Dental Caries Risk Assessment

• Dental Caries Risk Assessment is covered as part of Oral and Dental Science, presented by Josh Hudson

GDC Learning Outcomes

• Recognize and record a comprehensive and contemporaneous patient history
• Recognize the significance of changes in the patient's reported oral health status and action accordingly
• Discuss the roles of the dental therapist and other members of the dental team in treatment planning

Session Learning Outcomes

• Define oral health assessment and risk assessment
• List factors for consideration in risk assessment
• Describe how risk assessments inform future care
• Describe the importance of documenting the risk assessment processes

Oral Health Assessment and Review (OHAR)

• Oral Health Assessment and Review (OHAR) is a comprehensive patient assessment in primary dental care
• OHAR covers social, dental, and medical histories and oral health status
• OHAR supports diagnosis and risk assessment, personalized care planning, and ongoing review

Caries Risk Assessment

• A systematic process evaluates potential risks and protective factors
• Helps identify a patient's future disease risk before it occurs
• Requires structure and consideration of both risks and protective factors
• Considers oral hygiene, social history, diet, general health, and clinical conditions

Research Findings

• Diet relates to future caries incidence with food type and frequency
• Water fluoridation reduces DMFT by 35% in deciduous and 26% in permanent dentition
• Topical fluoride, increased brushing and parental supervision reduce caries incidence in children
• Previous caries in deciduous teeth is a strong indicator of future caries
• Parental and socioeconomic status relates to future caries incidence in children
• Caries prevalence is recorded as higher in patients with special needs

Risk Assessment Tools

• Structured caries risk assessment tools (CRA) exist
• CRA tools include: American Dental Association CRA tool (for <6 and >6 age groups), CAMBRA CRA tool (Parts 1 & 2), American Academy of Paediatric Dentistry (AAPD) CRA tool, Dundee CRA tool, and Cariogram
• Unstructured approaches to risk assessment involve evaluating medical and dental history, diet, oral hygiene, and clinical examination
• Limited scientific evidence exists for the validity of current CRA systems

Assessments without a Tool

• If not using a tool, assess medical history (diabetes, medications, xerostomia, limited opening)
• Assess diet history (timing, frequency, sugars)
• Assess social history (familial caries, drug/alcohol use, age)
• Assess dental history (previous caries, attendance, appliance use)
• Assess oral hygiene (fluoride use, brushing frequency/quality, access to fluoridated water)
• Assess the examination (plaque control, retention factors, current caries, restorations, exposed roots)

Factors

• Balance risk factors with protective factors
• Protective factors: good oral hygiene, fluoride use, regular attendance, no medical history, and no current/previous decay
• Risk factors: poor oral hygiene, smoking, medical history, caries and restorations are present

Risk Category Allocation

• Allocate patients to a risk category: high, moderate, or low risk
• This information influences patient management
• Influences preventative advice and treatments
• Impacts access to complex treatments
• Helps with radiographic and recall assessments

Local Guidance

• DBOH (2021) advises to consider fluoride concentration and varnish/rinse when referring to caries risk
• NICE (2004) recall guidelines are based on determining patient caries risk
• Recall guidelines are: children (3-12 months), adults (3-24 months) dependent on risk
• Dental radiography selection criteria is based on patient caries risk

Treatment Phasing

• Risk assessment helps with phasing of treatment
• Stabilization of disease initially, followed by a review of risk assessment
• Undertake more complex treatment if risk lowers
• It is not advisable to undertake complex/cosmetic work on high-risk patients

Record Keeping

• All actions must be justifiable with records
• Documenting risk assessment supports treatment plans/recall periods justification

Summary

• The effective assessment of risk needs methodic procedures
• The patient's risk changes over time and should be reviewed regularly
• All information must be gathered; a single factor cannot determine overall risk
• Risk assessment directs ongoing care and is essential for treatment programs
• Multiple types of equipment can be used to aid