CARIES RISK ASSESSMENT, CARIOGRAM ,CARIES VACCINE.ppt.pptx

Preventive dentistry

Caries Risk Assessment and PreventionDR. MANZAR ANWAR Associate Professor & Head Preventive & Community DentistryKhyber College Of DentistryCaries risk assessmentRisk:The probability that some harmful event will occur. To predict that carious lesion (harmful event) will grow or incipient lesion will continue to grow is assessment of carious risk.

Why assess?

If proper prediction of carious lesion is done, preventive actions can be directed, to those persons having high risk of caries and scarce resources can be properly utilized.

RISK INDICATORSSocially deprived, no work, bad economy.Low knowledge, low education of parents.No regular dental check ups.

How?If CHO products are cheaper than proteins than more cariogenic food, less good oral hygiene, saliva problems and reduced fluoride support can lead to caries.Caries risk assessmentAssessment is highly indicated in populations where a large portion is caries free, but some individuals are still highly caries active.

Caries risk assessmentInitiation, development and progression depends on:

Oral health statusEtiologyPreventing factorsRisk factors

Caries risk assessmentRisk for caries development varies significantly for different:Age groups,Individuals and,Teeth and teeth surfaces in dentition.Caries risk assessmentCaries preventive measures must be integrated based on knowledge and understanding of the predicted risk groups.Risk groups can be divided into two categories:Risk age groupOther risk groups.Caries risk assessmentRisk Age Group:

In children specifically when the permanent molars are erupting, caries is initiated.In older age group root caries develops due to higher prevalence of exposed root surfaces.Caries risk assessmentMothers with high Salivary Streptococci Mutans

Mothers most frequently transmit Streptococcus Mutants to their children, leading to greater chances of development of caries as soon as 1st primary teeth erupts.

AGE 1-3 year old Caries risk assessmentSpecific immune system, particularly immunoglobulin (IgA) in saliva among 1-3 year old infant is immature.

In addition poor oral hygiene favors establishment of carious micro flora.

On this basis, the first priority age groups are 1-3 year old children.Caries risk assessmentAge 5-8 years:

The enamel of erupting and newly erupted permanent teeth is particularly more susceptible to caries development .Until secondary maturation is completed, that is more two/three years of eruption, this age group is at continuous risk.Caries risk assessmentAge 11-15 years:

The next high risk group is age 11-15 years, and is true during eruption of second molar (11-12years). Total eruption time is 14-18 months

Proximal surfaces of newly erupted posterior teeth are their most caries susceptible area.

Caries risk AssessmentYoung adults and adults (19-22):

Most of individuals in this age group have, erupting or newly erupted third molars, with highly caries susceptible fissures on mesial surfaces. (peer pressure to good or bad habits).

Caries risk assessmentOlder adults: Another age group susceptible to caries who have :Multiple restorations with plaque retentive margins.Exposed root surfaces by chronic periodontitis.Caries risk assessmentOther Risk groupsObese persons (frequent/ sugary snacking)Persons taking regular medication for systemic diseases affecting salivary function Pregnant and lactating mothers.3.Persons with impaired salivary functions or immune response.Persons undergoing radiation therapy for head and neck region. Key Risk teeth and surfaces Factors Relevant to Assessment of caries risk

Low Risk individual:Social componentMiddle classDentally awareRegular attendeeHigh dental aspirations.No medical problemNormal salivary flow

Factors relevant to Assessment of Caries Risk

No long-term medicationDietary habitsInfrequent sugar intakeLow sugar snacks intakeIntake of sugars at mealsFluoride useFluoridated areaFluoride supplements useFluoride toothpaste and mouth rinses Factors relevant to Assessment of Caries Risk

Frequent effective cleaning after every meals.Good oral hygiene statusHigh buffering capacityLow Streptococcus Mutans and lactobacilli counts.

Factors relevant to Assessment of Caries Risk

Clinical evidence

No new lesionsNo extractions for cariesNo or few restorationsRestorations inserted years agoSound anterior teeth No appliances

High risk individuals:

Individuals at high risk of development of caries exactly the opposite of low risk individuals is true.

