Dental Caries Risk Assessment Overview

Dental Caries Risk Assessment

• Caries risk assessment is a systematic process to evaluate potential risks or protective factors impacting a patient's future caries risk.
• Key to this is understanding factors influencing caries development, including social history, oral hygiene, diet, and clinical/medical conditions.
• Research demonstrates strong links between diet, fluoride intake, parental education, socioeconomic factors, and caries incidence.
• A caries risk assessment identifies high-risk individuals to develop preventative strategies, manage risk effectively, and support personalized care to prevent or manage dental caries.
• Assessing caries risk is better than reactive interventions.
• Comprehensive assessment of the patient is crucial: social history, oral health status, medical history, and dental hygiene habits.
• This patient-centered approach informs a personalized treatment plan.

GDC Learning Outcomes for Dental Caries Risk Assessment

• GDC outcomes emphasize the importance of:
  • Recording a comprehensive and contemporaneous patient history.
  • Recognizing and responding appropriately to changes in the patient's reported oral health status.
  • Understanding and discussing the role of all dental team members in the treatment plan.

Tools for Risk Assessment

• Structured Approaches: Various tools exist, including the American Dental Association CRA tool (<6 & >6), CAMBRA (Part 1 and 2), AAPD tool, Dundee tool, and Cariogram app.
• Unstructured Approaches: Unstructured methods involve open-ended questions to assess patient factors, including medical history, social history, oral hygiene, diet, and dental history, along with a clinical examination.

Caries Risk Assessment in Practice

• A multi-faceted approach is key, not focusing on only one aspect.
• Protective factors (e.g., good oral hygiene, fluoride use, regular attendance) and risk factors (e.g., poor oral hygiene, high sugar intake, medical conditions, significant caries history) must be identified and evaluated to classify each patient effectively.

Risk Categories and Recall Periods

• Patients are typically categorized into low, moderate, and high risk categories based on an assessment.
• Treatment phases are established based on risk levels to maximize effectiveness and prevent future disease: preventative advice and treatment; ability to access complex treatment including radiographic assessment; and recall assessment.
• Tables provide examples of management pathways based on caries risk and age groups (0-5 years old and 6+ years old).

Risk and Likelihood Matrix

• Caries activity is categorized as low, moderate or high based on the assessment.

Essential Considerations

• Risk assessment informs ongoing patient care and essential for treatment planning.
• Regular review of the patient’s risk status is vital, as circumstances can change.
• Effective protocols ensure patient records are detailed and justify treatments and recall periods.
• Evidence shows caries risk assessment tools are limited in their validity. However, it is still essential in practice.
• Local and national guidelines should be followed for recall intervals and fluoride recommendations tailored to different risk groups.

Helpful Tips

• Implement a structured process for assessing risk factors and protective factors for each patient.
• Evaluate the impact of each factor on the patient's overall caries risk level.
• Develop a patient care plan informed by the risk assessment.