Caries risk assessment in young children and its...
Transcript of Caries risk assessment in young children and its...
CARIES RISK ASSESSMENT IN
YOUNG CHILDREN AND ITS
SIGNIFICANCE IN CARIES
PREVENTION
By: Dr. Nick Lekic DMD, M.Dent, FRCD(C)
Introduction
Completed all my studies at the University of
Manitoba
DMD Degree in 2010
Pediatric hospital dentistry residency in 2011
Master of Dentistry-Pediatric Dentistry Graduate
Program in 2014
Fellow of the Royal College of Dentists of
Canada in 2014
Joined Children’s Dental World in July 2014
Permission given by Natalie Lekic
Course objectives
Comprehending the multi-factorial
nature of caries development and
the association between presence of
risk factors and caries susceptibility
Understanding the principles and
application of caries-risk assessment
for caries prevention in everyday
clinical practice
Introduction
Early childhood caries (ECC) has been
found to be the most prevalent chronic
disease
ECC is rapidly progressing and
significantly affecting a child’s growth and
developmental
Early assessment and identification for
presence of caries-risk factors is critical for
prevention of ECC
Restorative treatment alone may not be
sufficient and overall requires modification
to a child’s daily life practices
University of Manitoba Pediatric Dentistry Graduate Program
Introduction
The American Academy of Pediatric
Dentistry (AAPD) and Canadian Academy
of Pediatric Dentistry (CAPD) advise that
the first dental check up should occur
within 6 months of the eruption of the first
tooth and no later than 12 months of age
Importance of establishing a dental home
is to provide a continuous relationship
between the dentist and the family
Allowing for timely assessment and
application of caries-risk assessment,
individualized prevention strategies and
disease management
Google Images of Baby and teeth
Caries development
• Understanding caries etiology may
lead to improved provision of
preventive measures
• Caries is a multifactorial disease
• Pathologic factors include: cariogenic
bacteria, salivary dysfunction and
carbohydrates intake
• Additional risk factors include
sociodemographic, presence of plaque,
lack of fluoride and environmental
effects (ie. enamel hypoplasia)
http://www.ohiodentalclinics.com/curricula/sealant/mod3_1.html
S. Mutans and caries-risk
• Presence of Streptococcus mutans in
young caries-free children has been
associated with a considerable caries
risk
• Its has also been shown to be a reliable
indicator of future caries status
• S. mutans may invade oral cavity
soon after birth
• Two modes of transmission with a
window of infectivity seen as early as
birth
• Eruption of primary teeth increases the
number and complexity of bacteria
http://microbiologyfall2010.wikispaces.com/file/view/
Streptococcus-mutans.jpg/185899615/Streptococcus-mutans.jpg
S. Mutans and caries-risk
Bacterial and host factors affect
transmission and colonization of
Streptococcus mutans
S. mutans are acidogenic, aciduric,
adherent to teeth and capable of
secreting carbohydrates
Screening for S. mutans may identify
caries risk
Google Images of Streptococcus Mutans
Salivary dysfunction and caries-risk
Saliva contains minerals, proteins, immunologic factors and
buffers which all play a part in caries prevention
Saliva also has a mechanical role of washing away debris
from the oral cavity
Google images of Saliva
Salivary dysfunction and caries-risk
Studies have found salivary dysfunction to be associated with
an increased caries risk
Salivary flow rate less than 0.8-1.0 ml/min is an indicator of caries
risk
Salivary flow may be reduced by illnesses, medications and
radiation therapy
Google images of Saliva
Diet and caries-risk
Refined carbohydrates cause a measurable drop in pH and
increase a child’s caries risk
Carbohydrates that are a greater risk for caries development
in particular are:
Retentive,
Increased sugar content,
Result in decreased salivary flow,
Consumed more frequently
Google Images of Sugar and Teeth
Diet and caries-risk
Children with delayed weaning from the bottle and
with prolonged nighttime feeding with sugar
containing products are at an increased risk for
dental decay
Studies reported as high as 86 % caries in the maxillary
primary incisors
Google Images of Baby bottle decay
Diet and caries-risk
Although no study has found human
breast milk as cariogenic, its
combination with sugar may increase
caries risk
A systematic review reported that
prolonged breast-feeding at night for
greater than a year following the eruption
of the primary teeth may be associated
with ECC
Google images of breast-feeding
Diet and Caries Risk
Recent studies have shown that although
sugar consumption has a proven role in
the development of caries, the increased
exposure to systemic fluoride has
lessened its affect
Water fluoridation may decrease the caries risk of
carbohydrate intake
Google Images of Water fluoridation
Caries-risk assessment
A risk-based approach to caries management enables
identification of patients who are most vulnerable to the
development of this disease
Caries-risk assessment should be predictable, repeatable and
easily accomplished by all members of the dental team
Google images of dental examination
Caries-risk assessment
