Conclusions
Caries risk
From a cost-effectiveness aspect caries-preventive measures should be applied strictly according to predicted caries risk. In populations with very high caries prevalence and caries incidence (where almost everyone develops new lesions every year) the traditional whole population strategy would be cost effective. The number of such populations is dwindling, however, particularly in the industrialized countries where caries prevalence was high 20 to 30 years ago. Most of the world's populations have low or moderate caries incidence. In such populations, particularly those with wellestablished self-care habits and access to well-organized oral health services, the socalled high-risk strategy would be very cost effective; caries-preventive measures should target key-risk age groups and other risk groups, key-risk individuals, key-risk teeth, and key-risk tooth surfaces.
Preventive programs should target the following key-risk age groups in children:
1. One to two year olds, to establish good oral health habits as early as possible and prevent bad habits for as long as possible
2. Five to seven year olds, to prevent fissure caries in the erupting permanent first molars
3. Eleven to fourteen year olds, to prevent fissure caries in the erupting second molars and the approximal surfaces of the posterior teeth, until secondary maturation of the enamel surfaces is completed
Other age groups are at risk:
1. Young adults who leave home to study or work elsewhere, often changing their lifestyle and dietary habits
2. Elderly dentate people with exposed root surfaces, reduced salivary function, and other risk factors
Other risk groups include:
1. Persons in dietary-related occupations.
2. Individuals taking medication that impairs salivary function.
3. Poorly educated people, particularly those of immigrant background.
A combination of etiologic factors, caries prevalence (experience), caries incidence
(increment), external and internal modifying risk indicators, risk factors, and
prognostic risk factors, as well as preventive factors, may be used to assess the
individual caries risk as no risk, low risk, risk, or high risk.
The pattern of dental caries in the dentition, reflected in terms of missing teeth, and
decayed, missing, or filled surfaces, is generally as unevenly distributed as caries
prevalence among individuals. Caries-preventive measures, therefore, not only should
be tailored to predicted individual risk but also should target the key-risk teeth and
surfaces in the dentition. The molars are clearly the key-risk teeth. Related to age
group and the caries prevalence of the population, the key-risk surfaces could be
ranked in the following order:
1. The fissures of the molars
2. The approximal surfaces of the posterior teeth, from the mesial surfaces of the
second molars to the distal surfaces of the first premolars.
3. The approximal surfaces of the maxillary incisors, the buccal surfaces of the
molars, and the lingual surfaces of the mandibular molars
In elderly people with reduced salivary function, exposed root surfaces should be
regarded as key-risk surfaces, particularly buccally and approximally.
Risk profiles
Risk profiles for tooth loss, dental caries, and periodontal diseases can be visualized
graphically using manual or computer-aided methods. The graphs should also be used
as an interactive tool for communication with the patient during discussion of the oral
health status, etiology, modifying factors, prevention, possibilities, responsibilities,
reevaluations, and results.
The Cariogram was developed to illustrate the interaction of caries-related factors. An
interactive version for estimation of individual caries risk has been developed.
