__________________________ Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition
Separate caries risk assessment forms for patients ages 0 to 6 years and for patients older than 6 years can be found on the ADA website at http://www.ada.org/en/member-center/ oral-health-topics/caries. Use of these forms will facilitate and standardize the dental team’s caries risk assessment. In addition, the use of risk assessment forms can help uncover the role of poor nutrition as a risk factor and allow the topic of nutrition to be more effectively woven into the risk reduc- tion discussion. NUTRITIONAL COUNSELING All patients stand to benefit from nutritional counseling. Once a caries risk level has been established, all patients should be counseled on how their diet affects their teeth, their caries risk, and their general oral health. Personalized oral hygiene instruc- tions should be established for each patient. Those patients identified as being at moderate to high risk for caries may need to have nutritional counseling and preventive measures not just discussed but also incorporated into their treatment plans. Dental caries is a preventable disease. However, a high inci- dence of caries in early childhood is the single strongest predic- tor of the development of carious lesions into adolescence and adulthood [86]. For patients at low to low-moderate risk for dental caries, nutritional counseling may be performed at the dental cleaning, or recare, appointment. Questions regarding diet, such as those listed later in this section, may be asked on the medical history form or directly of the patient by the dental professional. For these patients, the goal of nutritional counseling is education designed to maintain their low caries risk level.
CARIES RISK ASSESSMENT Dental caries is a multifactorial disease. Counseling a patient who is at risk for caries requires the clinician to consider the various factors that can put patients at risk for, or protect them from, dental caries. In addition to caries-promoting diets and belonging to one or more of the high-risk populations dis- cussed previously, the following are factors that can increase an individual’s caries risk [15; 28; 83]: • Poor oral hygiene • Family history of poor dental health • Prolonged bottle- or breastfeeding • High bacterial titers of S. mutans • Intermittent dental care • Mental or physical disabilities that limit oral hygiene ability • Numerous multisurface restorations • Restorations with open or overhanging margins • Orthodontic appliances • Enamel defects and genetic tooth abnormalities • Radiation or chemotherapy treatments • Eating disorders • Alcohol and drug abuse • Smoking and vaping Determining a patient’s caries risk level, and therefore the rela- tive importance of nutritional counseling and other interven- tions, requires consideration of these factors and communica- tion with the patient and/or patient’s parent. Some of these factors can be identified during the dental examination, such as recession, multisurface restorations, and enamel defects. Other factors, such as personal and family dental history, are elusive and require an open dialogue with the patient and/or patient’s parent [84]. There are several caries risk assessment tools available [4; 84]. Practitioners need to find a tool that allows them to evaluate the variety of factors associated with caries risk as they begin to discuss how diet and nutrition affect the patient’s risk for caries. Caries risk assessments categorize patients into one of three categories. A patient at low caries risk exhibits no caries risk factors and a dental history of no incipient or active caries lesions in the past three years. Patients at moderate risk for caries include those that had either one or two incipient or active caries lesions in the past three years or no caries history in the past three years but at least one caries risk factor. High caries risk is the determination given to patients who have developed three or more caries lesions (incipient or active) in the past three years, have low fluoride contact, present with multiple caries risk factors, or have severe xerostomia [85].
THE NUTRITIONAL COUNSELING APPOINTMENT
Patients with a moderate- to high-risk level of caries may ben- efit from a separate nutritional counseling appointment. The appointment length is individualized based on the patient’s dental knowledge, dietary habits, and motivation level. During this appointment, the dental professional and patient have an opportunity to evaluate the patient’s current diet, discuss preventive treatments, and set goals to improve the diet and reduce caries incidence. To gain information concerning dietary habits, the dental professional may have patients complete a diet questionnaire and food log [87]. An example of a dietary questionnaire and food log was previously shown in Table 1 . Alternatively, the dental professional may choose to interview patients concern- ing dietary habits, using questions such as: • What are your favorite snacks? • On a typical school or workday, what do you eat for lunch?
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