The goal of the caries risk assessment is to minimize causative
factors and maximize protective factors
The current best predictor of future caries is past caries
experience
Google image of caries risk factors
Caries-risk assessment tools
Several Caries-risk assessment tools have been created for
everyday clinical practice
AAPD Caries-risk assessment
AAP – Oral Health Risk assessment Tool
ADA – Caries-risk assessment form
CAMBRA (Caries management by risk assessment)
Caries-risk assessment
The AAPD Caries-risk assessment
tool has become the principle
guide for early assessment of
children
The three main factors for
caries risk assessment in
children include biological,
protective, and clinical findings
Google images of caries and primary teeth
Caries-risk assessment
Biological risk factors
Mother/primary caregiver with carious lesions
Socioeconomic status of the family
Child has 3 or more between meal sugar
containing snacks or beverages a day
Child is put to bed with a bottle containing sugar
Special health care needs child
Child is a recent immigrant
Google images of pregnant women and dental exam
Caries-risk assessment
Protective risk factors
Child’s water fluoridation or fluoride
supplements consumption
Daily oral hygiene with fluoridated
toothpaste use
Professional topical fluoride application
Child has regular dental recall
appointments
Additional preventive measures (i.e.xylitol)
Caries-risk assessment
Clinical risk factors
Child has one or more
decayed/missing/filled tooth surface
Child has active white spot lesions or
enamel defects
Child has elevated S. mutans levels
Child has visible plaque on teeth
Google image of white spot lesions
Caries-risk assessment
In our study, higher levels of S. mutans were associated with
increased caries experience
Contrary, children with low Streptococcus mutans levels were
significantly less likely to develop new dental caries
Findings suggest that chair-side Immunoassay tests for
Streptococcus Mutans counts could be used to assess caries risk
and encourages clinicians to provide anticipatory guidance to
their patients to help avoid the development of new caries
Caries-risk assessment
A simple and quick 15 minute chair-side Immunoassay test was
conducted to determine levels of S. mutans using Saliva-Check
Mutans
The test was positive with the levels for S. mutans determined
as high at >5x105 CFU/ml
Saliva-Check Mutans
Caries-Risk assessment
Video of chair-side Immunoassay test with Saliva-Check
Mutans performed by myself to be inserted here
Factors
High Risk Moderate Risk Low Risk Biological
Mother/primary caregiver with carious lesions
Yes
Low Socioeconomic status of the family
Yes
Child has 3 or more between meal sugar containing snacks or beverages a day
Yes
Child is put to bed with a bottle containing sugar Yes
Special health care needs child
Yes
Child is a recent immigrant
Yes
Protective
Child’s water fluoridation or fluoride supplements consumption
Yes
Daily oral hygiene with fluoridated toothpaste use
Yes
Daily oral hygiene with fluoridated toothpaste use
Yes
Child has regular dental recall appointments
Yes
Additional preventive measures (i.e.xylitol)
Yes
Clinical
Child has one or more decayed/missing/filled tooth surface
Yes
Child has active white spot lesions or enamel defects
Yes
Child has elevated S. mutans levels
Yes
Child has visible plaque on teeth
Yes
Clinical implications of caries-risk
assessment
Caries management and determined time period for recalls is
dependent on the caries-risk status of the patient, age and
compliance
Efficient caries management requires self-management goals
and with proper identification and prevention of risk factors,
caries progression may be hindered or stopped entirely
Patients that are at higher risk should be followed-up more
frequently (i.e. every 3 months) with professional application
of topical fluoride, whereas patients in the low risk group can
be seen less frequently (i.e. every 12 months)
Caries-risk management
Risk
Category
Diagnostic Fluoride Diet Sealants Restorative
Low Recall 6-12
months
Radiographs 12-
24 months
Baseline MS
Twice daily with
fluoridated
toothpaste
No Yes Surveillance
Moderate Recall 6 months
Radiographs 6-
12 months
Baseline MS
Twice daily with
fluoridated
toothpaste
Professional
topical fluoride
every 6 months
Counseling Yes Active
surveillance of
incipent lesions
Restoration of
cavitated or
enlarging lesions
High Recall 3 months
Radiographs 6
months
Baseline and
follow-up MS
Twice daily with
fluoridated
toothpaste
Professional
topical fluoride
every 3 months
Fluoride
supplements
Counseling Yes Active
surveillance of
incipent lesions if
parents engaged,
otherwise
restoration of
incipient,
cavitated or
enlarging lesions
Conclusion
Reducing caries-risk is the most important element in caries
prevention
Proper oral hygiene, decreased presence of cariogenic
bacteria, reduced carbohydrate intake, adequate fluoride
exposure and adequate salivary flow are all important
components in caries prevention
To achieve this goal, frequent dental visits that begin at latest
by 12 months of age is essential for implementation of all
preventive and caries management measures
References
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