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