Caries Risk Assessment

Caries risk assessment methods are used for early detection of increased caries risk with the aim of providing intensive and close-meshed care to affected patients to avert the disease of caries (tooth decay) or to be able to treat it at an early stage. Caries is a disease of the tooth hard substances dentin (tooth bone) and enamel, which is caused by acids that are formed during the decomposition of carbohydrates by microorganisms. These adhere to the tooth surfaces by means of a structured coating of a polysaccharide- and glycoprotein-rich matrix, the plaque (dental plaque) or biofilm. Time plays an important role in the development of caries: the longer the plaque is left on the teeth, i.e. the thicker and thus more mature it is, the higher its cariogenicity (caries-producing potential): within the plaque microorganisms, there is a shift in the ecological balance, accompanied by an increase in acid-tolerant bacterial species, especially mutans streptococci and lactobacilli. These produce acids in the form of carbohydrates when food is available, which lead to demineralization (softening) of the enamel and, after frequent acid attacks, to initial lesions (chalk spots, white spots) and finally to irreversible cavitation (loss of substance, formation of a hole). In order to do justice to the complex multifactorial process of caries development, quite a few risk markers must be used to determine the caries risk, which individually do not allow a reliable prognosis:

  • Caries already suffered
  • Initial caries (chalk spots, white spots: decalcifications without substance loss).
  • General diseases
  • Diet – habits, frequency, composition (amount of sugar).
  • Plaque (bacterial plaque) and its extent.
  • Fluoride prophylaxis
  • Non-bacterial salivary parameters: Determination of salivary flow rate, buffer capacity determination.
  • Bacterial saliva tests: saliva test for Streptococcus mutans, saliva test for lactobacilli.
  • General clinical assessment of oral health status

Indications (areas of application)

Caries risk assessment is necessary in the daily practice routine to plan the scope of therapy of prophylactic measures and to determine recall intervals (frequency of screening appointments). Methods such as the Dentoprog method or the Cariogram are useful aids for clearly demonstrating the caries risk in patient discussions. The Dentoprog method is also popular for group prophylaxis due to its ease of use.

Contraindications

  • None

The procedures

I. Dentoprog method

The method was developed for children in the 1990s by the working group led by preventive physician Marthaler. A mathematical formula relates the following clinical findings:

  • The number of caries-free deciduous molars (posterior molars).
  • The number of first permanent molars with fissure discoloration.
  • The number of initial lesions (white spots, chalk spots) on smooth surfaces of the first permanent molars.
  • The age of the child

The caries risk is determined simply by reading the value on a kind of slide rule, the caries risk slider, which takes into account the 6-9 year olds(front) or 10-12 year olds (back). Since the two important predictors (variables used for prediction) caries experience and initial caries are taken into account, the prediction quality can be described as good. The disadvantage of the method is based on its limitation to children aged 6 to 12 years.

II. criteria of the German Association for Youth Dentistry (DAJ)

The DAJ methodologically bases its criteria on the caries experience of children and defines the 20% with the highest caries incidence in their age group as the high-risk group, with classification based on the dmft/DMFT index. Individual caries risk is determined using the so-called dmft index:

  • D – decayed (destroyed).
  • M – missing (missing)
  • F – filled (filled)
  • T – teeth (teeth)

or S = surfaces (surfaces) in the deciduous dentition (dmf-t) or permanent dentition (DMF-T/ DMF-S).

Age dmft index
2 to 3 year olds dmft > 0
4-year-olds dmft > 2
5-year-olds dmft > 4
6- to 7-year-olds dmft, DMFT > 5 or DT > 0
8- to 9-year-olds dmft, DMFT > 7 or DT > 2
10- to 12-year-olds DMFS > 0 on proximal and smooth surfaces.

III Cariogram

The Cariogram, a small computer program, was developed by Swedish scientist Bratthall in 1998. It works independently of patient age and does great justice to the many factors that contribute to caries risk. It takes into account the above-mentioned risk markers in different weights and records them in a fairly simple way, so that a qualitatively good prediction can be made with it. The patient gets the result of the evaluation clearly presented in a pie chart, from which he can read,

  • How high his current chance is of not getting new cavities (holes),
  • How high the impact of his diet,
  • How high the bacterial colonization with the caries causers Streptococcus mutans and lactobacilli,
  • How susceptible he is to caries in the current situation and.
  • What influence the accompanying circumstances have.

The program has the great advantage of showing the relationship between individual risk markers and caries risk. On the computer, for example, the positive effect of fluoridation measures can be demonstrated very clearly by the change in the pie chart. Individual recommendations for patients to reduce their caries risk can then be printed out.