Caries Risk Assessment Dr. Zahra Saied Moallemi DDS, PhD Oral - PDF document

6/25/2013 Caries Risk Assessment Dr. Zahra Saied Moallemi DDS, PhD Oral Public Health Dept., Isfahan Univ. of Medical Sciences Esfand 1391 Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 1

6/25/2013 CAMBRA • Prevention: “brush and floss” and “don’t eat sugar.” • physicians should identify and treat patients by risk rather than treating all patients the same. • According to the CAMBRA, prevention will be • CAMBRA = defined as risk factor management (by Caries Management by Risk Assessment maximizing protective factors and minimizing pathological factors). • CAMBRA does not stop at prevention and chemical treatments; it includes evidence-based decisions on when and how to restore a tooth to • Management dental caries minimize structural loss. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Guidelines Risk factors for dental caries • Assessing caries risk is important for all • Previous disease: patients and – Past caries experience is the most powerful • the process has to be repeated at intervals. single predictor of future caries increment – in young children (aged six years), caries in • An explicit caries risk assessment should be deciduous teeth is a better criterion than caries in permanent first molars. made for each person presenting for dental care Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 2

6/25/2013 Risk factors for dental caries • Dietary factors are associated with caries incidence: – amount of fermentable carbohydrate consumed • Diet: – sugar concentration of food – consumption of sugary food and drinks both – physical form of carbohydrate between meals and at meals is associated with a – oral retentiveness (length of time teeth are large caries increment (Vipeholm study, 1945-1953). exposed to decreased plaque pH) – frequency of eating meals and snacks – Children average nearly seven intakes of food – length of interval between eating per day, many of which are snacks rich in added sugars. – sequence of food consumption. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Risk factors for dental caries • Dietary factors are associated with caries incidence: – amount of fermentable carbohydrate consumed • Social factors: – sugar concentration of food – Dental caries is most prevalent in schoolchildren – physical form of carbohydrate from low socio-economic status families. – Children from these families: – oral retentiveness (length of time teeth are exposed to decreased plaque pH) • higher caries prevalence, – frequency of eating meals and snacks • fewer caries-free teeth, • fewer sealants and – length of interval between eating • more untreated lesions – sequence of food consumption Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 3

6/25/2013 Risk factors for dental caries Risk factors for dental caries • Use of fluoride: • Plaque control: – Consideration of water fluoridation as a public – Removal of bacterial plaque is important in health measure minimizing one of the etiological factors in caries. – Health benefits are primarily due to the incorporation of fluoride into most toothpastes. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Risk factors for dental caries Risk factors for dental caries • Medical history and disability: • Saliva: – Physical and learning disabilities result in decreased ability to perform oral self-care. – Saliva fulfils a major protective role against dental Learning disability is often associated with poor caries. oral hygiene and frequent consumption of sweet snacks. – Reduction in salivary flow - usually as a – Some disabled patients are resident in institutions consequence of medical history and related drug where carers are responsible for their oral therapy hygiene. Clinicians should therefore be aware of the need to provide appropriate preventive care to individuals within these groups. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 4

6/25/2013 Caries risk factors Caries risk factors Risk category Clinical Dietary Social Use of Plaque Medical Risk Saliva category evidence habits history fluoride control history Clinical Dietary Plaque Medical Social history Use of fluoride Saliva evidence habits control history Infrequent Social Drinking Frequent, Normal flow No medical No new lesions sugar advantage water effective rate problems New lesions Frequent Social Drinking water Infrequent, Low flow Medically intake fluoridated cleaning Low caries High No physical sugar deprivation not fluoridated ineffective rate compromised Nil extractions Premature siblings Fluoride Good buffering problems intake cleaning extractions High caries in No fluoride Low Physical for caries supplements manual capacity siblings supplements Poor buffering disability Dentally Normal Anterior used control manual capacity aware Low S salivary flow Sound anterior caries or Low No fluoride Xerostomia control Fluoride mutans and teeth restorations knowledge of toothpaste High S Regular No long Long term toothpaste lactobacillus dental disease mutans & attendance term Multiple cariogenic used counts lactobacillus Low risk No or few medication restorations Irregular medicine Limited counts High risk restorations attendance No fissure availability of sealants Ready snacks Restorations availability of Fixed High dental inserted years snacks appliance aspirations ago orthodontics Low dental aspirations Partial Fissure sealed dentures Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi No appliance PREVENTING DENTAL CARIES IN CHILDREN AT HIGH CARIES RISK • Moderate risk – Individuals who do not clearly fit into high or low risk categories are considered to be at moderate 1. risk PRIMARY PREVENTION OF DENTAL CARIES Adapted from Professor Edwina Kidd Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 5

6/25/2013 Primary prevention Primary prevention Behavior modification in high caries risk Identifying children at high caries risk patients • 1. Dental health education • Given the pattern of development of dental • Dental health education advice should be provided to caries and its widespread prevalence in individual patients at the chairside. adulthood, most children are " at risk " of – The dental and allied professions have an ethical responsibility dental caries. to inform patients about disease and how to prevent it. – Consistent preventive messages should be reinforced. – Dental health education carried out by a professional at the chairside is more often effective than other types of oral health promotion interventions (systematic review) Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Primary prevention Primary prevention Behavior modification in high caries risk patients • Adults and children over 7 years should: – brush teeth twice a day using toothpaste containing at • 2. Oral hygiene least 1000 ppm fluoride – ensure that all accessible surfaces of teeth are cleaned – spit out the toothpaste and avoid rinsing out with water. • The value of toothbrushing in caries • children up to 7 years of age: prevention lies with the regular topical – only a smear or small pea-sized quantity of toothpaste application of fluoride. – encourages children to spit out toothpaste after brushing – 1000-2800 ppm in children 6 -16 years – active rinsing out after brushing Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 6

6/25/2013 Primary prevention Primary prevention Behavior modification in high caries Behavior modification in high caries risk patients risk patients • 4. Xylitol • 3. Diet and sugar consumption – lowering sugar intake reduces the incidence of caries – substitution of xylitol for sugar in the diet results in children in very much lower caries increments (studies in – incidence of approximal lesions reduce by diet and Finland) oral hygiene training. – Limiting the ingestion of refined carbohydrate to meal times is also widely recommended – Dietary advice to patients should encourage the use of non-sugar sweeteners, in particular xylitol, – The need to restrict sugary food and drink consumption to meal times only should be in food and drink. emphasized. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi Primary prevention Primary prevention Behavior modification in high caries Behavior modification in high caries risk patients risk patients • Sugar-free medicines • 5. Sugar-free chewing gum – Medicines for children had highly sweetened – danger to teeth from frequent consumption of – Chewing gums containing xylitol and sorbitol have sweetened medicines. anti-caries properties through salivary stimulation. – iatrogenic damage to children's teeth – Xylitol is more effective than sorbitol in caries – widespread availability of sugar-free alternatives for reduction, as it also has antibacterial properties. most paediatric medications – Patients should be encouraged to use sugar-free – Clinicians should prescribe sugar-free medicines chewing gum, particularly containing xylitol, whenever possible and should recommend the use of sugar-free forms of non-prescription medicines. when this is acceptable. Dr . Zahra Saied Moallemi Dr . Zahra Saied Moallemi 7