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Dental Caries Risk Assessment:
What Is It? Why Do It ?
Dental Caries Risk Dental Caries Risk Assessment:Assessment:
What Is It? Why Do It ?What Is It? Why Do It ?
National Oral Health ConferenceMay 2, 2006
Norman Tinanoff
National Oral Health ConferenceMay 2, 2006
Norman Tinanoff
OutlineOutlineStrength of Single Caries Risk Factors in Preschoolers
Strength of Multiple Caries Risk Factors in Preschoolers
Preventive and Restorative Care Based on Caries Risk Assessment
Value of Caries Risk Assessment in Public Health and Clinical Practice
Strength of Single Caries Risk Factors in Strength of Single Caries Risk Factors in Preschoolers Preschoolers
Strength of Multiple Caries Risk Factors in Strength of Multiple Caries Risk Factors in Preschoolers Preschoolers
Preventive and Restorative Care Based on Preventive and Restorative Care Based on Caries Risk AssessmentCaries Risk Assessment
Value of Caries Risk Assessment in Public Value of Caries Risk Assessment in Public Health and Clinical PracticeHealth and Clinical Practice
Single Risk FactorsSingle Risk FactorsSingle Risk Factors
caries/white spot prevalence
mutans streptococci
income/education
plaque
caries/white spot prevalencecaries/white spot prevalence
mutans streptococcimutans streptococci
income/educationincome/education
plaqueplaque
caries free
pit and fissure
maxillary anterior
caries free
pit and fissure
maxillary anterior
initial caries patternsinitial caries patterns baseline year 2baseline year 2
0.0 1.4
3.0 5.9
5.0 10.1
0.0 1.4
3.0 5.9
5.0 10.1
Relationship of initial caries pattern to caries incidence
in 142, 3- to 4-year-old (at baseline) inner city children
Relationship of initial caries pattern to caries incidence
in 142, 3- to 4-year-old (at baseline) inner city children
Does not take a dental scientist Does not take a dental scientist to know this child is high riskto know this child is high risk
Single Risk FactorsSingle Risk FactorsSingle Risk Factors
caries/white spot prevalence
mutans streptococci
income/education
plaque
caries/white spot prevalencecaries/white spot prevalence
mutans streptococcimutans streptococci
income/educationincome/education
plaqueplaque
Mutans Strep range baseline dmfs year 2 dmfs
low 0.2 1.2
moderate 1.4 3.1
high 3.4 7.9
Mutans Strep range baseline dmfs year 2 dmfs
low 0.2 1.2
moderate 1.4 3.1
high 3.4 7.9
Relationship of mutans streptococci levels to caries incidence
in 148, 3- to 4-year-old (at baseline) inner city children
Relationship of mutans streptococci levels to caries incidence
in 148, 3- to 4-year-old (at baseline) inner city children
Risk FactorsRisk FactorsRisk Factors
caries/white spot prevalence
mutans streptococci
income/education
plaque
caries/white spot prevalencecaries/white spot prevalence
mutans streptococcimutans streptococci
income/educationincome/education
plaqueplaque
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0Education
Income
<$10K $10K-20K $20K-30K >$30K
No HighSchool
Some HighSchool
CompletedHigh School
College
Correlation of caries prevalence to SES indicators in 1,539 4-year-old Arizona children
Correlation of caries prevalence to SES indicators in 1,539 4-year-old Arizona children
Risk FactorsRisk FactorsRisk Factors
caries/white spot prevalence
mutans streptococci
income/education
plaque
caries/white spot prevalencecaries/white spot prevalence
mutans streptococci mutans streptococci
income/educationincome/education
plaqueplaque
Variable Variable CategoryCategory Mean Mean dtdt at 36 monthsat 36 months
MotherMother’’s DMFTs DMFT lowlow 0.30.3
highhigh 1.31.3
MotherMother’’s mutans strep s mutans strep ** lowlow 0.50.5
highhigh 1.21.2
Use of nursing bottle Use of nursing bottle (19 months) (19 months) **
nono 0.10.1
yesyes 1.41.4
Presence of plaque Presence of plaque (19 months old) (19 months old)
nono 0.10.1
yesyes 2.82.8
Adapted from Alaluusua and Malmivirta, Comm Dent Oral Epi 22: 273-276, 1994Adapted from Alaluusua and Malmivirta, Comm Dent Oral Epi 22: 273-276, 1994
Correlation of plaque to Mutans strepCorrelation of plaque to Mutans strep(mean age 24.7 mo)(mean age 24.7 mo)
B
B
B
B
B
BB
B
B
B
BB
B
B
B
B
BB
B
B
B
B
B
0
0.5
1
1.5
2
2.5
3
0.0001 0.001 0.01 0.1 1 10 100
Plaq
ue R
egro
wth
Sco
re
log10 Percent MS of Total Flora on Baseline Visit
Pearson’s r = 0.51; p=0.013
Multiple Risk FactorsMultiple Risk Factors
Risk = child reportedly took bottle to bed + had high levels of MSCondition = caries after 2 yearsRisk = child reportedly took bottle to bed + had high levels of MSCondition = caries after 2 years
Yes No Total
30 4 34
7 73 80
37 77 114
Yes No Total
30 4 34
7 73 80
37 77 114
Yes
No
Yes
NoRiskRisk
ConditionCondition
Sensitivity = 81%Specificity = 95%PPV = 88%NPV = 91%
Sensitivity = 81%Specificity = 95%PPV = 88%NPV = 91%
Effect of Baseline Criteria (age 4) on Effect of Baseline Criteria (age 4) on Caries Years 6 Yrs. Later (age 10)Caries Years 6 Yrs. Later (age 10)
Baseline CriteriaBaseline Criteria Year 6 DFMS Year 6 DFMS (prevalence)(prevalence)
Year 6 DMFS Year 6 DMFS (prevalence)(prevalence)
Caries PresentCaries Present 2.21 (73%)2.21 (73%) 0.85 (44%)0.85 (44%)
High Mutans Strep.High Mutans Strep. 2.18 (68%)2.18 (68%) 1.03 (51%)1.03 (51%)
Caries Present + Caries Present + High Mutans Strep.High Mutans Strep.
2.68 (84%)2.68 (84%) 1.03 (48%)1.03 (48%)
Criteria PresentCriteria Present Criteria AbsentCriteria Absent
HISTORICAL PRESENT FUTURE
psychological factors
baby bottle usage sucrose consumption
race/ethnicity
parent’s dental knowledge mutans strep. levels
Δ CARIES
CARIES
HISTORICAL PRESENT FUTURE
psychological factors
baby bottle usage sucrose consumption
race/ethnicity
parent’s dental knowledge mutans strep. levels
Δ CARIES
CARIES
Litt et al. Public Health Reports 110: 607-617, 1995Litt et al. Public Health Reports 110: 607-617, 1995
EvidenceEvidence--based Recommendation for based Recommendation for Professionally Applied Topical FluorideProfessionally Applied Topical Fluoride
ADA, 2006ADA, 2006
Risk CategoryRisk Category <6<6 66--1818 18+18+
LowLow NoneNone NoneNone NoneNone
ModerateModerate Varnish or Foam Varnish or Foam at 6 month at 6 month intervalsintervals
Varnish or Gel at Varnish or Gel at 6 month intervals 6 month intervals
Varnish or Gel at Varnish or Gel at 6 month intervals6 month intervals
HighHigh Varnish or Foam Varnish or Foam at 3 or 6 month at 3 or 6 month
intervalsintervals
Varnish or Gel at Varnish or Gel at 3 or 6 month 3 or 6 month
intervalsintervals
Varnish or Gel at Varnish or Gel at 3 or 6 month 3 or 6 month
intervalsintervals
Age Age
Low RiskLow RiskLow Risk
Child - no lesions in 2 yrs.Adult - no lesions in 5 yrs.DMFS 0 No white spot lesionsLow mutansLow risk SES
Child Child -- no lesions in 2 no lesions in 2 yrs.yrs.Adult Adult -- no lesions in 5 no lesions in 5 yrs.yrs.DMFS 0 DMFS 0 No white spot lesionsNo white spot lesionsLow mutansLow mutansLow risk SESLow risk SES
Fluoridated dentifrice1-2 yr. recallFluoridated dentifriceFluoridated dentifrice11--2 yr. recall2 yr. recall
AssessmentAssessment Suppression StrategiesSuppression Strategies
Moderate RiskModerate RiskModerate Risk
Child - 1+ lesions in 2 yrs.Adult - 1+ lesions in 5 yrs.DMFS >0; < pt. ageInfrequent white spotsModerate mutansModerate risk SES
Child Child -- 1+ lesions in 2 1+ lesions in 2 yrs.yrs.Adult Adult -- 1+ lesions in 5 1+ lesions in 5 yrs.yrs.DMFS >0; < pt. ageDMFS >0; < pt. ageInfrequent white spotsInfrequent white spotsModerate mutansModerate mutansModerate risk SESModerate risk SES
Fluoridated dentifriceFluoride supplements6 mo. recall with prof. FSealants
Fluoridated dentifriceFluoridated dentifriceFluoride supplementsFluoride supplements6 mo. recall with 6 mo. recall with profprof. F. FSealantsSealants
AssessmentAssessment Suppression StrategiesSuppression Strategies
High RiskHigh RiskHigh Risk
Child - >2 lesions in 1 yr.Adult - >2 lesions in 5 yrs.DMFS > pts. ageNumerous white spots High mutansHigh risk SES
Child Child -- >2 lesions in 1 >2 lesions in 1 yr.yr.Adult Adult -- >2 lesions in 5 >2 lesions in 5 yrs.yrs.DMFS > pts. ageDMFS > pts. ageNumerous white spots Numerous white spots High mutansHigh mutansHigh risk SESHigh risk SES
Fluoridated dentifriceFluoride supplements3-6 mo. recall, with FDaily F/antimicrobialVarnish F/antimicrobialXylitol gumMonitor mutansrestore progressing white spotslower risk definitive restorative
Fluoridated dentifriceFluoridated dentifriceFluoride supplementsFluoride supplements33--6 mo. recall, with F6 mo. recall, with FDaily F/antimicrobialDaily F/antimicrobialVarnish F/antimicrobialVarnish F/antimicrobialXylitol gumXylitol gumMonitor mutansMonitor mutansrestore progressing white restore progressing white spotsspotslower risk definitive lower risk definitive restorativerestorative
AssessmentAssessment Suppression StrategiesSuppression Strategies
Value of Caries Risk AssessmentValue of Caries Risk AssessmentValue of Caries Risk Assessment
Makes prevention strategies cost-effective
Strongest correlations with caries prevalence/incidence
and mutans strep.
Serves as a guide for selecting preventive and restorative
procedures
Helps one understand prognosis
Broadens the understanding of the disease process
Fosters treatment of caries instead of cavities
Makes prevention strategies costMakes prevention strategies cost--effectiveeffective
Strongest correlations with caries prevalence/incidence Strongest correlations with caries prevalence/incidence
and mutans strep.and mutans strep.
Serves as a guide for selecting preventive and restorative Serves as a guide for selecting preventive and restorative
proceduresprocedures
Helps one understand prognosisHelps one understand prognosis
Broadens the understanding of the disease processBroadens the understanding of the disease process
Fosters treatment of caries instead of cavitiesFosters treatment of caries instead of cavities