what caries is most commonly seen in GDH?
secondary caries
caries a.k.a.
tooth decay
what factors are necessary for caries?
- tooth
- substance (for bacteria to feed off)
- flora
- time
what flora most commonly causes caries?
streptococcus mutans
what influences are on the tooth that can effect its rate of getting tooth decay?
- age
- fluorides
- morphology
- nutrition
- trace elements
- carbonate level
what is a caries risk assessment?
the risk of the patient developing new/progressive disease in furture
what level does caries risk assessment need to be carried out on?
individual level
not population
although risk information is used within Dental Public Health to make population level decisions
what 2 categories are there for caries risk factors?
general
local
what are general caries risk factors?
- social status (lifestyle, priorities, means of associated care)
- general health - as has impact on oral health
what are local caries risk factors?
- oral hygiene - barriers to it (disability, age)
- diet - parental input, social status, easy to make healthy choices
- fluoride experience
- past caries experience
- orthodontic treatment - harder to clean well and takes longer
what is a cariogram?
computerised version of caries risk assessment
- pie chart
7 elements of caries risk assessment
- clinical evidence
- dietary habits
- social history
- fluoride use
- plaque control (oral hygiene)
- saliva
- medical history
how do we assess clinical evidence for caries risk assessment?
- dmft > 5 (primary dentition), DMFT > 5 (permanent dentition)
- Caries in 6s (1st permanent molars) at 6 - high risk
- 3 lesions in 3 years = high risk; 3 year caries increment > 3
- fresh or unrecorded, past restorations with underlying caries,
- Orthodontics can change as harder to clean
- Prosthetics – fixed or removable
what does dmft/DMFT stand for?
decayed
missing and
filled
teeth
what does dmfs/DMFS stand for?
decayed
missing and
filled
surfaces
how do we assess dietary habits for caries risk assessment?
- Greater than equal to 3 sugar intakes per day - concerning. Hidden sugar too
- Frequency more important than volume
- Better to eat in one go than over time
- Highly processed/refined carbohydrate more cariogenic than natural sugars e.g. sucrose more cariogenic than glucose or fructose
- Natural sugars - still harmful e.g. lactose in early childhood caries
Generic advice doesn’t work that well - so DIET DIARY good as specific to individual
- 4 days everything eat and drink and times (one weekend)
- Toothbrushing times too – stephen curve acid attack, only H20 after, 20 mins from last food and brush teeth
how do we assess social history for caries risk assessment?
- SIMD category (Scottish index of Multiple Deprivation)
- Education
- Employment
- Work stressors
- Single parent
- Violence
- Inequalities and access to healthcare
- Dependents
how do we assess fluoride use for caries risk assessment?
- Are they getting from toothpaste twice a day consistently?
- Floriated water area - down south
- Fluorapatite is more caries resistant than Hydroxyapatite
- There is some resistant streptococcal strains - upset there adhesion so not necessarily bactericidal
- Interferes with the adhesion force of bacteria reducing their ability to stick to the surface of the teeth
how does fluoride help lower caries risk?
Interferes with the adhesion force of bacteria reducing their ability to stick to the surface of the teeth
how do we assess plaque control in caries risk assessment?
- Oral hygiene (Technique, irregular brushing (definitely needed at night))
- unassisted (very young/very old, manual dexterity issues)
- access to toothbrush/paste,
- difficulty due to changes in oral cavity (mixed dentition e.g. child’s mouth/orthodontics/gaps/recession)
how do we assess saliva in caries risk assessment?
- Role of saliva (amount, flow, buffering capacity, pH, viscosity)
- Can just have poor saliva buffering quality - more prone to acid erosion
- Need to be low viscosity so can wash between teeth
- Xerostomia - dry mouth, congenital, due to medication side effect or intended side effect e.g. cerebral palsy
- `
how to assess medical history in caries risk assessment?
- Inhalers - can make mouth dry or alter pH
- Sugars in medicine - e.g. liquid medicines for children
- Lactulose used in children to stop constipation - sugar - used to be taken just before bed but bad time to take
- Frequency of sugar containing medicine- if medication for long time better to be sugar free or tablet form
- Recreational drug use/rehabilitation from drug addiction (Methadone - highly cariogenic)
- Sweets given to ill friends
- Xerostomia - dry mouth, congenital, due to medication side effect or intended side effect e.g. cerebral palsy
typical high caries risk child
Social
- Mother’s education secondary only
- Poor dental attender
- Family Unit: single parent, social class, unemployment
Health
- Poor health/chronic sick
- Sugar-based medications
Caries Experience
- dmft > 5, DMFT > 5
- > 10 initial lesions in primary dentition at first attendance
- caries in 6’s at 6 years
- 3 year caries increment > 3
Orthodontics
- Fixed appliance therapy
social status of typical high caries risk child
- Mother’s education secondary only
- Poor dental attender
- Family Unit: single parent, social class, unemployment
