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U of M DDS 6436 - Caries Risk Assessment

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Caries Risk AssessmentCOLONIZATIONPROLIFERATIONDEMINERALIZATIONREMINERALIZATIONERADICATIONSUPPRESSIONIIIIIIIVCAVITATIONSUBCLINICALCLINICALCONTROLLABLE DISEASESCONTROLLABLE DISEASESDIABETES MELLITUSDIABETES MELLITUS• NO CUREAVAILABLE• CAN LIMIT DISEASEEXPRESSION• CONTROLTHROUGHMEDICATIONS &DIETDENTAL CARIESDENTAL CARIES• NO CUREAVAILABLE• CAN LIMIT DISEASEEXPRESSION• CONTROLTHROUGH MULTI-PRONG STRATEGYCOMPREHENSIVE CARIESCONTROL• ATTENDING TO THE WHOLEPATIENT• NOT FIXATING ON THE DENTITION• RESTORATIONS ARE ONLY PARTOF THE TREATMENTOBJECTIVES OF CARIESCONTROL EFFORTS• IDENTIFY AT-RISK PATIENTS PRIOR TOTISSUE MORBIDITY• INSTITUTE MEASURES TO– PREVENT TISSUE MORBIDITY– REVERSE EARLY LESIONS– REDUCE RISK STATUS• MONITOR CHANGES IN RISK OVER TIMEWhat Is CARIES RISKASSESSMENT?A SCREENING TOOLWhy ASSESS CARIES RISK?• CHANGING CARIES PREVALENCETARGET AT-RISK SEGMENT OF PATIENTPOPULATION• DISEASE HAS SUBCLINICAL PHASEIDENTIFY AT-RISK PATIENTS PRIOR TOSIGNIFICANT TISSUE MORBIDITY• QUESTIONABLE LESIONS & RESTORATIONSADDITIONAL INFORMATION FOR MAKINGTREATMENT DECISIONSHow Is CARIES RISKASSESSED?• AT INITIAL EXAM• MULTIFACTORIAL ASSESSMENT• USING DATA GATHERED FROM– CLINICAL EXAMINATION– RADIOGRAPHIC SURVEY– FEW SIMPLE QUESTIONS TO PATIENTCaries Risk Assessment• Oral Dryness• Fermentable Carbohydrates• Low Fluoride Exposure• History of Caries ActivityHyposalivation resultsin1. diminished ability to buffer acids,2. reduced clearance of food,microorganisms, and microbial byproducts,3. gross impairment remineralizationcapabilities,4. loss of host defense mechanisms,5. alterations to eating and drinking habits1. History of any diseaseassociated with oral dryness,e.g., Sjögren's syndrome orpernicious anemiaMUST BE CHRONIC(PRESENT MORE THAN 6 MONTHS)Common Diseases Causing Oral DrynessANXIETYACQUIRED IMMUNODEFICIENCY SYNDROMECYSTIC FIBROSISDEPRESSIONDIABETES MELLITUSMALIGNANT LYMPHOMAPARKINSONS DISEASEPERNICIOUS ANEMIARHEUMATOID ARTHRITISSARCOIDOSISSCLERODERMASJOGREN'S (SICCA) SYNDROMESYSTEMIC LUPUS ERYTHEMATOSUS2. History of diseasetreatments that may result inoral dryness, e.g., head & neckradiation or chemotherapyTreatments Causing Oral DrynessBONE MARROW TRANSPLANTSCHEMOTHERAPYHEAD & NECK RADIATIONNEUROLOGIC SURGERY3. Protracted use ofmedications that reduce salivaryflow• PROTRACTED USE (MORE THAN 6MONTHS)• MULTIPLE MEDICATIONS WORSETYPES OF MEDICATIONTYPES OF MEDICATIONFREQUENTLY ASSOCIATEDFREQUENTLY ASSOCIATEDWITH ORAL DRYNESSWITH ORAL DRYNESS• CARDIAC MEDICATIONS• ANTIHYPERTENSIVE MEDICATIONS• PSYCHOTROPIC MEDICATIONS(FOR MENTAL OR EMOTIONAL PROBLEMS)• COLD / ALLERGY MEDICATIONS4. Protracted use of sugar-containing medications, e.g.,antacids, cough drops, coughsyrups, or sweetenedsuspensions• PROTRACTED USE (MORE THAN 6MONTHS)• FREQUENT USE (AVERAGING 3DAYS/WEEK)5. History of diseasesassociated with deleteriousdietary change,e.g., diabetes or bulimia• UNCONTROLLED