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, followedSDCEP by 2012 personalised care planning and ongoing review Where does caries risk assessme nt 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 occur! needs 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 Anything that has account risks but also potential, does not positive protective necessarily need to be 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 Diet (both food type and teeth is a strong indicator of frequency of intake) relates to future caries in both future caries incidence deciduous and permanent (Gustafsson BE et al 1954) teeth (Tagliaferro EP et al 2006) (Steiner ParentalM et al 1992) education as (Li wellY,as Water fluoridation reduces Wang W 2002) status relates socioeconomic DMFT ny 35% in the to future caries incidence in deciduous dentition and 26% children in the permanent dentition (Radford JR et al 2000) (Cochrane 2015) (Tagliaferro E et al 2006) Use of topical fluoride, increased brushing frequency Caries prevalence has been and supervision of paediatric recorded as higher in patients patients have all been shown with special needs so may be to reduce incidence of caries 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 to ol Dundee CRA tool Cariogram (available on app stores) Unstructured Approaches Unstructured questions and evaluation around.. Medical A D Diet history 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 - Sugar containing meds - experience Xerostomia/Radiotherapy - Regular attendance - Limited opening - Use of appliances 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 - Poor plaque control children - Local plaque retentive - Drug/alcohol use 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 Good Regular No current Use of oral attenda medical or fluoride hygiene nce history 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 NICE (2004) recall guidelines patient caries risk level refer to patient caries risk; when considering; - Fluoride concentration in - Children recalls of 3-12 toothpaste (higher months dependant on concentrations for higher risk) risk - Fluoride varnish application (all - Adults recalls of 3-24 children, high risk adults) months dependant on - Fluoride mouth rinse risk (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, Treatment Phasing Risk assessment aids with phasing of treatment (you wouldn’t build a house on poor foundations!). Ultimately means; If moved from Review Stabilise high to low risk risk, can disease assessmen undertake initially more complex t 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.  Patien Patient t1 This 22 year old patient recently lost their job and are now 2 This 22 year old patient has immaculate oral hygiene with no struggling with depression. Due plaque present, no restorations to this, their diet has got a lot and no caries. Upon enquiring, worse and they say they no they have no previous caries longer have the energy to brush. experience, use fluoride They have started taking toothpaste and mouth rinse and antidepressants and have have 6 monthly fluoride varnish noticed their mouth is dry. application. Management? Management?  Patient Patient 1 This 45 year old patient has 2 This 45 year old patient immaculate oral hygiene, attends sporadically every uses topical fluoride products few years. Every time they and has attended annually for attend they have an energy the last 30 years. They report drink in hand and you usually they had these restorations find either a restoration that placed nearly 30 years ago needs replacing due to and have not had one placed recurrent caries or a new since. 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!