Seminar Nasional Jatim Dentistry VI

CARIES RISK ASSESSMENT

& MANAGEMENT
in Children
Dr. Sindy Cornelia Nelwan, drg, SpKGA(K)
Udijanto Tedjosasongko, drg, Ph.D, Sp.KGA(K)
 Introduction

elwan, drg, Sp.KGA(K)

entistry Department,
cine, Universitas Airlangga
r Gigi Anak Indonesia Pengda
atim

Udijanto Tedjosasong
Head Department in Pe
Faculty of Dental Med
Chairperson of Ikatan D
References
• Dentistry for the Child and Adolescent 10th
ed – McDonald and Avery (2016)
• Diagnosis and Risk Prediction of DENTAL
CARIES – Per Axelsson, DDS, PhD (2000)
• Textbook of Clinical Cariology 2nd ed –
editors Anders Thylstrup & Ole Fejerskov
(1996)
How would you
Manage?
 Early Decay

Moderate Decay Advanced Decay

Restoration
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Figure 1. Caries decline in Brazil from 1968 to 2003.
From Narvai, 2000 (14) and Health Ministry of Brazil (15)* 1989;
Fluoride dentifrices reached the market on large-scale basis.
LET’S UNDERSTAND
CARIES IS A MULTI FACTORIAL DISEASE

Newbrun, 1978
Sumber : Diagnosis and Risk Prediction of Dental Caries – Per Axelsson (2000)
 Personal factors
Oral Environmental factors
Factors that directly contribute
To caries development
The Biological Factor
For Caries
 The Caries Evolution
Restoration
Pulpal lesion

Dentin lesion
Carries process

Enamel lesion
Cavity
White spot
No cavity
De-and Re-mineralization
Diagnosis
Colonization

Adhesion Prevention
Time
Demineralization-Remineralization Cycle
Caries Management
Caries Management

CARIES RISK ASSESSMENT PREVENTIVE CONTROL & TREATMENT

Early Diagnosis Home - Proffesional Stop Progress & Restore
 CARIES RISK ASSESSMENT
Microbial Test
A caries risk assessment is
a preventative test used Caries Activity Test
to evaluate a person's risk
of developing dental
caries Salivary test

Survey / questionare
Microbial Test
Laboratory Method

Saliva (or dental plaque) Sent to microbiological lab After incubation,

for sample result expressed as number of
Colony forming
Microbial Test
Chairside Method

BASED ON MICROBIAL COLONIZATION

(103 CFU/ml  low risk, >106CFU/ml  high risk)
Dentocult-LB
BASED ON SALIVARY
SALIVARY FLOW RATE
(< 0,7ml/min  high risk)

C
SALIVARY BUFFER CAPACITY TEST
BUFFER CAPACITY
(pH <3  high risk, pH > 6 Low risk)

C
Survey /
Questionaire
(Nutrition analysis,
education, social
economic,
gender, age, etc)
American Academy of Pediatric Dentistry.

Guideline on caries-risk assessment and

management for infants, children, and
adolescents.

Pediatr Dent 2013;35(5):E157-64.

Caries Risk Assessment
Survey Caries Risk Assessment

Faktor Biologis

Faktor Protektif

Faktor Klinis
(Clinical Findings)
 Faktor biologis
DATA-DATA UMUM TENTANG IBU / CARE GIVER

DATA-DATA UMUM TENTANG ANAK / POLA ASUHNYA

DATA TENTANG POLA DIETNYA

 Faktor Biologis

DATA TENTANG KUNJUNGAN KE PENGGUNAAN OBAT KUMUR FISSURE SEALANT

PEMAKAIAN FLUOR DOKTER GIGI SIKAT GIGI
FAKTOR TEMUAN KLINIS

ADANYA KARIES / WHITE SPOT TUMPATAN SALIVARY FLOW RATE

LEVEL MUTANS ADANYA PLAK

TABLE 3. CARIES-RISK ASSESSMENT FROM FOR ≥ 6 YEAR OLDS
(FOR DENTAL PROVIDERS)

