Caries risk assessment By: Dr. Amany Moussa

Definition of Dental Caries Is a chronic ,transmissible mal-nutrition disease. Caries clinically manifested by three microbial events: 1-primary infection by S.Mutans. 2-formation of complex biofilm (dental plaque). 3-demeralization of enamel &cavitation.

Risk factors of Dental caries 1- diet &nutrition: -cariogenic diet as freely fermentable carbohydrates -malnutrition during period of teeth development. 2- age: -the highest peak is at age 4-8 years. -11-19 years (pit &fissures). -35-45 years (proximal caries). -55-65 yeaars (root caries).

4-emotional disturbances: 3- gender: Females have a higher incidence than males 4-emotional disturbances: Stress was found to be associated with high caries incidence. 5- role of microorganisms: Streptococcus Mutans is the main microorganisms that is responsible for caries initiation.

Definition of Caries Risk Assessment It is a qualitative and quantitative procedure to predict future caries development and introduce appropriate measures before the clinical onset of irreversible lesions of the disease.

Aim Is to predict whether the disease is likely to develop in caries-free individual. To determine the rate of progression in a patient who already has some caries experience . To create a specific model for treatment of cases which are suitable for each case. To direct effort and money to those that are in need for prevention.

Important Terms Risk: defined as the probability that an unwanted or even a harmful event will occur. Caries susceptibility: it is the possibility to develop caries in a caries producing environment. Caries activity: is a measure of the speed of progression of a carious lesion. Caries activity test: it is our tool to estimate the actual state of disease activity (progression or regression).

Levels of prevention Primary Secondary Tertiary

caries prevention Primary prevention: It means stop occurrence of the dental caries By: 1- plaque control which essentially is the instruction of proper home care for the mechanical removal of the plaque. 2- use of fluorides either systemic or local to increase the resistance of the tooth towards decay. Prevention of initiation of the disease-implement program –procedures &measures to prevent the disease as fluoridation the community drinking water –application of topical fluorides, tooth brushing , flossing, diet control, sealent application

3-Dietary control through limitation of frequent intake of sucrose & other food stuffs which enable micro-organism to grow 4- use of sealants which act as a plastic like mechanical barrier on occlusal surfaces of teeth to prevent caries

Secondary prevention: is the prevention of progression &recurrence of the caries process through Remineralization , the use of certain dental compounds which will help the dentin to remineralize Operative dentistry techniques to remove the caries Pulp capping procedures Removal of initial stages of the disease

Tertiary prevention: That is to prevent total loss of function Extensive prevention & intervention to replace some or all of the teeth in indentation

Services provided by the dental professional Primary Provision of oral hygiene aids; patient education Plaque control Program recall reinforcement Topical fluoride application Correction of tooth mal-alignment prophylaxis Preventive orthodontics

Secondary Periodic examination Attention to developmental defects Prompt treatment of incipient lesions Scaling and curettage Corrective restorative and orthodontic treatment Treatment of well developed lesions Pulp capping Root canal therapy Deep curettage Root planning Extractions

Services provided by the dental professional Tertiary Replacement of tooth structure by appliances (removable or fixed prosthodontics) Services provided by the dental professional

Preventive level Primary Secondary Tertiary Health promotion Specific protection Secondary Early diagnosis Prompt treatment Tertiary Disability limitation Rehabilitation

Services provided by the individual Primary Periodic visits to dental office Demand for preventive services Oral hygiene measures Avoidance of sticky food, particularly between meals. Secondary Self-examination and referral ;use of dental services Periodic screening and referral Tertiary Disability limitation Provision of dental services Use of dental services

Services provided by community Primary Dental health education programs. Promotion of research efforts. Dental prophylaxis. Supervised school brushing programs Fluoridation of public water Secondary Provision of dental services