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• Dental Caries Risk Assessment
• Oral and Dental Science presented by Josh Hudson

GDC Learning Outcomes

• Recognise the importance of and record a comprehensive and contemporaneous patient history
• Recognise the significance of changes in patients reported oral health status and take appropriate action
• Discuss the role of the dental therapist and other members of the dental team in the treatment plan

Intended Learning Outcomes

• Define what is meant by an oral health assessment
• Explain what is meant by a risk assessment
• List the factors that need to be considered as part of such an assessment
• Describe how the results of the risk assessment inform future care
• Describe the importance of documenting this process

Oral Health Assessment

• Oral Health Assessment and Review (OHAR) involves a comprehensive assessment of a patient
• The assessment includes social, dental, medical histories, and oral health status
• The assessment leads to diagnosis, risk assessment, personalised care planning, and ongoing review
• Oral Health Assessment should occur every 24 months for adults or 12 months for children

The Caries Risk Assessment

• A systematic process of evaluating potential risks or protective factors
• Identifies a patient's future risk of disease ideally before it has occurred
• Factors that could influence caries development should be considered
• Caries Risk Assessment includes evaluation of Oral Hygiene, General Health Conditions, Diet, Clinical Conditions and Social HIstory

Research Findings

• Diet, including food type and frequency of intake, relates to future caries incidence based on Gustafsson BE et al. in 1954
• Water fluoridation reduces DMFT by 35% in the deciduous dentition and 26% in the permanent dentition as per Cochrane 2015
• Topical fluoride, increased brushing frequency, and supervision in pediatric patients can reduce caries incidence base don Cochrane 2003
• Previous caries in deciduous teeth is a strong indicator of future caries in both deciduous and permanent teeth and includes Tagliaferro EP et al 2006, Steiner M et al 1992, Li Y, Wang W 2002
• Parental education and socioeconomic status relate to future caries incidence in children as discovered by Radford JR et al 2000 and Tagliaferro E et al 2006
• Caries prevalence is higher in patients with special needs, potentially increasing their risk including Shyma M 2001 and Morgan J 2012

Structured Approaches to Caries Risk Assessment

• American Dental Association CRA tool <6 and > 6
• Caries Management by Risk Assessment (CAMBRA) CRA tool parts 1 and 2
• American Academy of Paediatric Dentistry (AAPD) CRA tool
• Dundee CRA tool
• Cariogram available on app stores

Unstructured Approaches to Caries Risk Assessment

• Unstructured questions and evaluation around:
  • Medical history
  • Social history
  • Oral hygiene
  • Diet
  • Dental history
  • Examination

Risk and Protective Factors to Assess

• Assess factors even without a structured tool, applying them to caries risk assessment

• Factors to assess should include:

  • Medical History:
  • Diabetes
  • Sugar-containing medications
  • Xerostomia/Radiotherapy
  • Limited opening
  • Diet History:
  • Timing
  • Frequency
  • Sugars
  • Social History:
  • Familial caries for children
  • Drug/alcohol use
  • Age
  • Dental History:
  • Previous caries experience
  • Regular attendance
  • Use of appliances
  • Oral Hygiene:
  • Use of fluoride
  • Frequency of brushing
  • Quality of regime
  • Access to fluoridated water
  • Examination:
  • Poor plaque control
  • Local plaque retentive factors
  • Current caries
  • Restorations
  • Exposed roots

Protective vs Risk Factors

• Good oral hygiene, fluoride use, regular attendance, no medical history, and no current or history of decay are protective
• Allocate patients to a risk category: high, moderate, or low

Utilizing Risk Assessment Outcomes

• Risk-based information will influence the management in numerous ways:
  • Preventative advice and treatment
  • Ability to access more complex treatment
  • Radiographic and recall assessment

Caries Management Pathways for 0-5 Years Old:

• Based on risk category (Low, Moderate, High):
  • Diagnostics (Recall frequency, Radiographs)
  • Interventions (Fluoride, Dietary Counseling, Sealants, Restorative)

Caries Management Pathways for ≥6 Years Old:

• Based on risk category (Low, Moderate, High):
  • Diagnostics (Recall frequency, Radiographs)
  • Interventions (Fluoride, Dietary Counseling, Sealants, Restorative)

Caries Risk and Likelihood Matrix Considerations:

• Risk status vs. current caries activity at the patient level.

Homecare and Clinical Interventions/Approaches Considerations:

• Homecare approaches, clinical interventions or approaches is based on risk (Low, Moderate, High). -Homecare tooth brushing 2/day with toothpaste, or Fluoride prescriptions
  • Clinical Interventions Motivational engagment, sealants, varnish treatments, gels etc

General guidance

• DBOH (2021) advises dentists to consider fluoride concentrations in toothpaste
• Fluoride varnish application, is advised for children
• NICE (2004) recall guidelines advise appropriate recalls Bitewing radiographs are recommened

Treatment Phasing and its Importance

• Risk assessment aids with phasing of treatment and stabilising any disease;
• Undertake more complex treatment, only when risk is low
• Cannot undertake any treatments without assessing risk

The Importance of Record Keeping

• It is crucial to justify the process should anyone review any records
• Documenting a process of risk assessment will help
• You can justify any treatment plans/recall periods with your risk assessment

Summary Points

• Effective risk assessment requires a systematic approach
• Patients can change in relation to their risk over time, needs review
• Cannot judge risk from just one element alone, need all the information
• Risk assessment can inform ongoing care and therefore is essential for planning
• Multiple tools are available to assist with this