Clinical Practice Guide for Dental Caries Prevention and Treatment (GPC) PDF

19/09/2024 Clinical Practice Guide for the prevention and non- invasive treatment of dental caries (GPC) 1 GPC The guide has been designed to reflect the current philosophy of prevention, monitoring and non-invasive treat...

19/09/2024 Clinical Practice Guide for the prevention and non- invasive treatment of dental caries (GPC) 1 GPC The guide has been designed to reflect the current philosophy of prevention, monitoring and non-invasive treatment of dental caries. 2  19/09/2024 GPC The Spanish Society of Epidemiology and Oral Public Health (SESPO) has brought together experts in the area of oral public health from Spain and Portugal to offer a clinical practice guide to help promote oral health and prevent caries dental according to available scientific evidence. 3 GPC In 2013the 1st Iberian Caries Advisory Council was created, which decided to identify and establish priority strategies to achieve the objectives of the "Alliance for a cavity free Future" through actions to be developed in dental clinics. 4  19/09/2024 GPC The three most voted ideas were: 1. Training for professionals 2. Motivation of the professional 3. Preparation of a clinical practice guide. 5 GPC The guide has been designed to reflect the current philosophy of prevention, monitoring and non-invasive treatment of dental caries that has emerged from research conducted over the last 30 years. In addition, this guide is intended to be a quick, easily understandable consultation document for all health professionals who do not work exclusively in the oral health sector so that they can intervene at the community level in the promotion of oral health by promoting proper self- care and acting as Trained referrals informing their patients about existing effective clinical treatments. This guide is not intended to be a standard for the prevention and non- invasive treatment of dental caries. 6  19/09/2024 In which patients should this CPG be applied? The current philosophy of prevention and control of dental caries suggests that all patients should receive recommendations in relation to their oral health, not only those considered as high risk. Tips and actions are detailed to be able to develop both in patients with low risk and in those with high risk of caries. For those patients who need a higher level of prevention, such as medically compromised patients, with evidence of active caries lesions or those in whom restorative activity is more problematic, there are recommendations to increase the intensity of the indicated actions. 7 Caries risk assessment Primary prevention aims to keep teeth healthy before disease occurs. The high prevalence of the disease and the multiple sequelae of the lesions promote the need for a caries risk assessment in all patients. To prevent and manage dental caries disease, it is ideal to perform the first assessment during a first visit at the age of one year. A reassessment of the patient's caries risk is necessary at each follow-up visit to the dentist. The control visits will be established according to the caries risk evaluated in the last visit. 8  19/09/2024 Caries risk assessment A complete oral examination and caries risk assessment should be performed in three areas: 1. Risk factors: dietary pattern, frequency and type of meal between meals, taking medications as well as other risk factors. 2. Protective factors: the use of fluoridated water, the use of fluoridated toothpaste or the use of xylitol on a regular basis. 3. Clinical signs: the presence of initial demineralized enamel lesions, cavitated lesions, the presence of plaque or the lack of salivary flow. 9 Caries risk assessment Use of protocolized tools: Cariogram Caries Risk Semaphore Modified Cambra questionnaire 10  19/09/2024 Caries risk assessment - Cariogram Of the various methods developed to assess caries risk, the one that has obtained the best results in its evaluation has been the Cariogram computer program. This program assesses various risk factors, which are introduced into the program to obtain the total risk of developing a new caries lesion. The computer program graphically shows the probability of avoiding a new injury (obtaining a result between 0 and 100%), once a minimum of six risk factors have been introduced, using a pie chart of sectors. 