Caries Risk Assessment and Management

CARIES RISK ASSESSMENT and
MANAGEMENT
Prepared by Hassan Mohamed Abdi
ABAARSO MD student
CONTENTS
1. Definition of Carries Risk Assessment.
2. Risk assessment in children.
3. History taking in assessing risk in infants
4. Categories of patients in risk assessment
 Assessing environmental risk factors
High risk
Moderate risk
Severe risk
 Clinical risk assessment
 High risk
Moderate risk
Severe risk
5. Guideline for preventing caries in children

Definition of risk assessment.
Risk assessment is normally used in medical

practice to have sufficient data to accurately
quantitate a person’s disease susceptibility and
allow for preventive measures.
Caries-risk assessment models involve a
combination of factors including diet, fluoride
exposure, a susceptible host, and micro flora
that interplay with a variety of social, cultural,
and behavioral factors
Risk assessment in children
Every child should begin to receive oral
health risk assessments by 6 months of age by a
qualified pediatrician or a qualified pediatric
health care professional. Children at high risk
should be referred to a dentist as early as 6
months of age and no later than 6 months after
the first tooth erupts or 12 months of age.
Infants at risk involve:
• Children with special health care needs.
• Children with demonstrable caries, plaque,
demineralization, and/or staining.
• Children who sleep with a bottle throughout
the night.
• Children in families of low socioeconomic
status.
History taking in assessing risk in infants
Questions directed at:

dietary practices, fluoride exposure, oral
hygiene, utilization of dental services, and the
number and location of the mother’s dental
fillings can give a relative indication of the
mother’s baseline decay potential.
Categories of patients in risk assessment:
• Low risk
• Moderate risk
• High risk
Assessing environmental risk factors
LOW RISK:
Adequate fluoride exposure (supplements,
water, dentifrice, etc.)
Primarily consumes sugary or starchy
foods/drinks only at mealtimes
No family history of carious lesions in past 24
months
MODERATE RISK:
Patients who exhibit any of the following conditions may be considered
at Moderate Risk.
No fluoride exposure (supplements, water, dentifrice, etc.)
Family history of carious lesions in past 7-23 months
Has some special health care needs that inhibit adequate oral home care
(in patients over 14 years of age)
• Has eating disorder
• Uses tobacco products
• Takes medication that reduces salivary flow
• Abuses drugs or alcohol
HIGH RISK
Patients who exhibit multiple Moderate Risk factors may
be considered at High Risk.
Additionally, any one of the following conditions may place
the patient at high risk.
• Frequently consumes sugary or starchy foods/drinks
between meals
• Had carious lesions in past 6 months
• Has some special health care needs that inhibit adequate
oral home care (in patients 6-14 years of age)
• Received chemo/radiation therapy
Clinical risk assessment
LOW RISK:
No carious lesions
No visible plaque
No unusual tooth morphology that compromises oral
hygiene
No exposed roots
No orthodontic appliances
No dry mouth
MODERATE RISK
Patients who exhibit any of the following conditions may
be considered at Moderate Risk
One or two carious lesions or restorations in past 36
months
Visible plaque
Unusual tooth morphology that compromises oral
hygiene
Exposed roots
Open margins or bad contacts in existing restorations
Orthodontic appliances
HIGH RISK
Patients who exhibit multiple Moderate Risk
factors may be considered at High Risk.
Additionally, any one of the following conditions
may place the patient at high risk.
Three or more carious lesions, restorations or
missing teeth in past 36 months
Severe dry mouth
PROTOCAL OF MANAGING PATIENTS AT RISK
ACCORDING TO ADA.
LOW RISK:
Encourage patients to maintain current lifestyle
and oral hygiene habits. Offer suggestions for
improvement where applicable, such as more
frequent flossing or eating less frequently.
MODERATE RISK
• The patients may need instruction on proper oral
hygiene habits.
Schedule recall appointments every 4-6 months.
Bitewing radiographs should be taken every 18-24
months (12-18 months for age 2-5 years).
Preventive treatments of topical fluoride application
at every recall.
Sealants should be applied
Restore any cavitated lesions
HIGH RISK
Schedule recall appointments every 3-4 months.
Bitewing radiographs should be taken every 6-18
months.
• office preventive treatments should include a
topical fluoride application at every recall.
• Sealants should be applied to surfaces
• A saliva test and bacterial culture should be
performed initially and at every recall
appointment to assess treatment efficacy and
patient compliance.
• Direct patients to use 10ml of chlorhexidine
gluconate 0.12% rinse for one minute daily,
one week per month.
Guide lines for preventing caries in infants
• Oral hygiene —the parent should be

instructed to brush thoroughly twice daily
(morning and evening) and to floss at least
once every day.
• Diet —the parent should be instructed to
consume fruit juices only at meals and to
avoid all carbonated beverages during the first
30 months of the infant’s life
• Fluoride—the parent should be instructed to
use a fluoride toothpaste approved by the
American Dental Association and rinse every
night with an alcohol-free over-the-counter
mouth rinse with 0.05% sodium fluoride.
• Caries removal —parents should be referred
to a dentist for an examination and restoration
of all active decay as soon as feasible.
• Delay of colonization —mothers should be
educated to prevent early colonization of
dental flora in their infants by avoiding sharing
of utensils (ie, shared spoons, cleaning a
dropped pacifier with their saliva, etc).
• Xylitol chewing gums —recent evidence
suggests that the use of xylitol chewing gum (4
pieces per day by mother) had a significant
impact on decreasing the child’s caries rates

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CARIES RISK ASSESSMENT and

5. Guideline for preventing caries in children

Risk assessment is normally used in medical

Questions directed at:

• Oral hygiene —the parent should be

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