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

Resident: Roberts

Date: 3/16/11

Article: Guideline on Caries risk Assessment and Management for Infants, Children, and Adolescents

Journal: Oral Health Policies

Volume: 32 pages: 101 - 107

Year: 2010

Purpose:

The AAPD recognizes and uses the Caries-risk Assessment Tool(CAT) for diagnosis and management of caries in Infants, children and adolescents. The purpose of this paper was intended to educate the clinician in decision making regarding diagnostic, fluoride, dietary and restorative protocols using the most updated and approved material by the AAPD.

Methods

This paper is an update to the guideline approved by the AAPD “ policy on Use of a Caries-risk Assessment Tool for Infants, children, and Adolescents, revised in 2006.

A search within the last ten years was performed using criteria, “caries risk assessment”, “caries clinical protocols” which yeilded 1909 ariticles of which 75 were used in formulation of the article.

Background

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 of the likelihood of caries or the likelihood of change in caries status within a host. Although all factors can play a part in the likelihood of a patient to be susceptible to caries the patients past caries experience is the best predictor of future development of the disease.

Factors to identify High/moderate risk patients include:

High risk category

Primary caregiver has active cavities

Primary caregiver has low SES

Child has more than 3 sugar containing snacks or beverages between meals a day

Child is put to bed with a bottle containing natural or added sugar

Child has white spot lesions(more than 1)

Child has visible cavities or fillings

Child has elevated mutans streptocoocci levels

Patient has more than one interproximal lesion

Patient has low salivary flow

Does not use fluoridated water or toothpaste

Moderate risk

Child has one white spot lesion

Child has 1 or 2 sugary snacks or beverages between meals

Child has special health care needs

Child is a recent immigrant(3x higher to have ECC)

Child has visible plaque on teeth

Patient is wearing an intraoral appliance

Patient has defective restorations

Uses fluoridated toothpaste but not water

Conclusion

Patients with moderate/high risk status should have xrays more frequently than low risk, their oral hygiene regime may include a high dose fluoride dentrifice, a professional topical application of fluoride on a more frequent basis(3 months) and will need counseling to instruct the parents on matters of concern such as diet( sugar substitutes such as xylitol, sugary snacks and beverages), fluoride exposure (via water, toothpaste, and in office tx), regular dental visits, and preventive measures such as sealants.

Assessment

The article was good however the diagrams did not include all the risk categories from the AAPD handbook. This article shies away from being too detailed, and would be a great article to refer to friends and colleagues within the medical health profession.