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Caries Risk Assessment and Prevention DR. MANZAR ANWAR Associate Professor & Head Preventive & Community Dentistry Khyber College Of Dentistry
Caries risk assessment Risk: “The probability that some harmful event will occur.” To predict that carious lesion (harmful event) will grow or incipient lesion will continue to grow is assessment of carious risk.
Why assess? If proper prediction of carious lesion is done, preventive actions can be directed, to those persons having high risk of caries and scarce resources can be properly utilized.
RISK INDICATORS 1. Socially deprived, no work, bad economy. 2. Low knowledge, low education of parents.
3. No regular dental check ups.
How? If CHO products are cheaper than proteins than more cariogenic food, less good oral hygiene, saliva problems and reduced fluoride can lead to caries.
Caries risk assessment Assessment is highly indicated in populations where a large portion is caries free, but some individuals are still highly caries active.
Caries risk assessment
Initiation, development and progression depends on:
1. 2. 3. 4.
Oral health status Etiology Preventing factors Risk factors
Caries risk assessment Risk for caries development varies significantly for different: 1. Age groups, 2. Individuals and, 3. Teeth and teeth surfaces in dentition.
Caries risk assessment Caries preventive measures must be integrated based on knowledge and understanding of the predicted risk groups. Risk groups can be divided into two categories: 1. Risk age group 2. Other risk groups.
Caries risk assessment Risk Age Group: In children specifically when the
permanent molars are erupting, caries is initiated. In older age group root caries develops due to higher prevalence of exposed root surfaces.
Caries risk assessment AGE 1-3 year old
Mothers with high Salivary Streptococci Mutans
Mothers most frequently transmit
Streptococcus Mutants to their children, leading to greater chances of development of caries as soon as 1st primary teeth erupts.
Caries risk assessment Specific immune system, particularly
immunoglobulin (IgA) in saliva among 1-3 year old infant is immature.
In addition poor oral hygiene favors
establishment of carious micro flora.
On this basis, the first priority age
groups are 1-3 year old children.
Caries risk assessment Age 5-8 years: The enamel of erupting and newly erupted
permanent teeth is particularly more susceptible to caries development . Until secondary maturation is completed, that is more two/three years of eruption, this age group is at continuous risk.
Caries risk assessment Age 11-15 years:
The next high risk group is age 11-15
years, and is true during eruption of second molar (11-12years). Total eruption time is 14-18 months
Proximal surfaces of newly erupted
posterior teeth are their most caries susceptible area.
Caries risk Assessment Young adults and adults (19-22): Most of individuals in this age group
have, erupting or newly erupted third molars, with highly caries susceptible fissures on mesial surfaces. (peer pressure to good or bad habits).
Caries risk assessment Older adults: Another age group susceptible to caries who have : a) Multiple restorations with plaque retentive margins. b) Exposed root surfaces by chronic periodontitis.
Caries risk assessment 1. 2.
3. 4.
Other Risk groups Obese persons (frequent/ sugary snacking) Persons taking regular medication for systemic diseases “affecting salivary function” Pregnant and lactating mothers. Persons with impaired salivary functions or immune response. Persons undergoing radiation therapy for head and neck region. Key Risk teeth and surfaces
Factors Relevant to Assessment of caries risk Low Risk individual:
1. Social component a) Middle class b) Dentally aware c) Regular attendee d) High dental aspirations. 2. No medical problem 3. Normal salivary flow
Factors relevant to Assessment of Caries Risk 4. No long-term medication 5. Dietary habits a) Infrequent sugar intake b) Low sugar snacks intake c) Intake of sugars at meals 6. Fluoride use a) Fluoridated area b) Fluoride supplements use c) Fluoride toothpaste and mouth rinses
Factors relevant to Assessment of Caries Risk 7 Frequent effective cleaning after every
meals. 8 Good oral hygiene status 9 High buffering capacity 10 Low Streptococcus Mutans and lactobacilli counts.
