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 pa7ent history 1.2.3 Recognise the signi:cance of changes in the pa7ents reported oral health status and take appropri...

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 pa7ent history 1.2.3 Recognise the signi:cance of changes in the pa7ents reported oral health status and take appropriate ac7on 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.. De:ne 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 documen7ng this process Which paBent is at the highest risk of developing dental caries? PaBent 1 PaBent 2 Oral Health Assessment Within rou7ne primary dental care, Oral Health Assessment and Review (OHAR) involves a comprehensive assessment of a pa7ent’: Multiple factors 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 Initial Recall caries risk assessment Lt within this? SDCEP 2012 SDCEP 2012  This where caries risk assessment comes in Specific for patient Recall included As pa7ents circumstances are constantly changing, it is important each pa7ent 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 waiBng for it to Therefore this needs occur! structure A systemaBc process of evalua7ng potenBal risks or protecBve factors to iden7fy a pa7ents future risk of disease ideally before it has occurred Need to take into account Anything that has potenBal, does risks but also posiBve not necessarily need to be protecBve factors happening now Good and bad - overall assessment So what factors do we need to consider as part of this? All factors that could inRuence caries development Medical history need to be considered including.. What we find in patients mouth 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) Decayed, missing and filled teeth Parental educa7on as well as Water Ruorida7on reduces DMFT ny socioeconomic status relates to future 35% in the deciduous den77on and caries incidence in children 26% in the permanent den77on (Radford JR et al 2000) (Tagliaferro E (Cochrane 2015) et al 2006) Use of topical Ruoride, increased brushing frequency and supervision of Caries prevalence has been recorded paediatric pa7ents have all been as higher in pa7ents 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 systema7cally assess each pa7ent against these to ascertain a risk level. How do we undertake caries risk assessment in pracBce? Structured approaches Useful for quantative date Good for starting point Structured – Caries risk assessment tools (CRA) Work through and make sure you ask same questions to everyone Only evaluate things to ask in relation to questionnaire American Dental Associa7on CRA tool 6 Caries management by risk assessment (CAMBRA) CRA tool Part 1 and Part 2 American Academy of Paediatric Den7stry (AAPD) CRA tool Dundee CRA tool Cariogram (available on app stores)  More common Asking questions and undertaking evaluation around various different factors, and asking follow up question based on what patient tells you Unstructured Approaches Follow up with questions if information is found Unstructured ques7ons and evalua7on around.. Medical history A D Diet Social history B E Dental history Patient, family and care givers Oral hygiene C F Examina7on Ask questions about what you see in mouth Do these tools work? “The evidence on the validity for exis7ng systems for CRA is limited. It is unknown if the iden7:ca7on of high-risk individuals can lead to more eeec7ve long-term pa7ent management that prevents caries ini7a7on and arrests or reverses the progression of lesions.” So should we assess caries risk? YES! For tailored advice and education to patients What should you assess if not using a tool? These are all things you rouBnely assess, just need to apply them to caries risk assessment! Link answers to caries risk Medical History: Dental History: More at risk of future caries - risky - Diabetes (Poorly controlled-regular snacking) - Previous caries experience behaviours - Sugar containing meds - Regular agendance Regular exposure to preventative - Xerostomia/Radiotherapy - Use of appliances advice and examinations - Limited opening Trisms, access difficult-not very effective oral hygiene Denture, orthotic- increased risk of plaque accumulation Diet History: Oral Hygiene: What they’re eating, how regularly and timing - Timing - Use of Ruoride How much fluoride and how often - Frequency - Frequency of brushing - Sugars - Quality of regime - Access to Ruoridated water Social History: ExaminaBon: Look at: - Familial caries for children Caries within family - Poor plaque control - Drug/alcohol use High sugar alcohol - Local plaque reten7ve factors Overhangs - Age Drug abuse can impact oral hygiene and diet - Current caries Crowding Elderly patient- struggle to brush effectely- reduced manual dexterity - Restora7ons Suggests history of dental caries - Exposed roots More susectible  Look as positive as well as negatives Considered as part of overall risk assessment ProtecBve factors vs risk factors It is important to remember not just the risk factors but also the protec7ve factors as these may alter the pa7ents risk pro:le as well e.g. Factors at prevent risk No current Good oral Use of Regular No medical or history hygiene [uoride a\endance history of decay What next once you have undertaken your assessment? Allocate paBents to a risk category Most common Moderate High Risk Low Risk Risk  This informa7on will then inRuence how that pa7ent is managed in a number of ways; Preventa7ve advice required Preventa7ve 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.. Delivering better oral health DBOH (2021) refers to paBent caries NICE (2004) recall guidelines refer to risk level when considering; paBent caries risk; - Fluoride concentra7on in toothpaste - Children recalls of 3-12 (higher concentra7ons for higher risk) months dependant on risk - Fluoride varnish applica7on (all children, - Adults recalls of 3-24 months high risk adults) dependant on risk - Fluoride mouth rinse (recommended for those at high risk) SelecBon criteria for dental radiography refers to paBent 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 founda7ons!). Ul7mately means; Stabilise If moved from high Review risk to low risk, can disease undertake more assessment iniBally complex treatment E.g. you would not undertake complex or cosme7c work on a pa7ent 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 jus7:able should anyone review our records. Documen7ng a process of risk assessment will help us to do this! You can jus7fy treatment plans/recall periods with your risk assessment.  PaBent 1 PaBent 2 This 22 year old pa7ent recently lost This 22 year old pa7ent has immaculate their job and are now struggling with oral hygiene with no plaque present, no depression. Due to this, their diet has got restora7ons 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 Ruoride toothpaste and started taking an7depressants and have mouth rinse and have 6 monthly Ruoride no7ced their mouth is dry. varnish applica7on. Low risk High risk Management? Management?  PaBent 1 PaBent 2 This 45 year old pa7ent has This 45 year old pa7ent agends immaculate oral hygiene, uses topical sporadically every few years. Every Ruoride products and has agended 7me they agend they have an energy annually for the last 30 years. They drink in hand and you usually :nd report they had these restora7ons either a restora7on 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 Low risk also have a lower denture. High risk Management? Management? Summary Eeec7ve risk assessment requires a systemaBc approach Pa7ents can change in rela7on to their risk over 7me so needs review You cannot judge risk from just one element alone, need all the informaBon Risk assessment can inform ongoing care and therefore is essenBal for planning Mul7ple tools are available to assist with this Thank You!