Caries-risk Assessment and Management for Infants, Children, and Adolescents - AAPD
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.
|Primary care dentistry
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.
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American Academy of Pediatric Dentistry (AAPD) – Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents