1st D: DETERMINE Caries Risk

The Patient Perspective:

Understanding their personal level of risk of disease is a key determinant of a patient’s motivation to engage with healthcare and modify their own behavior to enhance their oral health. Patients who perceive that they are susceptible to a disease are more likely to take action to ameliorate the impact of that susceptibility.

What it is:

Caries risk assessment is the first essential step in the 4D-cycle for effective and personalized care. The aim of this step is to assess the probability of whether a patient will develop carious lesions in the near future, and the likelihood that there will be a progression of lesions if already present. Caries risk assessment also helps the dental team understand why the patient has disease activity and consequently informs on adjustments that might be made to improve their risk status. Knowing a patient’s caries risk will aid clinical decision-making and enable an individualized caries management plan to be developed.

How to assess the patient’s caries risk:

Lots of tools already exist which help clinicians to systematically assess caries risk. Common tools are Cariogram, ADA, CAMBRA and ICCMS™; many of these use 3 or more categories of caries risk. However, in practice, it is probably quicker, easier and sufficient to focus on correctly identifying patients at the extremes of the spectrum of risk because those at ‘low risk’ of caries and those at ‘high risk’ of caries have clear management needs. Therefore, the CariesCare Practice Guide uses just two risk categories, “at lower risk” and “at higher risk”, when choosing between caries management options.

Risk factors and protective factors:

A patient’s risk level is derived from social, medical, behavioural (oral hygiene, diet, etc.) and past dental histories, together with an oral examination. The clinician must weigh-up the patient’s risk and protective factors against each other in order to assess the likely risk of future caries. Low risk is easy to identify as the absence of both caries risk factors and active lesions. The most important information to consider is set out in Figure 2.

Good practice points:

• Patients’ caries risk must be assessed regularly since their risk category may change over time and should be documented in their health record.
• Risk assessment should inform the frequency of patient recall. Patients with higher caries risk should have a more frequent recall period than patients at lower risk patients, for monitoring, re-evaluation, and provision of preventive interventions.
• The risk level should be clearly communicated to the patient and influence clinical decision-making regarding treatment needs and alternatives, and the provision of other services.
• Whichever of the many risk assessment tools available is used, it should be integrated into the oral health record and if possible, into a digital record system.
• Sugar is an important risk factor for caries initiation and progression but it is also a common risk factor for obesity, diabetes and cardiovascular disease. Reducing sugar consumption is therefore important for both oral and general health.

Figure