Introducing caries risk assessment for a teaching clinic

Background: Conventional management of dental caries has focused on the removal of decayed tooth structure followed by the placement of restorative material with little attention to risk factors associated with the disease. While restorative dentistry will always have its place in treating carious lesions, the identification and management of risk factors associated with dental caries is equally important to diagnosis and treatment planning. With the latter approach, patients are managed according to their individual oral environment where therapy is guided by assessed risk factors.

Objective: To examine current best practices for dental caries risk assessment and to gain a better understanding of how these principles may fit with clinical diagnosis and treatment planning of patients seen in a teaching clinic.

Method: To carry out the objective, a twofold approach was taken: 1. A literature and web-based scan of best practices for caries risk assessment (CRA) tools was carried out using Medline, Pubmed, Cochrane, Novanet. Grey literature sources were searched using the internet. 2. After obtaining ethics approval, a retrospective chart audit of a sample (n=200) of patients who were treatment planned in the Dalhousie Dental Clinic between January and December 2006 was conducted to estimate the incidence and prevalence of caries in new patients. When available, relevant caries risk factors (eg, diet, xerostomic medications) were also documented.

Results: 1. Of three CRA tools identified in the literature, two provide promise for introduction into the Dalhousie teaching clinic. All three tools include validated risk factors in the assessment but one was limited to the pediatric population. 2. The chart audit revealed that the average new patient (mean age 47) requires 1 extraction due to caries and 4 restorations. Ninety percent of new patients require at least one restoration, an extraction or both.

Conclusion: The introduction of CRA is indicated based on the high proportion of patients who require dental treatment as a result of dental caries. However, modifications to clinic protocols for assessment and documentation are required to accommodate CRA.