Factors relevant to Assessment of Caries RiskCaries Diagnosis and Risk Assessment, American Dental Association, 1995Caries Risk Assessment

Low Caries RiskNo new carious lesions in last 3 years Adequately restored surfacesGood oral hygiene Regular dental visits22 Caries Risk uses 1995 JADA Supplement GuidelinesCaries Risk AssessmentModerate Caries RiskOne carious lesion in last 3 yrsExposed roots Fair oral hygieneWhite spots and/or interproximal radiolucenciesIrregular dental visitsOrthodontic Treatment

Caries Diagnosis and Risk Assessment, American Dental Association, 199523Note that exposed root surfaces automatically place someone in the Moderate Risk group, even if they have excellent oral hygiene and no history of caries in the past 3 years.

Caries Risk Assessment

High Caries Risk2 or more new carious lesions in last 3 yearsPast root caries/numerous exposed rootsDeep pits and fissures Poor oral hygieneInadequate use of topical fluorideIrregular dental visitsInadequate salivary flowElevated Streptococcus Mutans count24Note that a large number of exposed roots or inadequate salivary flow alone are sufficient to place someone at High Risk for caries.

Preventive ArsenalEducation/reinforcementDietary analysis and counselingSealantsXylitol gumWater fluoridationTopical fluoridesProfessionally applied topical fluorideTobacco education & cessation25The DENCOM Implementation Guide contains many examples of how to design preventive treatment plans based on your Risk Assessment results. Treatment Planning DecisionsRemaining unsealed pits and fissures?Does patient drinkfluoridated water and brush with fluoride toothpaste?YesNoApply sealantNo treatmentReinforce Oral Hygiene12 month recall visitRadiographs 12-24 monthsYesNoApply topical fluoride 1 2 x yearlyNo topicalfluorideLow Caries Risk Algorithm 26This is an example of the treatment planning decision algorithms that are in the Implementation Guide for the DENCOM Population Health Metrics, Caries & Tobacco Risk.

Sample Caries Risk-based Preventive PlansLow Caries Risk

1. Seal uncoalesced pits and fissures Reinforce oral hygieneFluoride dentifrice12 month recall

1. Reinforce oral hygiene and diet2. Verify sealant retention3. BWX in 24 months

27These are some sample preventive plans from the Implementation GuideHome fluoride options for patients in these risk groups - mouthrinse, Rx treatment (5,000 ppm F)Moderate Caries Risk Preventive Plans

1. Restore cavitated lesions 2. Seal remaining pits & fissures 3. Professionally applied fluoride Reinforce hygiene & dentifrice Dietary counseling Home fluorides Xylitol chewing gum

28Moderate Caries Risk Preventive Plans

6 month recallReinforce oral hygiene, diet modification, fluoride use2. BWX in 12 months3. Modify as necessary

High Caries Risk patients Preventive Plans

1. Restore cavitated lesions 2. Seal remaining pits & fissures 3. Professionally applied fluoride (varnish 6mo?)4. Reinforce hygiene & dentifrice5. Dietary counseling (referral?)6. Fluoride varnish7. Home fluorides 8. Chlorhexidine rinse9. Xylitol chewing gum 30Home fluoride options- mouthrinse, Rx gel, home fluoride tray for at bedtime

High Caries Risk patients Preventive Plans

3 - 4 month recall1. Reinforce oral hygiene, diet modification, fluoride use.2. Bite Wing X Rays in 6-12 months3. Modify as necessary

Prerequisites For Early DiagnosisGood LightingClean teeth i.e. free from deposits.both wet and dry.Sharp eyes.Blunt Explorer.Good bite wing radiographs.Dental Caries VaccineImmunizationActive ImmunizationPassive ImmunizationImmune Bovine milk, Egg Yolk Antibody, Replacement Therapy.S. Sanguis 01 year age, S. Mutants primary teeth eruptsWindow of infectivity, period of 02 years after primary teeth begin to erupt.Advantages H&N radiation, Xerostomia, Chronically sick patient, handicap.Developing countries vs developed countriesCariogramIt is a model which illustrates the interactions between bacteria, diet and host response. The process of making the evaluation (one year) is called Cariography.Caries risk, will there be demineralization or new cavity will occur, based on Cariogram model.Low%, 5% indicates high risk for caries.High%, 90% indicates low risk for caries.

Bratthal D 1996 of Sweden.

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