Factors relevant to Assessment of Caries Risk 11.Clinical evidence a) b) c) d) e) f)
No new lesions No extractions for caries No or few restorations Restorations inserted years ago Sound anterior teeth No appliances
Factors relevant to Assessment of Caries Risk High risk individuals: Individuals at high risk of development
of caries exactly the opposite of low risk individuals is true.
Caries Risk Assessment Low Caries Risk No new carious lesions in last 3 years Adequately restored surfaces Good oral hygiene Regular dental visits
Caries Diagnosis and Risk Assessment, American Dental Association, 1995
Caries Risk Assessment Moderate Caries Risk One carious lesion in last
3 yrs Exposed roots Fair oral hygiene White spots and/or interproximal radiolucencies Irregular dental visits Orthodontic Treatment
Caries Diagnosis and Risk Assessment, American Dental Association, 1995
Caries Risk Assessment High Caries Risk
2 or more new carious
lesions in last 3 years Past root caries/numerous exposed roots Deep pits and fissures Poor oral hygiene Inadequate use of topical fluoride Irregular dental visits Inadequate salivary flow Elevated Streptococcus Mutans count
Preventive Arsenal 1. 2. 3. 4. 5. 6. 7. 8.
Education/reinforcement Dietary analysis and counseling Sealants Xylitol gum Water fluoridation Topical fluorides Professionally applied topical fluoride Tobacco education & cessation
Treatment Planning Decisions Low Caries Risk Algorithm Remaining unsealed pits and fissures?
Yes
Apply sealant
Reinforce Oral Hygiene12 month recall visit Radiographs 12-24 months
No
No treatment
Does patient drink fluoridated water and brush with fluoride toothpaste?
Yes
No
No topical fluoride
Apply topical fluoride 1 –2 x yearly
Sample Caries Risk-based Preventive Plans Low Caries Risk 1. Seal uncoalesced pits and fissures 2. Reinforce oral hygiene 3.Fluoride dentifrice
12 month recall 1. Reinforce oral hygiene and diet 2. sealant retention 3. BWX in 24 months
Moderate Caries Risk Preventive
Plans
1.
2. 3. 4. 5. 5. 6.
Restore cavitated lesions Seal remaining pits & fissures Professionally applied fluoride Reinforce hygiene & dentifrice Dietary counseling Home fluorides Xylitol chewing gum
Moderate Caries Risk Preventive Plans 6 month recall 1. Reinforce oral hygiene, diet
modification, fluoride use 2. BWX in 12 months 3. Modify as necessary
High Caries Risk patients Preventive Plans 1. Restore cavitated lesions
2. 3. 4. 5. 6. 7. 8. 9.
Seal remaining pits & fissures Professionally applied fluoride (varnish 6mo?) Reinforce hygiene & dentifrice Dietary counseling (referral?) Fluoride varnish Home fluorides Chlorhexidine rinse Xylitol chewing gum
High Caries Risk patients Preventive Plans 3 - 4 month recall 1. Reinforce oral hygiene, diet modification, fluoride use.
2. Bite Wing X Rays in 6-12 months 3. Modify as necessary
Prerequisites For Early Diagnosis 1. Good Lighting 2. Clean teeth i.e. free from deposits.
both wet and dry. 1. Sharp eyes. 2. Blunt Explorer. 3. Good bite wing radiographs.
Dental Caries Vaccine Immunization Active Immunization ive Immunization o Immune Bovine milk, Egg Yolk Antibody, Replacement Therapy. o S. Sanguis 01 year age, S. Mutants primary teeth erupts o Window of infectivity, period of 02 years after primary teeth begin to erupt. o Advantages H&N radiation, Xerostomia, Chronically sick patient, handicap. o Developing countries vs developed countries
Cariogram It is a model which illustrates the
interactions between bacteria, diet and host response. The process of making the evaluation (one year) is called “Cariography”. Caries risk, will there be demineralization or new cavity will occur, based on Cariogram model. Low%, 5% indicates high risk for caries. High%, 90% indicates low risk for caries. Bratthal D 1996 of Sweden.