11 Caries risk assessment - Cariogram The larger the green sector shown, the greater the possibility of avoiding new caries lesions and, therefore, the lower the risk of caries. Depending on the size of the green sector, the risk of caries will be classified as: Low (80% or more) Relatively low (61-79%) Intermediate (40-60%) High (0-39%). The other four sectors of the Cariogram represent the distribution of risk in relation to four large blocks: diet, individual susceptibility, bacterial biofilm, and habit- circumstances. 12  19/09/2024 Caries risk assessment - Cariogram The program is accompanied by recommendations based on the scientific evidence available at the time of development of the program. This means that some of the recommendations, which can be printed to be delivered to the patient together with the pie chart, are not perfectly updated. This program has been shown to be useful for risk assessment in schoolchildren and adults, although not for preschoolers. The use of this program implies the availability of a computer in the dental office to be able to enter the different parameters used to evaluate the risk, as well as a printer if the results report is to be delivered to the patient. 13 Caries risk assessment - Cariogram Some of the ten risk factors to be used in the Cariogram require the use of complementary tests, such as the case of evaluating the presence of cariogenic bacteria or the production of saliva, which implies an additional economic cost. The effect of eliminating bacterial cultures in the caries risk assessment process has been evaluated and it has been observed that despite the Cariogram continuing to be predictive, its precision decreases, especially with the elimination of the mutans streptococcal culture. Given that some of the parameters of the Cariogram program are redundant and do not provide an improvement in its predictive capacity, it seems interesting to develop simpler and more current systems to assess caries risk. 14  19/09/2024 CARIOGRAM 15 CARIOGRAM Aims: Illustrates the interaction of caries related factors. Illustrates the chance to avoid caries. Expresses caries risk graphically. Recommends targeted preventive actions. Can be used in the clinic. Can be used as an educational programme. 16  19/09/2024 CARIOGRAM Caries risk is the probability that an individual will develop carious lesions, reaching a given stage of the disease in progression during a specified period of time, conditional that the exposure status for risk factors remains stable during the period in question. 17 CARIOGRAM Which factors are to be considered in the estimation of caries risk? These factors can be divided into two groups: 1. Factors immediately involved in the caries process, either as ‘attack’ or ‘defence’ mechanisms, at the site of the development of the lesion. 2. Factors related to the occurrence of caries, without actually participating in the development of the lesion. 18  19/09/2024 CARIOGRAM ‘Weights’ - the relative impact of factors 19 CARIOGRAM Green - estimation of the ‘Actual chance to avoid new cavities’. Dark blue - ‘Diet’ based on a combination of diet contents and diet frequency. Red ‘Bacteria’ based on a combination of amount of plaque and mutans streptococci. Light blue ‘Susceptibility’ based on a combination of fluoride program, saliva secretion and saliva buffer capacity. Yellow ‘Circumstances’ based on a combination of past caries experience and related diseases. 20  19/09/2024 CARIOGRAM The bigger the green sector, the better from a dental health point of view. Small green sector means low chance of avoiding caries = high caries risk. For the other sectors, the smaller the sector, the better from a dental health point of view. 21 CARIOGRAM What does ‘Chance to avoid caries’ really imply? 22  19/09/2024 CARIOGRAM 23 CARIOGRAM 24  19/09/2024 CARIOGRAM 25 CARIOGRAM 26  19/09/2024 CARIOGRAM 27 CARIOGRAM 28  19/09/2024 CARIOGRAM 29 CARIOGRAM 30  19/09/2024 31 CARIOGRAM 32  19/09/2024 CARIOGRAM 33 CARIOGRAM 34  19/09/2024 CARIOGRAM 35 CARIOGRAM 36  19/09/2024 CARIOGRAM 37 CARIOGRAM 38  19/09/2024 CARIOGRAM 39 CARIOGRAM 40  19/09/2024 CARIOGRAM 41 CARIOGRAM Estimation of the caries risk. How to build the Cariogram? 