Caries Risk Assessment

Dr Hidayathulla Shaikh

objectivesAt the and of the lecture student should be able to

• Define Risk• Write indications of risk assessment• Explain what are risk indicators and Biochemical factors• Discuss Cariogram.

Introduction • Risk is defined as “the probability (chance) that some harmful

event will occur”.

• To predict if new carious lesion ( a harmful event) will develop, or if early lesions will continue to grow, is to assess caries risk.

• The importance of properly predicting the occurrence of the lesion is to use the preventive services available for the high risk individuals for caries.

Indications for caries risk assessment

• Assessment is highly indicated in populations where a large portion is caries free, but some individuals are still highly caries active.

• Where services are available to take care of these targeted persons.

How to select Risk groups or Risk individuals

• There are many factors which increases the number of carious lesions, and helpful in caries risk assessment they are…

a) Factors or circumstances that are indirectly related, they are referred as Risk Indicators.

b) Factors that are directly involved in the biochemical events resulting in the carious lesions called as Biochemical factos.

a) Risk indicators

• They are factors which may indicate increased caries risk,• Ex – socially deprived, lack of health knowledge, no regular

dental check ups.

• These factors result in more cariogenic food, less oral hygiene, saliva problems and reduced fluoride support.

• The other examples are – a) Living in high DMF country, or high DMF area, or high DMF

family.b) High past caries experiencec) Crowded teeth, deep fissures, exposed root surfaces.

b) Biochemical factors

• Factors to which the tooth surface is directly exposed to and which contributes to the development of the lesion.

• These factors may depend on dose and duration, indicating high risk and low risk for caries.

• For example – a large amount of plaque (high dose) indicates high risk only if present for a longer period of time (long duration).

Cariogram

• It is the model proposed by Bratthall D, from Sweden to illustrate the interactions between bacteria, diet and host response.

• The process of making the evaluation is termed as “Cariography”.

• Caries risk is a term used to indicate what will happen in future – will there be demineralization and will new cavities occur??.

• The evaluation is made for a certain period of time for example for the coming year.

Principles of Caries Risk estimation – Based on the Cariogram concept.

• The cariogram model can be used to illustrate the caries risk.

• The risk is expressed as “Per Cent (%) Chance to Avoid Cavities”.

• A low percentage, for example 5% indicates a high caries risk, where as 90% chance to avoid cavities indicate a very low risk.

Points to consider when using Cariogram for risk evaluation.• The ‘Chance to Avoid Cavities” must be between 0 and 100%,

it cannot be negative or more than 100%

• In addition to Diet, Bacteria and Susceptibility a fourth factor Circumstances is also included.

• Cariogram principles

• The interactive Cariogram computer program calculates the percent chance to avoid cavities.

• This is done by entering the values ranging from 0-3 for different parameters.

• The score 0 is the most favorable value and the maximum score 3 indicates a high, unfavorable risk value.