Thank you
Caries risk assessment Risk: “The probability that some harmful event will occur.” To predict that carious lesion (harmful event) will grow or incipient lesion will continue to grow is assessment of carious risk.
Why assess? If proper prediction of carious lesion is done, preventive actions can be directed, to those persons having high risk of caries and scarce resources can be properly utilized.
RISK INDICATORS 1. Socially deprived, no work, bad economy. 2. Low knowledge, low education of parents.
3. No regular dental check ups.
How? If CHO products are cheaper than proteins than more cariogenic food, less good oral hygiene, saliva problems and reduced fluoride can lead to caries.
Caries risk assessment Assessment is highly indicated in populations where a large portion is caries free, but some individuals are still highly caries active.
Caries risk assessment
Initiation, development and progression depends on:
1. 2. 3. 4.
Oral health status Etiology Preventing factors Risk factors
Caries risk assessment Risk for caries development varies significantly for different: 1. Age groups, 2. Individuals and, 3. Teeth and teeth surfaces in dentition.
Caries risk assessment Caries preventive measures must be integrated based on knowledge and understanding of the predicted risk groups. Risk groups can be divided into two categories: 1. Risk age group 2. Other risk groups.
Caries risk assessment Risk Age Group: In children specifically when the
permanent molars are erupting, caries is initiated. In older age group root caries develops due to higher prevalence of exposed root surfaces.
Caries risk assessment AGE 1-3 year old
Mothers with high Salivary Streptococci Mutans
Mothers most frequently transmit
Streptococcus Mutants to their children, leading to greater chances of development of caries as soon as 1st primary teeth erupts.
Caries risk assessment Specific immune system, particularly
immunoglobulin (IgA) in saliva among 1-3 year old infant is immature.
In addition poor oral hygiene favors
establishment of carious micro flora.
On this basis, the first priority age
groups are 1-3 year old children.
Caries risk assessment Age 5-8 years: The enamel of erupting and newly erupted
permanent teeth is particularly more susceptible to caries development . Until secondary maturation is completed, that is more two/three years of eruption, this age group is at continuous risk.
Caries risk assessment Age 11-15 years:
The next high risk group is age 11-15
years, and is true during eruption of second molar (11-12years). Total eruption time is 14-18 months
Proximal surfaces of newly erupted
posterior teeth are their most caries susceptible area.
Caries risk Assessment Young adults and adults (19-22): Most of individuals in this age group
have, erupting or newly erupted third molars, with highly caries susceptible fissures on mesial surfaces. (peer pressure to good or bad habits).
Caries risk assessment Older adults: Another age group susceptible to caries who have : a) Multiple restorations with plaque retentive margins. b) Exposed root surfaces by chronic periodontitis.
Caries risk assessment 1. 2.
3. 4.
Other Risk groups Obese persons (frequent/ sugary snacking) Persons taking regular medication for systemic diseases “affecting salivary function” Pregnant and lactating mothers. Persons with impaired salivary functions or immune response. Persons undergoing radiation therapy for head and neck region. Key Risk teeth and surfaces
Factors Relevant to Assessment of caries risk Low Risk individual:
1. Social component a) Middle class b) Dentally aware c) Regular attendee d) High dental aspirations. 2. No medical problem 3. Normal salivary flow
Factors relevant to Assessment of Caries Risk 4. No long-term medication 5. Dietary habits a) Infrequent sugar intake b) Low sugar snacks intake c) Intake of sugars at meals 6. Fluoride use a) Fluoridated area b) Fluoride supplements use c) Fluoride toothpaste and mouth rinses
Factors relevant to Assessment of Caries Risk 7 Frequent effective cleaning after every
meals. 8 Good oral hygiene status 9 High buffering capacity 10 Low Streptococcus Mutans and lactobacilli counts.