42  19/09/2024 CARIOGRAM Preliminary interpretation and proposed measures 43 CARIOGRAM Print Out 44  19/09/2024 CARIOGRAM 45 46  19/09/2024 47 48  19/09/2024 49 50  19/09/2024 51 52  19/09/2024 53 54  19/09/2024 55 56  19/09/2024 57 Caries risk assessment – Caries Risk Semaphore The Preventive and Community Dentistry unit of the Faculty of Dentistry of the University of Valencia has designed an online caries risk predictor questionnaire, after evaluating the correlation between the parameters established in the Cariogram and development in a Spanish population of new caries lesions in a prospective study. www.cariesrisksemaphore.com 58  19/09/2024 Caries risk assessment – Caries Risk Semaphore The parameters that offered high predictivity in the assessment of caries risk in the Spanish population were: past caries experience mutans streptococcus count fluoridation program and capacity saliva buffer Parameters such as the DMFT index, the DMFS index or the plaque index that were shown to be good risk predictors are not part of the Cariogram. www.cariesrisksemaphore.com 59 Caries risk assessment – Caries Risk Semaphore It allows the risk of caries to be assessed free of charge. This questionnaire is valid for the Spanish population with permanent dentition and is free. However, unlike the Cariogram, it requires the introduction of all fifteen parameters, obtained from the clinical and radiological examination, to obtain an assessment of the risk of caries. This implies carrying out bacterial cultures. www.cariesrisksemaphore.com 60  19/09/2024 Caries risk assessment – Caries Risk Semaphore Three levels of risk are established in the Semaphore Caries Risk (high, medium or low). Recommendations generated based on risk are obtained. This online application will periodically update the risk assessment calculation system based on the results obtained with its use. To apply the Caries Risk Semaphore results the authors of the clinical practice guide recommend converting the medium risk level to a high level. To use this questionnaire, it is necessary to have an internet connection, but it is not necessary to install any www.cariesrisksemaphore.com program. 61 Caries risk assessment – Modified CAMBRA In case of not being able to use the Cariogram application or the online Caries Risk Semaphore questionnaire, the risk assessment can be carried out using a written questionnaire. The last questionnaire to be developed and to have an evaluation of its predictive capacity is the CAMBRA questionnaire (Caries Management by Risk Assessment), promoted by the Californian Dental Association (CDA - California Dental Association www.cda.org) in 2002. 62  19/09/2024 Caries risk assessment – Modified CAMBRA The Assessment using the CAMBRA questionnaires (questionnaire from 0 to 5 years and questionnaire from 6 years) establishes four risk levels (Low, Moderate, High and Extremely high). The two questionnaires have been translated and the questions have been adapted to the Spanish sociocultural context, converting their four risk categories to only two risk categories (high and low). 63 Caries risk assessment – Modified CAMBRA The modified CAMBRA questionnaire for ages 0-5 years involves filling in the caries risk assessment form after conducting an interview with parents or caregivers and a clinical examination. Subsequently, the risk will be quantified numerically by adding one point for each answer "YES" of the risk indicators (categories 1, 2 and 5), adding two points for each answer "YES" of a risk indicator in the box red and subtract one point for each “YES” answer from the protective indicators (categories 3 and 4). The numerical result will determine the overall caries risk (low: -5 to 5 points and high: 6 to 18 points). The annotations in the questionnaire are used to evaluate some cases that would be found in a border strip, between 4 and 8 approximately. 64  19/09/2024 Caries risk assessment – Modified CAMBRA The modified CAMBRA questionnaire for ages 6 years and older also involves filling in a questionnaire by the professional after the patient's clinical examination and, depending on the age, conducting an interview with the parents or caregivers. The risk will be quantified numerically by adding two points for each “YES” answer in the column of risk indicators, one point for each “YES” answer in the column with risk factors and subtracting one point for each “ YES ”from the Protective Factors column. The numerical result will determine the overall caries risk: low (-9 to 4 points) or high (5 to 18 points). (Table 5) 65 66  19/09/2024 67 68  19/09/2024 69 70  19/09/2024 71 72  19/09/2024 73 74  19/09/2024 75 76  19/09/2024 77 78