__________________________ Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition
Discussion Treatment Plan
A : Not very often. Q : What do you drink when you’re thirsty? A : Water.
Savannah has ECC, with several carious lesions in each quad- rant needing extensive restorative intervention. Her mother does not want her sedated, so the restorations will require no fewer than five appointments. Vision for Preventing New Carious Lesions Restore all existing cavitated lesions, promote remineralization of the noncavitated lesions, develop excellent oral self-care habits, and perform preventive dental hygiene care every four to six months until no new caries activity has been observed for a period of three years. In other words, the goal is to reduce Savannah’s caries risk to low. It is imperative to break the chain of the four elements required for caries activity: Caries-causing micro-organisms, a susceptible tooth surface, fermentable carbohydrates, and time.
Discussion Dental professionals commonly see this scenario. The patient knows all the right answers, and you can’t dispute his oral health routine, as his periodontal condition is excellent. How- ever, he does have recurrent decay on tooth #8. What follow-up questions might you choose to ask to fill in the blanks about the role his nutritional intake may play in this case? Recalling the four factors necessary for the caries disease progression—susceptible tooth, diet, time, and bacteria—you need to be a bit of a detective. Mr. Ribeiro’s history of dental care also includes several crowns and a recent restoration. This tells you that his teeth are susceptible. He maintains a clean mouth, or so he says, so you must consider that he removes the oral bacteria from his teeth regularly. Diet may be the culprit. A good way to begin with a patient who knows all the right answers and does not want to be lectured might be to go through your caries risk assessment out loud. Begin by tell- ing him why you are asking these questions. Tooth decay is preventable, and you want to help him prevent the need for more costly crowns and fillings in the future. Ask him to tell you what he has eaten in the past 24 hours. Share with him that even though he brushes three times a day, the bacteria and acids on his teeth will eventually begin to demineralize his teeth. Often, letting that fact form a picture in a patient’s head can spur questions or even solutions for reducing the risk. Change is most likely to happen when the patient is a partner in the change. CONCLUSION Many patients take oral health for granted and will benefit from learning that caries is a preventable disease, and their dietary choices can either promote the progression of disease or aid in preventing caries development. Addressing nutritional choices during dental visits can positively affect patients and can help them make healthier choices for their entire fam- ily. Dental professionals as a community have the ability to educate hundreds of thousands of people. Taking the time to discuss nutrition with patients will pay the dividend of hav- ing healthier patients who truly value their teeth and overall health. As patients come to understand the relationship between oral health and systemic health, the impact of their dietary choices on both will become evident.
What Would You Consider to be a Manageable Step 1?
Initial examination should include simple nutritional counsel- ing and thorough oral hygiene instruction that includes both the mother and child. Poor oral hygiene and eating habits are difficult to change. A good first step may be to give the family the goal of brushing their teeth after each meal. Discuss the bacteria and food that remain on teeth after eating and how they need to be removed after each meal. Comparing this pro- cess to the habit of washing hands before each meal to remove bacteria and dirt may help the child make the connection. Have Savannah’s mother complete the Nutritional Questionnaire and Food Log and bring it to the next nutritional counseling session.
CASE SCENARIO 2: HE’S GOT ALL THE ANSWERS
Mr. Ribeiro, a 68-year-old male, arrives for his dental hygiene recare appointment. He is a pleasant, retired gentleman. He appears happy, healthy, and quiet, as usual. His medical history is unchanged from his last visit six months ago. He has high blood pressure and prostate malfunction. He takes losartan, finasteride, and terazosin. He has no dental complaints. During your oral health and caries risk assessment, you detect very little plaque biofilm, no bleeding on probing, stable periodontal health, adequate saliva flow, a broken cusp on tooth #31, and what appears to be a recurrent carious lesion under the crown on tooth #8. As you complete your caries risk assessment, your
first inquiry goes as follows: Q : How often do you brush? A : Three times a day.
Q : How do you clean in between your teeth? A : I use that flosser thing three times a day. Q : Do you snack?
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