A review of caries risk and management

Transcription

1 A review of caries risk and management Nashville Area Dental CE Call February 24, 2010 Tim Ricks, DMD, MPH Nashville Area Dental Officer Help us prevent Caries!

2 Some slides are from the IHS Caries Risk Management Series IHS Module Development Workgroup Jeanine Tucker, DMD, MPH Suzanne Eberling, DMD, PhD Mary Beth Kinney, MPH, EdD Raymond Lala, DDS Bridget Swanberg-Austin, DDS

3 At the conclusion of the presentation, participants should be able to: 1. Discuss dental caries risk assessment and the IHS risk categories. 2. Describe the various factors that place some patients at greater risk of developing dental caries. 3. Describe how the concept of caries management might be used to improve access to dental care.

4 Dental Caries Diagnosis Visual exam Clean teeth Bright light Dry field

5 Dental Caries Diagnosis Visual exam CLEAN TEETH!

6 Percent of Adolescents IHS Oral Health Status Survey Alaska Data Preliminary Results: Distribution of DMFT in Year Olds Score Dental caries and dental caries experience scores are not evenly distributed (DMFT)

7 Distribution of Decayed Teeth, Alaska Adolescents (aged years) participating in the 1999 IHS Survey Percent of Children Number of teeth

8 IHS Oral Health Status Survey Alaska Data Preliminary 15 Results: Distribution of DMFT in Year Olds Percent of Adolescents Score

9 IHS Risk Classification Age Risk Category Low- no active lesions High- any lesions Low-no active Moderate-1 lesions active lesion High-2 to 5 active lesions Very High-6+ active lesions

10 Age Past caries experience, family s dental experience Cariogenic diet White spot lesions Tooth morphology Fluoride exposure Rate of caries progression Oral hygiene SES of family Frequency of dental visits Medical conditions or medications Salivary properties Root exposure mutans strep levels Ortho/prosthetic appliances

11 Used to guide clinicians in placing patients in appropriate risk categories Help to determine recall intervals

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19 initial BWX BWX one year later

20 ORAL HYGIENE

21 SOCIOECONOMIC STATUS (SES)

22 FREQUENCY OF DENTAL VISITS

23 MEDICAL CONDITIONS/ MEDICATIONS

24 MEDICAL CONDITIONS/MEDICATIONS

25 SALIVARY PROPERTIES

26 ROOT EXPOSURE

27 LEVELS of mutans streptococci

28 ORTHO/PROSTHETIC APPLIANCES

29 Special Assistance Requirements

30 IHS RISK CLASSIFICATION Age Risk Category Low-no active lesions High-any lesions Low-no active lesions Moderate-1 active lesion High-2 to 5 active lesions Very High-6+ active lesions

31 AGE 0-4 Low Risk No active lesions of any type at exam.

32 AGE 0-4 High Risk Any cavitated or white spot lesions at exam, continued bottle feeding after 12 months or family caries history.

33 AGE 5+ Low risk No active lesions of any type (cavitated or non-cavitated) and protective risk modifiers.

34 AGE 5+ Moderate Risk 1 active cavitated smooth surface lesion at exam or any number of pit and fissure lesions.

35 AGE 5+ High Risk 2-5 active cavitated smooth surface lesions at exam or 2 new lesions with a history of smooth surface lesions in permanent teeth.

36 AGE 5+ Very High Risk 6+ active cavitated smooth surface lesions at exam.

37 Caries Management Managing active carious lesions involves three steps: 1. Arresting the infectious disease process and preventing disease 2. Completing the restorative process 3. Evaluating outcome through recall examination

38 Caries Management Arrest the infectious disease process and prevent disease by utilizing a medical model.

39 Caries Management: Moderate Risk Patients Complete the restorative process using a conservative approach.

40 Caries Management: High and Very High Risk Patients Complete the restorative process using an aggressive surgical approach.

41 Caries Management Evaluate the outcome of the medical and surgical interventions through recall examinations.

42 SUMMARY Dental caries is an infectious disease. With limited resources and high dental disease rates, it is critically important that clinicians manage the infectious disease process rather than focus only on restorative treatment.

43 SUMMARY (continued) The goals of this conservative approach are twofold: To avoid unnecessarily placing the first restoration. To minimize the unnecessary replacement of restorations. Remember, the decision to do one thing is a decision not to do something else. Decisions to provide extensive treatment frequently translate to the provision of services to one patient at the expense of access to care for others.

44 SUMMARY (continued) Assessing the patient s risk, applying appropriate preventive regimens, and evaluating compliance with these regimens before providing invasive restorative procedures is essential. Following these guidelines should assure wise use of limited resources and increase patient access to the health care delivery system.

45 Curtis SpottedOwl is 3 years old. This is his first appointment at your dental clinic. He was weaned from the bottle at 10 months, according to Mom. Upon a clinical examination, he has no cavitated or white spot lesions. How would you manage Curtis? What would you do at this appointment? What is his caries risk?

46 Nathan Begay is 5 years old. He was referred by Head Start for a possible cavity. According to his mother, Nathan brushes his teeth twice daily and eats no candy. Upon a clinical examination, you find 20 carious lesions, including the anterior teeth as shown in the photo. How would you manage Nathan? What would you do at this appointment? What is his caries risk?

47 Janet Dunn is aged 15. Upon the clinical exam, you find caries on #18-O. What is Janet s caries risk classification? Upon interviewing Janet, you find out that her diet consists of Mountain Dew throughout the day and Reece s Pieces. How would this change her risk classification, if any?

48 John Watson is a 43 years old. He has no medical issues. Upon clinical examination, he is found to have 14 teeth with caries. He hasn t been to the dentist in 25 years. You determine that all of his teeth are restorable. How would you manage John? How frequently would you recall him?

49 Tyler Billie is 14 months old. Upon the clinical exam, you note no caries or even white spot lesions. He is still on the bottle; his mother says he cries whenever he doesn t have a bottle of juice. His aunt often watches him, and she dips his pacifier (which he is still on) in honey to sooth him, as he still has teeth erupting. What is his caries risk? How would you manage Tyler? How often would you recall him?

50 Go to the IHS Dental Portal ( Click on the Clinic tab Review the slides for each of the 6 caries risk module