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Individual Risk
29-03-2010
Individual Risk By combining etiologic factors, caries prevalence (experience), caries incidence (increment), external and internal modifying risk indicators, risk factors, and prognostic risk factors, as well as preventive factors, caries risk may be evaluated at the individual level, as no risk (C0), low risk (C1), risk (C2), and high risk (C3). As discussed earlier in this chapter, these conditions may vary in different age groups. Therefore, the criteria for C0, C1, C2, and C3 should be defined for at least the following general groups: preschool children (primary teeth), schoolchildren (permanent teeth), adults, and the elderly. Caries prevalence and caries incidence as well as socioeconomic conditions may vary considerably among different populations and countries. The criteria listed for caries prevalence and incidence in children (C0 to C3) apply to Scandinavian conditions (low caries prevalence). Boxes 15, 16, 17, and 18 exemplify criteria for C0 to C3 in preschool children, children, adults, and the elderly, respectively, starting with etiologic factors, followed by caries prevalence, caries incidence, external modifying risk factors, internal modifying risk factors, and preventive factors. The more factors that can be identified in the individual subject, the greater the validity of the predicted risk evaluation. In adults, as in children, caries prevalence and incidence as well as treatment needs may also vary significantly among different populations and countries. For example, in many developing countries, caries prevalence (decayed or filled surfaces) and incidence are relatively low in adults, but treatment needs (new decayed surfaces) are very high. In industrialized countries, on the other hand, caries prevalence (decayed, missing, or filled teeth and surfaces) is high, while caries incidence is moderate and treatment needs (new carious surfaces) are limited, because of well-organized dental care systems. The caries prevalence and caries incidence values given for different risk categories (C0 to C3) in adults, based on figures from the county of Varmland, are representative for Swedish conditions. Extrapolation should be made with caution, and reevaluation may be necessary. Although it is difficult to identify all the criteria for risk prediction in one individual, the higher the number of criteria identified, the greater the validity of the risk prediction. Recently, all the adult patients in the Public Dental Health Service of the county of Varmland were categorized by risk for dental caries as no risk, low risk, risk, or high risk (C0 to C3). Preliminary data show that more than 85% of the 20 to 50 year olds were categorized as C0 to C1 and less than 5% as C3.
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Comments
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Articles for theme “caries”:
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29-03-2010
Risk GroupsRisk age groupsRecent studies have shown that carious lesions are initiated more frequently at specific ages. This applies particularly to children but also to adults. In children, the key-risk periods for initiation of caries seem to be during eruption of the permanent molars and the period during which the enamel is undergoing secondary maturation. In adults, most root caries develops in the elderly, partly because of the higher prevalence of exposed root surfaces.
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29-03-2010
Prediction of Caries Risk and Risk ProfilesIntroductionFor successful prevention and control of dental caries in both children and adults, some basic principles must be adopted: For example, the higher the risk of developing caries (new carious surfaces) in most of the population, the greater the effect of one single preventive measure. This may be illustrated by the Swedish experience, where 30 to 35 years ago, caries prevalence was extremely high. Almost every child developed several new lesions every year, mainly because of very poor oral hygiene.
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29-03-2010
Tooth-related factorsPhysical characteristics of the teeth may increase the risk for caries: tooth size, tooth morphology, cusp and fissure patterns, enamel structure (defects, opacities, mottling, and roughness of the surface), the morphology of the cementoenamel junction, and exposed root surfaces. In addition, the chemistry of the enamel, dentin, and root cementum may influence caries susceptibility. Studies to date indicate that large teeth in crowded mouths are more likely to develop caries, but this cannot be predicted on an individual basis.
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29-03-2010
Systemic and immunologic factorsOf the chronic systemic diseases, by far the most important risk factor and prognostic risk factor for dental caries is Sjogren’s syndrome, because of its extremely depressive effect on both the salivary secretion rate and the quality of the saliva. Indirectly, reduced SSR is associated with other chronic diseases in which medical management involves regular use of drugs with side effects on the salivary system. Some other general chronic diseases, such as leukemia, acquired immunodeficiency syndrome, diabetes mellitus, and Down’s syndrome, impair the immune system generally or specifically.
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29-03-2010
ConclusionsIntroductionThe most important internal modifying factors related to dental caries are salivary hypofunction, some chronic diseases, impaired host factors, and unfavorable macroanatomy and microanatomy and eruption stage of the teeth that favor plaque retention. Of utmost importance is impaired salivary function, particularly stimulated salivary secretion rate. Salivary factorsSalivary secretion rate, the buffering effect, and possibly the in vivo concentrations of some salivary constituents, such as fluoride, hypothiocyanite, and agglutinins (possibly including IgA), seem to be the most important determinants of caries susceptibility and/or activity.
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