Dental Caries Risk Assessment PDF

Dental Caries Risk Assessment Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.2.2 Recognise the importance of and record a comprehensive and contemporaneous patient history 1.2.3 Recognise the significance of changes in the patients reported oral health status and take appro...

Dental Caries Risk Assessment Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.2.2 Recognise the importance of and record a comprehensive and contemporaneous patient history 1.2.3 Recognise the significance of changes in the patients reported oral health status and take appropriate action 1.5.5 Discuss the role of the dental therapist and other members of the dental team in the treatment plan Pre-reading Dental Caries Lectures Intended Learning Outcomes By the end of this session you will be able to.. 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 Which patient is at the highest risk of developing dental caries? Patient 1 Patient 2 Oral Health Assessment Within routine primary dental care, Oral Health Assessment and Review (OHAR) involves a comprehensive assessment of a patient’: 1. Social 2. Dental 3. Medical histories 4. Oral health status that leads to diagnosis and risk assessment, followed by personalised care planning and ongoing review SDCEP 2012 Where does caries risk assessment fit within this? SDCEP 2012 SDCEP 2012 As patients circumstances are constantly changing, it is important each patient is reassessed at the start of each course of treatment SDCEP 2012 So, what is a caries risk assessment?  Need to pre-empt disease rather than waiting for it to Therefore this needs occur! structure A systematic process of evaluating potential risks or protective factors to identify a patients future risk of disease ideally before it has occurred Need to take into account Anything that has potential, does risks but also positive not necessarily need to be protective factors happening now So what factors do we need to consider as part of this? All factors that could influence caries development need to be considered including.. What does research say? Previous caries in deciduous teeth is a Diet (both food type and frequency of strong indicator of future caries in intake) relates to future caries both deciduous and permanent teeth incidence (Tagliaferro EP et al 2006) (Steiner M (Gustafsson BE et al 1954) et al 1992) (Li Y, Wang W 2002) Parental education as well as Water fluoridation reduces DMFT ny socioeconomic status relates to future 35% in the deciduous dentition and caries incidence in children 26% in the permanent dentition (Radford JR et al 2000) (Tagliaferro E (Cochrane 2015) et al 2006) Use of topical fluoride, increased brushing frequency and supervision of Caries prevalence has been recorded paediatric patients have all been as higher in patients with special shown to reduce incidence of caries needs so may be higher risk (Cochrane 2003) (Shyma M 2001) (Morgan J 2012) How does this link? From the last slide and your previous teaching, we know what leads to dental caries or reduces dental caries. We can therefore systematically assess each patient against these to ascertain a risk level. How do we undertake caries risk assessment in practice? Structured approaches Structured – Caries risk assessment tools (CRA) American Dental Association CRA tool 6 Caries management by risk assessment (CAMBRA) CRA tool Part 1 and Part 2 American Academy of Paediatric Dentistry (AAPD) CRA tool Dundee CRA tool Cariogram (available on app stores) Unstructured Approaches Unstructured questions and evaluation around.. Medical history A D Diet Social history B E Dental history Oral hygiene C F Examination Do these tools work? “The evidence on the validity for existing systems for CRA is limited. It is unknown if the identification of high-risk individuals can lead to more effective long-term patient management that prevents caries initiation and arrests or reverses the progression of lesions.” So should we assess caries risk? YES! What should you assess if not using a tool? These are all things you routinely assess, just need to apply them to caries risk assessment! Medical History: Dental History: - Diabetes - Previous caries experience - Sugar containing meds - Regular attendance - Xerostomia/Radiotherapy - Use of appliances - Limited opening Diet History: Oral Hygiene: - Timing - Use of fluoride - Frequency - Frequency of brushing - Sugars - Quality of regime - Access to fluoridated water Social History: Examination: - Familial caries for children - Poor plaque control - Drug/alcohol use - Local plaque retentive factors - Age - Current caries - Restorations - Exposed roots Protective factors vs risk factors It is important to remember not just the risk factors but also the protective factors as these may alter the patients risk profile as well e.g. No current Good oral Use of Regular No medical or history hygiene fluoride attendance history of decay What next once you have undertaken your assessment? Allocate patients to a risk category Moderate High Risk Low Risk Risk  This information will then influence how that patient is managed in a number of ways; Preventative advice required Preventative treatment required Ability to access more complex treatment Radiographic assessment Recall assessment AAPD 2019 AAPD 2019 ICCMS 2014 ICCMS 2014 ICCMS 2014 SDCEP 2012 More local guidance.. DBOH (2021) refers to patient caries NICE (2004) recall guidelines refer to risk level when considering; patient caries risk; - Fluoride concentration in toothpaste - Children recalls of 3-12 (higher concentrations for higher risk) months dependant on risk - Fluoride varnish application (all children, - Adults recalls of 3-24 months high risk adults) dependant on risk - Fluoride mouth rinse (recommended for those at high risk) Selection criteria for dental radiography refers to patient caries risk; - Children at high risk 6 monthly bitewings, 12 monthly if moderate or low - Adults at high risk 6 monthly bitewings, 12 monthly moderate, 24 monthly low Treatment Phasing Risk assessment aids with phasing of treatment (you wouldn’t build a house on poor foundations!). Ultimately means; Stabilise If moved from high Review risk to low risk, can disease assessment undertake more initially complex treatment E.g. you would not undertake complex or cosmetic work on a patient with high caries risk as this is more likely to fail. You would not know their risk without assessing it! Record Keeping Everything we do needs to be justifiable should anyone review our records. Documenting a process of risk assessment will help us to do this! You can justify treatment plans/recall periods with your risk assessment.  Patient 1 Patient 2 This 22 year old patient recently lost This 22 year old patient has immaculate their job and are now struggling with oral hygiene with no plaque present, no depression. Due to this, their diet has got restorations and no caries. Upon a lot worse and they say they no longer enquiring, they have no previous caries have the energy to brush. They have experience, use fluoride toothpaste and started taking antidepressants and have mouth rinse and have 6 monthly fluoride noticed their mouth is dry. varnish application. Management? Management?  Patient 1 Patient 2 This 45 year old patient has This 45 year old patient attends immaculate oral hygiene, uses topical sporadically every few years. Every fluoride products and has attended time they attend they have an energy annually for the last 30 years. They drink in hand and you usually find report they had these restorations either a restoration that needs placed nearly 30 years ago and have replacing due to recurrent caries or a not had one placed since. new cavity that needs restoring. They also have a lower denture. Management? Management? Summary Effective risk assessment requires a systematic approach Patients can change in relation to their risk over time so needs review You 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 Thank You!