Dental caries is a complex, multi-factorial disease. In the initial phase, it results in small molecular changes, and when untreated, it can progress to advanced tissue destruction. With the emphasis on prevention, caries risk assessment aims to highlight risk factors that together indicate a patient's risk level. Based on that risk level, recommended interventions can be provided for patients to help prevent dental caries before its onset, and to reverse (or halt) its progression at the earliest stage possible.
Assessing the risk of dental caries
It is important to differentiate between a diagnostic assessment and a caries risk assessment. In a diagnostic assessment, you will be looking for evidence of existing disease. In a caries risk assessment, you will also be looking for the presence of factors that place patients at risk for dental caries.
In their Caries Risk Assessment forms for age 6 and under and over age 6 age groups, the American Dental Association (ADA) provides a list of conditions to consider that includes:
- Level of fluoride exposure
- Caries experience in the immediate family
- Dietary behaviors such as high sugar intake
- Health conditions such as eating disorders or drug abuse
- Clinical conditions such as xerostomia (dry mouth) or exposed root surfaces
- Special healthcare needs that limit the ability to maintain adequate oral hygiene.
A patient's caries risk factors can change over time, so a caries risk assessment should be carried out during every routine oral health appointment to support early detection and intervention.
Why every patient should be assessed for caries risk
Despite being preventable, caries remains a major public health concern. According to the Centers for Disease Control and Prevention (CDC), the prevalence of dental caries is:
- 45.8% in individuals aged 2-19 years
- Around 90% in individuals
- 96% for individuals 65 years-of-age and older.
Given these statistics, it is clear that patients of every age can benefit greatly from frequent, pro-active, and systematic caries risk assessment. Prevention and management of dental caries based on risk level helps to maintain and improve patients' oral health, improving outcomes and facilitating more cost-effective early-stage interventions.
Strategies for managing caries risk
When a patient is identified as being at risk of developing dental caries, the ADA recommends the interventions discussed below.
Topical fluoride application
A 2013 systematic review published by the ADA supports the use of prescription-strength topical fluoride agents for the prevention of dental caries in at-risk patients. Effective agents include in-office treatments, such as Colgate® PreviDent® Varnish, and prescription home-use toothpastes like Colgate® PreviDent® 5000 Plus® and Colgate® PreviDent® Booster Plus.
Biofilm control
As dental caries is a biofilm-mediated disease, controlling biofilm is an important factor for prevention. Patients at risk for dental caries should be supported in developing optimal oral hygiene practices and reducing the frequency and amount of fermentable carbohydrate consumption.
Pit-and-fissure sealants
In children and adolescents, the pits and grooves on the occlusal surfaces of permanent molars can support the growth of biofilm and increase caries risk. Sealants help to prevent dental caries and arrest non-cavitated lesions. Based on a 2016 systematic review, the ADA and the American Academy of Pediatric Dentistry (AAPD) recommend the use of pit-and-fissure sealants in adolescents and children for primary and permanent molar occlusal surfaces with sound or non-cavitated lesions.
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