cambra POHC

Risk assessment is an estimation of the likelihood that an event will occur in the future.

For more than two decades, medical science has recommended that physicians identify and treat patients based on their risk status, rather than treating all patients as if they were the same​

Patient who is at higher risk for heart attack or stroke due to high blood pressure or high cholesterol are given ...

medications to control blood pressure and cholesterol. ​

Not everyone is prescribed ​these medications.​

Caries management by risk assessment and evidence based

Caries management by risk assessment is an evidence-based approach to preventing, reversing and treating dental caries.​

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Evidence-based- the best research evidence, combined with clinical expertise and patient preference.​

Traditional caries management is the restoration of cavitated lesions.​ CAMBRA by contrast places emphasis on the whole ...

disease process and emphasizes prevention, reversing and, when necessary, repairing early damage to teeth using minimally invasive (only doing as much prep as needed) restorative techniques.​

The goal of caries risk management is to identify patients at risk for developing future caries and to implement

interventions that will help to remineralize areas before they become carious lesions and prevent future caries. ​

Dental caries is a transmissible bacterial infection that is preventable and in some cases even reversible. Dental decay, however, ...

remains the single most common disease of child-hood ​

risk indicators for carries: Risk indicator is an existing signs of the disease process.

Clinical observations of past or current caries. ​

Placing restorations does not significantly reduce the bacterial load in the mouth.​

Risk indicators are examples of what is happening with the patients current state of health, not how disease occurs.​

risk indicators for carries

Cavitations or lesions that penetrate into the dentin ​​

Proximal radiographic lesions ​

Visible white spots on smooth ​surfaces-demineralization​​

Any restorations placed in the ​last 3 years.

Risk factor is defined as an environmental, behavioral or biological factor that directly increases the probability that a disease...

will occur and, the absence or removal of which will reduce the possibility that disease will occur.​

Once disease has occurred, the removal of a risk factor may not always result in the cessation of the disease.​

Caries risk factors are the environmental, behavioral or biological factors that contribute to the level of risk for the patient of having new carious lesions in the future or having the existing lesions progress...

The risk factors are the reasons or factors that have caused or contributed to the disease, or will contribute to its future manifestation on the tooth. ​

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Risk factors can be modified or changed.

Risk factors for Caries​

Medium or high Strep Mutans and ​

Lactobacilli bacterial counts ​

Visible heavy plaque on teeth​

Frequent (> 3X daily) snacking ​

Drinking low PH drinks​

Deep pits and fissures ​

Recreational drug use

Risk factors for Caries​ continued

Inadequate saliva flow ​

Saliva reducing factors (medications/radiation/systemic)​

Exposed roots​

Orthodontic appliance​

Poor restorations/open margins​

Suboptimal fluoride exposure​

Developmental or acquired enamel defects​

These risk factors need to be offset by...

protective factors, to prevent further caries.

Low Caries Risk Patients​

Oral hygiene instructions including the use of fluoride toothpaste 2xdaily​

Routine dental hygiene care including professional fluoride treatment every 6 months​​

Moderate Caries Risk Patients​

Oral hygiene instructions including the use of fluoride toothpaste 2xdaily​

Routine dental hygiene care including professional fluoride treatment every 6 months​

Address special needs​

RX Fluoride​

Xylitol gums or mints​

High Caries Risk Patients​

Oral hygiene instructions including the use of fluoride toothpaste 2xdaily​

Nutritional counseling​

Routine dental hygiene care including professional fluoride treatment ​

every 3-6 months, more frequent radiographs​

Address special needs​

RX Fluoride​

Xylitol gums or mints​

Biotene or other dry mouth management​

Baking soda products to neutralize acid after snacking​

Calcium and phosphate products such as MI paste​​

xylotl

Natural occurring 5 carbon sugar alcohol, sweetener​

Inhibits attachment and transmission of bacteria​

Enhances remineralization ​

Stimulates saliva which neutralizes acids​

Chewing gum, mints, lozenges ​

carries risk assessment form: low risk for adults

flouride exposure

sugary stuff at meal times

no caries in last 2 years on mother/ sibling

has a dental home

no special health care needs, chemo/ radiation therapy, eating disorders, xerostomia inducing meds, or drug/ alc abuse

no new restorations or carious lesions in last 36 months

no ortho, exposed root surfaces, visibal plaque, unusual tooth morphology

carries risk assessment form: moderate risk for adults

no flouride

mother or sibling having carries last 7-23 months

no dental home

special health care needs 14 y/o+

eating disorder, xerostomia inducing med, drug/ alc abuse

1-2 new carries or restorations in last 36 months

ortho work, exposed root surfaces, unusual tooth morphology, visible plaque

carries risk assessment form: high risk for adults

frequent prolonged sugary stuff

carious lesion last 6 months of mother/ sibling

special health care needs age 6-14

chemo/ radiation therapy

3+ carries in last 36 months

teeth missing due to carries past 36 months

xerostomia

carries risk assessment age 6-16: low risk for peds

flouride exposure, sugary stuff at meal times

no carries last 24 months and a dental home

visible salivary flow

carries risk assessment age 6-16: moderate risk for peds

frequent/ prolonged sugary stuff

carries in last 7-23 months

visible plaque and ortho

carries risk assessment age 6-16: high risk for peds

bottle at bedtime w/o water

broke

carries last 6 months

special health care needs

carries or restoration last 24 months

new lesion 24 months

teeth missing due to carries

no visible salivary flow