CRA

Question 1

What factors place children ages 0-5yo in high risk CRA category?

Answer 1

• Risk factors:
  
  • Mother/primary caregiver has active dental caries
  • Parent/caregiver has life-time of poverty, low health literacy
  • Child has frequent exposure (>3x/day) between-meal sugar-containing snacks or beverages/day
  • Child uses a bottle or non-spill cup containing natural or added sugar frequently, between meals and/or at bedtime
• [No protective factors]
• Clinical findings
  
  • Child has non-cavitated (incipient/white spot) caries or enamel defects
  • Child has visible cavities or fillings or missing teeth due to caries
  • Child has visible plaque on teeth

Question 2

What factors place children ages 0-5yo in moderate risk CRA category?

Answer 2

• Risk factors:
  
  • Child is a recent immigrant
  • Child has special health care needs
• [No protective factors]
• [No clinical findings]

Question 3

What factors place children ages 0-5yo in low risk CRA category?

Answer 3

• [No risk factors]
• Protective factors:
  
  • Child receives optimally-fluoridated drinking water or fluoride supplements
  • Child has teeth brushed daily w/ fluoridated toothpaste
  • Child receives topical fluoride from health professional
  • Child has dental home/regular dental care
• [No clinical findings]

Question 4

What three factors are incorporated into CRA?

Answer 4

• Social + biological risk indicators
• Protective factors
• Clinical findings

Appropriate for age (0-5yo + 6yo+)

Question 5

CRA assessment…

Answer 5

1. Foster tx of disease process instead of treating the outcome of the disease
2. Allows an understanding of the disease factors for a specific patient + aids in individualizing preventive discussions
3. Individualizes, selects and determines frequency of preventive + restorative tx for a patient
4. Anticipates caries progression or stabilization

Also, the determination of the likelihood for the increased incidence of caries (i.e. the number of new cavitated or incipient lesions) during a certain time period or the likelihood that there will be a change in the size or activity of lesions already present.

Question 6

What factors place children ≥6yo in high risk CRA category?

Answer 6

• Risk factors, social/biological
  
  • Patient has a lifetime of poverty, low health literacy
  • Patient has frequent exposure (>3x/day) between-meal sugar-containing snacks or beverages/day
• [No protective factors]
• Clinical findings
  
  • Patient has ≥1 interproximal caries lesions
  • Patient has active non-cavitated (white spot) caries lesions or enamel defects
  • Patient has low salivary flow

Question 7

What factors place children ≥6yo in moderate risk CRA category?

Answer 7

• Risk factors, social/biological
  
  • Child is a recent immigrant
  • Patient has SHCN
• [No protective factors]
• Clinical findings
  
  • Patient has defective restorations
  • Patient wears an intraoral appliance

Question 8

What factors place children ≥6yo in low risk CRA category?

Answer 8

• [No risk factors, social/biological]
• Protective factors
  
  • Patient receives optimally-fluoridated drinking water
  • Patient brushes teeth daily w/ fluoridated toothpaste
  • Patient receives topical fluoride from health professional
  • Patient has dental home/regular dental care
• [No clinical findings]

Question 9

How often should a low risk child have recalls + radiographs?

Answer 9

RC every 6-12mo; radiographs every 12-24mo

Question 10

How often should a moderate risk child have recalls + radiographs?

Answer 10

RC every 6mo; radiographs every 6-12mo

Question 11

How often should a high risk child have recalls + radiographs?

Answer 11

RC every 3mo; radiographs every 6mo

Question 12

Recommended fluoride interventions in high risk children?

Answer 12

• Drink optimally fluoridated water
• Professional topical tx every 3mo
• SDF on cavitated lesions

**In the ≥6yo children, brushing w/ 0.5% fluoride gel/paste

Question 13

In what caries risk category are sealants + dietary counseling recommended?

Answer 13

All of them

Question 14

How often is professional topical fluoride applied?

Answer 14

• Moderate risk: every 6mo
• High risk: every 3mo

Question 15

“Smear” amount of fluoridated toothpaste is recommended for children how old?

Answer 15

under 3yo

Question 16

Pea-size amount of fluoridated toothpaste is recommended for children how old?

Answer 16

3-6yo

Question 17

Is caries risk assessed at the individual level or tooth level?

Answer 17

Both

Question 18

What is active surveillance of caries based on?

Answer 18

Active surveillance: Prevention therapies + close monitoring of enamel lesions.

Based on the concept that treatment of disease may only be necessary if there is disease progression, and that caries can arrest w/o tx.

Question 19

Is CRA analysis quantitative or qualitative?

Answer 19

Qualitative - there is not enough information currently to have quantitative CRA analyses.

For example, low salivary flow is difficult to measure/may be irrelevant in young children; frequent sugar consumption; fluoride intake is difficult to quantify