patient behavioral changes.
Whole plaque: Because plaque is one of the main etiologic factors for caries, it is important to estimate the number of surfaces affected, the amount of plaque accumulated, the age of the plaque and whether the presence of plaque is associated with the presence of carious lesions in those same sites.
Saliva: A chronically low salivary flow rate has been found to be one of the strongest salivary indicators for an increased risk of developing caries.
Diet: diet alone is an inadequate indicator of caries risk. Other risk factors also need to be considered, such as assessing a patient’s pattern and frequency of carbohydrate intake and its relationship with oral hygiene habits.
Exposure to fluoride: fluoride use, which can be considered one of the most important protective factors when assessing a patient’s caries risk, allows more conservative management strategies for the prevention and treatment of caries.
Past caries experience: This single caries risk indicator provides the greatest predictive ability. The presence of caries in the mother increases a young child’s risk. Caries prevalence in primary teeth can help predict future caries in permanent teeth. In adults, there is an association between existing caries and the risk of developing root caries.
Medical and demographic factors: