Risk Profiles – Introduction

Risk Profiles
By 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. The graphs are also appropriate tools for communication with the patient when discussing the details of case findings and treatment recommendations. 
Combined risk profiles for dental caries and periodontal diseases Because some patients may suffer from both dental caries and periodontal diseases, risk profiles for these diseases can be designed in combination or separately. Figure 137 illustrates a combined risk profile for a patient, who after the first detailed examination and history taking, was classified as a high-risk patient for both dental caries and periodontal diseases (C3P3), on the following basis:
1. The prevalence of caries and the prevalence of periodontitis were high.
2. The incidence of caries and periodontitis had been very high.
3. The patient had been exposed to many etiologic factors, both nonspecific (high plaque formation rate and plaque volume) and specific (caries-related pathogens and periopathogens).
4. The patient exhibited many external and internal modifying risk indicators, risk factors, and prognostic risk factors for dental caries as well as periodontal diseases.
a. For dental caries, the most important external factors were high frequency of intake of sticky, sugar-containing products and medication with salivary depressive side effects. For periodontal diseases, the most important external factor was regular smoking of 10 to 20 cigarettes per day.
b. Among internal factors, the most important for dental caries was reduced stimulated salivary secretion rate (0.6 mL/min). For periodontal diseases, it was diabetes mellitus.
5. The standard of oral hygiene was very low, and dietary habits were poor.
6. The patient had no preventive dental care habits and his dental care visits were irregular.
After presentation of the case findings and a session of self-diagnosis, the dentist and patient discussed a treatment strategy based on sharing of responsibilities between the patient (the owner of the oral cavity) and the oral health personnel. Two years later, he was classified as a low-risk patient for both dental caries and periodontal diseases (C1P1), on the following basis:
1. The etiologic factors had been dramatically reduced (from red to green), by an initial intensive combination of mechanical and chemical plaque control (self-care and professional) and by maintenance of a high standard of plaque control, ie, a dramatic improvement in the most important preventive factors.
2. Treatment needs (excavation and restoration of open carious lesions, and scaling,
root planing, and debridement of diseased periodontal pockets) and plaque-retentive
factors were eliminated.
3. Important external modifying factors were reduced. The patient stopped smoking
and reduced the estimated daily sugar clearance time by 80%. In addition, there was
no further need of medicine with salivary depressive effects. As a consequence of this
and regular use of fluoride chewing gum, the salivary secretion rate increased from
0.6 mL/min to 1.0 mL/min.
4. The use of fluorides was increased. A new fluoride toothpaste technique was
introduced, and use of fluoride chewing gum was recommended after meals; this was
supplemented by professional application of fluoride varnish.
As a consequence of these preventive measures and the healthier lifestyle, the patient
developed no new carious lesions and experienced no further loss of periodontal
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Articles for theme “caries”:
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.
Individual RiskBy combining 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, caries risk may be evaluated at the individual level, as no risk (C0), low risk (C1), risk (C2), and high risk (C3). As discussed earlier in this chapter, these conditions may vary in different age groups.  Therefore, the criteria for C0, C1, C2, and C3 should be defined for at least the following general groups: preschool children (primary teeth), schoolchildren (permanent teeth), adults, and the elderly.
Risk GroupsRisk age groupsRecent studies have shown that carious lesions are initiated more frequently at specific ages. This applies particularly to children but also to adults. In children, the key-risk periods for initiation of caries seem to be during eruption of the permanent molars and the period during which the enamel is undergoing secondary maturation.  In adults, most root caries develops in the elderly, partly because of the higher prevalence of exposed root surfaces.
Prediction of Caries Risk and Risk ProfilesIntroductionFor successful prevention and control of dental caries in both children and adults,  some basic principles must be adopted: For example, the higher the risk of developing caries (new carious surfaces) in most of the population, the greater the effect of one single preventive measure. This may be illustrated by the Swedish experience, where 30 to 35 years ago, caries prevalence was extremely high. Almost every child developed several new lesions every year, mainly because of very poor oral hygiene.