Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition __________________________
• What is your favorite soft drink or fruit juice, and how often do you drink it? • How long does it take you to finish a can of soda or a glass of juice? • How often do you brush your teeth? How often do you floss? Follow-up to the nutritional counseling appointment should take place in order to encourage the patient’s goals and rein- force habit changes. This follow-up may consist of a phone call to check in with the patient, or it may be a short appoint- ment a few weeks after the counseling appointment. The patient’s progress can be reevaluated at subsequent dental appointments. Establishing and routinely reassessing a patient’s caries risk level allows the dental professional to provide proactive care and recommend preventive measures to minimize the patient’s risk of dental decay. Occasionally, a patient may benefit from a referral to a dieti- cian, nutritionist, or primary care physician. This is especially true if a condition such as acid reflux, an eating disorder, or chemical dependency is suspected or confirmed. SETTING GOALS • The dental professional should be practical when recommending changes to a patient’s diet. Asking patients to forfeit their favorite foods in exchange for increased brushing and flossing will rarely improve patient compliance. It is important to note, however, that relatively minor changes in nutrition and habits can lower a patient’s caries risk. By evaluating each patient’s individual incentives and motivation level, dental professionals can help patients set goals that are realistic and achievable. Some examples of these goals are: • Limiting soda drinks to mealtimes • Exchanging sugared gum or candies for sugar-free or xylitol-sweetened varieties • Replacing soda with flavored water • Including sweet foods with meals, when the sugar content will be diluted • Making a conscious effort to eat a fruit or vegetable with every meal, as fruits and vegetables act as natural oral cleansers • Brushing with a xylitol-containing toothpaste and chewing xylitol gum twice a day
As patients set and achieve goals, additional changes can be recommended to further decrease caries risk. Nutritional counseling, like other behavioral modification interventions, is a dynamic process that is emphasized depending on need.
CASE SCENARIOS
CASE SCENARIO 1: SAVANNAH’S FIRST DENTAL APPOINTMENT
Savannah is a 4-year-old girl coming to your office for the first time. She is wearing a pretty dress and sparkly shoes, and she has a pink bow tying her long black hair up in a ponytail. She is obviously frightened. As you escort Savannah and her mother to the treatment room, the only thing Savannah says is that she does not want silver teeth. Savannah has an unremarkable medical history, takes no medications, is current with her vac- cinations, and has no allergies. When you ask Savannah if any of her teeth hurt, she quietly nods. Upon being asked whether Savannah has been to the dentist, her mother explains that Savannah lived with her aunt for several months and during that time had been taken to her aunt’s dentist. Her aunt’s dentist had recommended stainless-steel crowns for Savannah’s carious teeth #E and #F, but the aunt did not want to have the crowns placed without Savannah’s mother’s permission. Savan- nah is covered by insurance, but the insurance pays only for stainless-steel crowns, and Savannah’s mother admits to having been unable to afford the tooth-colored crowns until now. Establishing a caries risk level for this child should be easy, as her mother admits that she has active carious lesions. What is her caries risk level? One look at Savannah’s cute smile reveals severe caries on teeth #E and #F. At this point, you complete the caries risk assessment form, determining the child’s fluo- ride exposure level, oral hygiene routine, and snacking habits. Savannah’s mother works full time and has two children, Savannah and her 3-year-old sister, Lillian. Savannah’s mother admits that the girls don’t brush their teeth regularly, as they commonly fall asleep in front of the television and are carried to bed. A typical breakfast consists of sweetened cereal, milk, and a juice box. They eat lunch at the babysitter’s, and their mother tries to make them sit down to have dinner each night. The girls like to eat candy after dinner, frequently not eating all their dinner in order to save room for the candy. Treating Savannah’s oral conditions will be a long process. Because her caries risk is high, each appointment should include a short nutritional counseling session, which can be added to the treatment plan. If Savannah were your patient, what would be your plan for preventing new carious lesions? What would you consider to be a manageable step 1 for this child?
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