Factors relevant to Assessment of Caries Risk 11.Clinical evidence a) b) c) d) e) f)
No new lesions No extractions for caries No or few restorations Restorations inserted years ago Sound anterior teeth No appliances
Factors relevant to Assessment of Caries Risk High risk individuals: Individuals at high risk of development
of caries exactly the opposite of low risk individuals is true.
Caries Risk Assessment Low Caries Risk No new carious lesions in last 3 years Adequately restored surfaces Good oral hygiene Regular dental visits
Caries Diagnosis and Risk Assessment, American Dental Association, 1995
Caries Risk Assessment Moderate Caries Risk One carious lesion in last
3 yrs Exposed roots Fair oral hygiene White spots and/or interproximal radiolucencies Irregular dental visits Orthodontic Treatment
Caries Diagnosis and Risk Assessment, American Dental Association, 1995
Caries Risk Assessment High Caries Risk
2 or more new carious
lesions in last 3 years Past root caries/numerous exposed roots Deep pits and fissures Poor oral hygiene Inadequate use of topical fluoride Irregular dental visits Inadequate salivary flow Elevated Streptococcus Mutans count
Preventive Arsenal 1. 2. 3. 4. 5. 6. 7. 8.
Education/reinforcement Dietary analysis and counseling Sealants Xylitol gum Water fluoridation Topical fluorides Professionally applied topical fluoride Tobacco education & cessation
Treatment Planning Decisions Low Caries Risk Algorithm Remaining unsealed pits and fissures?
Yes
Apply sealant
Reinforce Oral Hygiene12 month recall visit Radiographs 12-24 months
No
No treatment
Does patient drink fluoridated water and brush with fluoride toothpaste?
Yes
No
No topical fluoride
Apply topical fluoride 1 –2 x yearly
Sample Caries Risk-based Preventive Plans Low Caries Risk 1. Seal uncoalesced pits and fissures 2. Reinforce oral hygiene 3.Fluoride dentifrice
12 month recall 1. Reinforce oral hygiene and diet 2. sealant retention 3. BWX in 24 months
Moderate Caries Risk Preventive
Plans
1.
2. 3. 4. 5. 5. 6.
Restore cavitated lesions Seal remaining pits & fissures Professionally applied fluoride Reinforce hygiene & dentifrice Dietary counseling Home fluorides Xylitol chewing gum
Moderate Caries Risk Preventive Plans 6 month recall 1. Reinforce oral hygiene, diet
modification, fluoride use 2. BWX in 12 months 3. Modify as necessary
High Caries Risk patients Preventive Plans 1. Restore cavitated lesions
2. 3. 4. 5. 6. 7. 8. 9.
Seal remaining pits & fissures Professionally applied fluoride (varnish 6mo?) Reinforce hygiene & dentifrice Dietary counseling (referral?) Fluoride varnish Home fluorides Chlorhexidine rinse Xylitol chewing gum
High Caries Risk patients Preventive Plans 3 - 4 month recall 1. Reinforce oral hygiene, diet modification, fluoride use.
2. Bite Wing X Rays in 6-12 months 3. Modify as necessary
Prerequisites For Early Diagnosis 1. Good Lighting 2. Clean teeth i.e. free from deposits.
both wet and dry. 1. Sharp eyes. 2. Blunt Explorer. 3. Good bite wing radiographs.
Dental Caries Vaccine Immunization Active Immunization ive Immunization o Immune Bovine milk, Egg Yolk Antibody, Replacement Therapy. o S. Sanguis 01 year age, S. Mutants primary teeth erupts o Window of infectivity, period of 02 years after primary teeth begin to erupt. o Advantages H&N radiation, Xerostomia, Chronically sick patient, handicap. o Developing countries vs developed countries
Cariogram It is a model which illustrates the
interactions between bacteria, diet and host response. The process of making the evaluation (one year) is called “Cariography”. Caries risk, will there be demineralization or new cavity will occur, based on Cariogram model. Low%, 5% indicates high risk for caries. High%, 90% indicates low risk for caries. Bratthal D 1996 of Sweden.
Thank you
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