Caries-Prone Patients: Prevention, Assessment, and Intervention _____________________________________
CHILDREN Because all teeth, once erupted, are susceptible to dental caries, even very young children are vulnerable. Early childhood car- ies (ECC) is defined as the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in the primary dentition of a preschool-age child [49]. This condition is seen throughout the general population but is more common in the poor and near-poor preschool children. In the United States, it is estimated that between 3% and 6% of children have early childhood caries [50]. The National Institute of Dental and Craniofacial Research (NIDCR) has indicated that between the years of 2011–2016 that 23% of children between the ages of 2 and 5 years had carious lesions in their primary teeth and that children from lower-income families were twice as likely to have decay in their primary teeth compared to children from higher-income families [51]. Among children ages 6 to 11 years, 17% had decay in their permanent teeth [51]. To prevent ECC development, the American Academy of Pediatric Dentistry (AAPD) recommends that children have their first dental appointment soon after their first tooth erupts and no later than their first birthday [49]. Educating the child’s primary caregiver about oral hygiene care for the child and proper use of bottles is one of the main objectives of this appointment. Sodas, juices, and other sugared drinks should not be given to children, or they should be given very sparingly, and they should never be dispensed through a bottle. Children using bottles should not be allowed to go to sleep with them unless the bottle contains water. The AAPD also advises eliminating the use of a baby bottle by age 12 months and avoiding foods and drinks that contain sugar for children under 2 years of age [49]. Parents and primary caregivers need to be reminded about the eruption pattern of teeth and the fact that children have new teeth exposed to the oral environment from age 6 months to approximately age 12 years. The enamel of primary teeth is thin- ner and less organized compared to the enamel of permanent teeth, so the former is more susceptible to demineralization and the formation of carious lesions compared to the latter [50]. Therefore, soda, sugar, and fermentable carbohydrate exposure is more detrimental in youth than in adults. ADOLESCENTS The incidence of caries continues to rise as children grow into teenagers. According to the NIDCR, approximately 57% of adolescents between ages 12 and 19 have had carious lesions in their permanent teeth [52]. Adolescence is a time of increased caries risk because teenagers consume diets that are higher in fermentable carbohydrates and sugars, and they often practice poor oral hygiene. Research shows that this age group responds to health behavior change requests through motivational interviewing (MI) tech- niques, rather than the traditional dissemination of informa- tion and dispensing of advice [53]. Motivational interviewing, a collaborative, goal-oriented form of communicating behavior change, has been shown to positively affect adolescents’ change
in diet, exercise, and compliance with medications. MI tech- niques that will help professionals better communicate oral healthcare principles with this age group and the mechanisms by which MI works to instill behavioral changes in adolescents is an area of continued research [54]. Among high school stu- dents between 2019–2021, approximately 16.5% of boys and 12.7% of girls had consumed one or more sugar-sweetened soda beverages each day [55; 88]. Soda is included with other sugary products and those made with solid fats in the category of empty calories. Empty calories account for 30.2% to 34.4% of 9- to 13-year-olds’ daily caloric intake and 30.5% to 35.5% of that of 14- to 18-year-olds [56]. Utilizing the principles of MI, the dental professional can work with each teenager to find easily accessible and tasty alternatives to sugar-laden foods. The Resources section contains links to websites that can be shared with young patients and their parents. Many adolescents have braces or other orthodontic appliances that complicate oral hygiene. The combination of susceptible tooth surfaces, a high-sugar diet, and poor oral hygiene is the perfect recipe for caries formation. To decrease caries risk in the adolescent population, medical and dental professionals should inform teenagers about the impact of diet choices on teeth and educate them about healthy eating. Minor changes such as limiting soda consumption to mealtimes and brushing after meals can have a large impact on caries development. In addition, the use of fluoride and sealants is extremely beneficial in preventing caries in the adolescent population. Adolescents are forming habits that will be a foundation for their adult life. Healthy eating, limiting snacks and sugars, and good oral hygiene will be invaluable practices that will help protect their teeth from caries. OLDER ADULTS Older adults are at increased risk for caries as a result of gingival recession, reduced saliva flow, inadequate oral hygiene, physi- cal and sensory limitations, and cognitive limitations [57]. In the United States alone, the elderly population (i.e., those age 65 and older) will grow to 20% (72 million) by 2030 [57; 58]. Aging baby boomers who have retained more of their teeth and have undergone more complex dental procedures will have a greater exposure to dental caries and periodontal concerns, as well as greater expectations of their dental care providers [57; 59]. Many studies have found root surface caries to be most prevalent in the elderly population [60]. Ideal oral hygiene may be difficult to achieve, as manual dex- terity often becomes limited in elderly patients. The presence of partial dentures also complicates oral hygiene, as food and plaque frequently accumulate where the dentures rest against the natural tooth structure. Educating elderly patients who wear partial dentures, and their caregivers when applicable, concerning proper oral hygiene is essential to protect the teeth adjacent to partials from caries. Practices such as cleaning the mouth after meals with fluoridated toothpastes and rinses, removing partials when performing oral hygiene, removing
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