DIABETES MELLITUS• DIABETICS WHO SNACK FREQUENTLY• BULIMIA NERVOSADIABETES MELLITUS& DENTAL CARIES• DRY MOUTH IS A COMMON COMPLAINTSreebny et al, Diabetes Care 1992• INSULIN-CONTROLLED DIABETICS HAVEMORE CARIES LESIONS THAN THOSE ONORAL MEDS Sandberg et al, Diabetes Res Clin Pract 2000• DIABETICS HAVE MORE CARIES LESIONSTHAN NON-DIABETICS WITH SAMESALIVARY FLOW & ORAL HYGIENE Miralles etal, Med Oral Patol Oral Cir Bucal 2006• GESTATIONAL DIABETES MAY INCREASERISK OF CARIES Friedlander et al, Oral Med Oral PatholOral Radiol Endod 20076. History of conditionsassociated with impaired oralhygiene, e.g., Parkinson'sdisease, cerebrovascularaccident, arthritis, debilitation, orhandicapLOCAL IMPAIRMENT OF ORALHYGIENE IS NOT INCLUDED7. Complaints of xerostomia,subjective sensation of drymouth• SENSATION OF DRYNESS ATCERTAIN TIMES OF DAY OR NIGHT• TEETH STICK TO CHEEKS• DIFFICULTY SWALLOWING DRYFOOD WITHOUT LIQUID CHASER• MAY NOT CORRELATE WITH ORALDRYNESS8. History of dental cariesactivity as determined by patientreportINSURE RESTORATIVE SERVICES WERE FORCARIES LESIONS AND NOT SOME OTHERPURPOSE9. Situations associated withdietary change, e.g., pregnancy,smoking cessation, going awayto school, death of spouse,retirement, drug addiction, ormarijuana useWITHIN THE LAST YEAR10. Deleterious dietary habits, suchas...(a) habitual use of sweetened liquidssuch as coffee, tea, pop, or fruitjuices(b) habitual use of sugared gum(c) habitual use of hard candy, breathmints, or breath sprays(d) habits involving snacks beforebedtime11. Minimal history of fluoride exposurein drinking water, dentifrices, or oral rinses• PATIENTS FROM RURAL SETTINGS OR OUTSIDE U.S.• NOT UTILIZING COMMUNITY WATER SUPPLY• INADEQUATE EXPOSURE FROM DENTIFRICE• NOT A LIFELONG BENEFIT•Most bottled waters lack F•If F added, mfr required to listamount•If F concentration 0.6 - 1.0 ppmcan label: "Drinking fluoridatedwater may reduce the risk oftooth decay"IN-HOME WATER FILTERSREMOVES FLUORIDE• REVERSE OSMOSIS• DISTILLATION• CARBONATEDALUMINADOES NOT REMOVEFLUORIDE• ION EXCHANGESOFTENERS• SEDIMENT FILTERS• ULTRAVIOLETSYSTEMS3 out of 4 carbon filters remove fluorideJobson, et al. ASDC J Dent Child 2000If patients use a water filter, they should havetheir water tested for fluoride levels12. Carious lesions currentlypresent (frank or incipient)QUESTIONABLE LESIONS(LESIONS NOT OBVIOUSLY OF CARIOUSORIGIN)ARE NOT INCLUDED13. History of dental cariesactivity as inferred by(a) number of restorations andmissing teeth,(b) position of restorations (e.g.,proximal, cervical, and rootsurface), and(c) restorations extending beyondideal depth as determined fromthe radiographs14. Poor oral hygiene• MODERATE TO HEAVY PLAQUE ACCUMULATIONS• MARGINAL GINGIVITIS WITHOUT PLAQUE• MINIMAL EXPOSURE TO FLUORIDE DENTIFRICE• PROLONGED EXPOSURE TO CARIOGENIC FOODSAt recall: 15. Caries activitysince last exam, determinedfrom the dental chartREQUIRES THAT NOTE BE MADE INCHART WHEN CARIOUS DENTIN ISENCOUNTERED DURING


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