Caries-risk Assessment and Management for Infants, Children, and Adolescents - AAPD

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Description: A decision support tool to assist dentists in caries-risk assessment and management for infants, children, and adolescents

Publet Introduction:

According to the WHO 60–90% of school children and nearly 100% of adults worldwide have dental cavities1. Dental caries can be prevented from occurring or stopped from progressing further if the risk factors associated with dental caries can be identified and adequate steps are taken. Caries risk assessment can help the clinician assess the overall caries risk for the individual dental patient and also help identify the risk factors that increase the risk of the patient from dental caries, or identify protective factors that can protect the patient from dental caries.

Caries risk assessment is also crucial for prescribing the proper clinical interventions to prevent dental caries and also assists in long term caries management of the patient. It also helps the patient understand his/her dental health status better and lets the patient set their own targets for dental hygiene improvement. 

The guideline used for developing this decision support tool is an update of American Academy of Pediatric Dentistry (AAPD)’s Policy on Use of a Caries-risk Assessment Tool (CAT) for Infants, Children, and Adolescents, Revised 2006 that includes the additional concepts of dental caries management protocols. The update used electronic and hand searches of English written articles in the medical and dental literature within the last 10 years using the search terms caries risk assessment, caries management, and caries clinical protocols.

Caries-risk assessment models currently involve a combination of factors including diet, fluoride exposure, a susceptible host, and microflora that interplay with a variety of social, cultural, and behavioral factors. Caries risk assessment is the determination of the likelihood of the incidence of caries (ie, the number of new cavitated or incipient lesions) during a certain time period or the likelihood that there will be a change in the size or activity of lesions already present. With the ability to detect caries in its earliest stages (ie, white spot lesions), health care providers can help prevent cavitation. 

Source AAPD - Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents

Guideline objectives

Risk assessment:

  1. Fosters the treatment of the disease process instead of treating the outcome of the disease.
  2. Gives an understanding of the disease factors for a specific patient and aids in individualizing preventive discussions.
  3. Individualizes, selects, and determines frequency of preventive and restorative treatment for a patient.
  4. Anticipates caries progression or stabilization.

Source AAPD - Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents

Target setting Primary care dentistry
Target users Primary care dental clinicians

Disease indicators such as cavities, approximal lesions, smooth surface lesions and recent restorations indicate the presence of dental decay.

Pathological factors such as acidogenic(acid producing) bacteria, salivary dysfunction, and frequent consumption of dietary carbohydrates can increase the risk of a patient getting dental caries.

Protective factors such as adequate salivary function, fluoride use, antibacterial agents and proper diet can protect the patient against dental decay.

The aim of proper caries management is to achieve the right balance between the risk factors and the protective factors by reducing the pathological factors and increasing the protective factors3. Patients at low risk of caries will have more protective factors than caries risk factors.

Once the caries risk for the patient has been estimated the clinician can prescribe the appropriate therapeutic interventions and undertake treatment planning.

Provenance 7.No provenance has been assigned (default value)
  • Author: Gopikrishnan Chandrasekharan
  • Release date:
  • Status: Draft - Under Review
  • History: Edited on 23/10/2015
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American Academy of Pediatric Dentistry (AAPD) - Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents