__________________________ Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition
In order to identify pits and fissures that are suitable for the application of preventive sealants or other minimally invasive procedures, dental examinations should include the clinical evaluation of tooth surfaces visually and with the use of a blunt explorer; laser detecting device; compressed air; and the new- est addition to caries classification, the International Caries Detection and Assessment System [81]. The ICDAS system is an evidence-based process for identifying and classifying dental caries lesions using visual cues [82]. This method of classifying carious lesions allows clinicians to apply appropriate evidence-based preventive and minimally invasive treatment methods to affected tooth surfaces. Using a scale of 0 (sound) to 6 (extremely decayed) to classify each pit and fissure, clini- cians can safely determine the best practice for treating the surface, which can include no treatment, fluoride application, sealants, or restorative procedures [82]. 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]. 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.
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Book Code: DPA1525
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