Connecting Caries Risk Levels to Treatment Options
Caries disease is multifactorial. Whether the disease is expressed, causing damage to the dental hard tissues, depends on the patient's unique make-up of pathogenic risk factors and opposing protective factors. Carefully evaluating these factors for each patient is called a caries risk assessment (CRA) and will in turn help determine appropriate treatment options.
Net demineralization or net remineralization is determined by the local tooth surface environment and depends on biofilm behavior, pH, and the concentrations of bioavailable calcium and phosphate.1 Certain products can help push these factors to favor remineralization. This process is usually made easier by use of a validated CRA form and ensures all patients will get a proper assessment independent of which healthcare professional they are interacting with at the time. A proper clinical hard-tissue examination and CRA should be completed prior to the initial stages of treatment planning. This assessment includes, but is not limited to, a CRA form, saliva assessment, and biofilm assessment.
The case studies that follow represent 4 different caries risk profiles-low, moderate, high, and extreme-and examples of possible treatment options. In each of these cases, the CRA form used was adapted from the form published in the Journal of the California Dental Association in October 20072 (visit www.cdafoundation.org/journal to view this form online). Products noted at the end of the article are products used at the University of the Pacific, Arthur A. Dugoni, School of Dentistry and do not represent endorsements. Biofilm behavior and bacterial load were evaluated using ATP bioluminescence3 where readings above 1500 are considered high, and readings below 1500 are considered low. Both resting and stimulated saliva was assessed to some degree based on flow and pH.
It is suggested that clinicians follow instructions for the validated CRA form of their choice and use clinical interventions based on the best available evidence.
1. Featherstone JD, Domejean-Orliaguet S, Jenson L, et al. Caries risk assessment in practice for age 6 through adult. J Calif Dent Assoc. 2007;35(10):703-7, 10-3.
2. Fazilat S, Sauerwein R, McLeod J, et al. Application of adenosine triphosphate-driven bioluminescence for quantification of plaque bacteria and assessment of oral hygiene in children. Pediatr Dent. 2010;32(3):195-204.
3. Jenson L, Budenz AW, Featherstone JD, et al. Clinical protocols for caries management by risk assessment. J Calif Dent Assoc. 2007;35(10):714-23.