Conclusions – Caries risk

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.
Views: 1134 | Comments: 14 Send reply
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Articles for theme “caries”:
Cariogram ModelA new model, the Cariogram, was presented in 1996 by Bratthall for illustration of the interactions of caries-related factors. The model makes it possible to single out individual risk or resistance factors. A special interactive version for the estimation of caries risk has been developed.The original Cariogram was a circle divided into three sectors, each representing factors strongly influencing carious activity: diet, bacteria, and susceptibility. The development of the model was based on a need to explain why, in certain individuals, carious activity could be low in spite of, for example, high sucrose intake, poor oral hygiene, high mutans streptococci load, or nonuse of fluorides.
Detailed risk profiles for dental cariesIf a patient is at high risk predominantly for either caries or periodontal disease, a more detailed risk profile is available for the specific disease. Box 19 shows a list of abbreviations for the most important variables related to caries risk.  Figure 138 illustrates how a high-risk patient (C3) has been transformed to a low-risk patient (C1) by improved self-care supplemented by professional preventive measures. The greater the difference between the solid line and the dotted line, the greater the improvement.
Risk ProfilesIntroductionBy combining the symptoms of disease (prevalence, incidence, treatment needs, etc); etiologic factors; external modifying risk indicators, risk factors, and prognostic risk factors; internal modifying risk indicators, risk factors, and prognostic risk factors; and preventive factors, it is possible to present risk profiles for tooth loss, dental caries, and periodontal diseases in graphic form. This can be done manually or by computer. The degree of risk, 0, 1, 2, or 3, is visualized using green, blue, yellow, and red, respectively.
Key-risk surfacesAs mentioned earlier, depending on the age and caries prevalence of the population, there may be pronounced variations in the pattern of both lost teeth and decayed or filled surfaces. Figure 130 shows caries prevalence and the pattern of decayed or filled surfaces in 12-year-old children in the county of Varmland, Sweden, in 1964, 1974, 1984, and 1994. The molars are clearly the key-risk teeth. In a toothbrushing population, the key-risk surfaces are the fissures of the molars and the approximal surfaces, from the mesial aspect of the second molars to the distal aspect of the first premolars.
Key-risk teethThe factors determining future tooth loss are related to age, dental caries, periodontal  diseases, iatrogenic root fractures, trauma, orthodontic therapy, and so on. Therefore, it may be argued that it is difficult to analyze the true reasons for tooth loss in the adult, particularly in the elderly. The reasons for tooth loss may vary not only among different age groups but also among different populations and countries, depending on differences in prevalence of dental caries and periodontal diseases as well as the availability of resources for dental care.