Factors High Risk Moderate Low

Risk Risk
Biological

Patient is low socioeconomics status Yes

Patient has > 3 between meal sugar-containing snacks Yes
or beverages per day
Patient has special health care needs Yes
Patient is a recent immigrant Yes
 TABLE 3. CARIES-RISK ASSESSMENT FROM FOR ≥ 6 YEAR OLDS
(FOR DENTAL PROVIDERS)

Protective
Patient receives optimally-fluoridated drinking water Yes
Patient has teeth brushed daily with fluoridated Yes
toothpaste
Patient receives topical fluoride from health professional Yes
Additional home measures (eg. xylitol, MI paste, Yes
antimicrobial)
Patient has dental home/regular dental care Yes
Clinical Findings
Patient has > 1 interproximal lesions Yes
Patient has active white spot lesions or enamel defects Yes
Patient has low salivary flow
Yes
Patient defective restorations Yes
Patient wearing an intraoral appliance Yes

Circling those conditions that apply to a specific patient helps the practitioner and
patient/parent understand the factors that contribute to or protect from caries. Risk
assessment categorization of low or high is based on preponderance of factors for the
individual. However, clinical judgment may justify the use of one factor (eg, frequent
exposure to sugar containing snacks or beverages, visible cavities) in determining overall
risk

Overall assessment of the child’s dental caries risk: High Low

Cariogram
Caries Management
 TABLE 6. EXAMPLE OF A CARIES MANAGEMENT PROTOCOL FOR ≥ 6 YEARS OLDS

Risk Diagnostics Interventions Restorative

Categor Fluoride Diet Scalants
y
Low Risk - Recall every - Twice daily brushing No No - Survelillance
six to 12 with fluoridated
months toothpaste
- Radiographs
every 12 to 24
months
Moderat - Recall every -Twice daily brushing - Yes -Active surveillance of
e Risk six months with fluoridated Counselin incipient lesions
Parent - Radiographs toothpaste g - Restoration of cavitated
engaged every six to 12 - Fluoride or enlarging lesions
months supplements
- Professional topical
treatment every six
months
Moderate - Recall every
-Twice daily brushing - Yes -Active surveillance of
Risk six months with fluoridated Counseling incipient lesions
Parent - Radiographs
toothpaste with limited - Restoration of cavitated
not every six to 12
-Professional topical expectatio or enlarging lesions
engaged months treatment every six ns
months
High - Recall every -Brushing with 0,5 - Yes - Active surveillance of
Risk three months percent fluoride (with Counsellin incipient lesions
Parent - Radiographs caution) g - Restoration of cavitated
engaged every six - Fluoride - Xylitol or enlarging lesions
months supplements
- Professional topical
treatment every three
months
High - Recall every -Brushing with 0,5 Counseling - Restore incipients,
Risk three months percent fluoride (with with limited cavitated, or enlarging
Parent - Radiographs caution) expectatio lesions
not every six - Professional topical ns
engaged months treatment every three
months
Risk Diagnostics Non Operative Inventions Operative Inventions
Category
Fluoride Diet
Low - Recall every 6 to - Twice daily Counselling - Survelillance
12 months supervised brushing periodic monitoring
- Baseline analysis with fluoridated for signs of caries
of salivary mutans toothpaste progression
streptococci
bacteria levels
Moderate - Recall every 6 -Twice daily supervised - Counseling -Active surveillance :
(Parent months brushing with regular monitoring for
engaged) - Baseline analysis fluoridated toothpaste progression of
of salivary mutans - Topical treatment incipient lesions
streptococci every 6 months
bacteria levels
Moderate - Recall every 6 -Twice daily supervised - Counseling -Active surveillance
(Parent months brushing with with limited
not - Baseline analysis fluoridated toothpaste expectations
engaged) of salivary mutans -Topical treatment
streptococci every 6 months
bacteria levels
High Risk - Recall every 3 -Twice daily - Counselling - Active surveillance
(Parent months supervised brushing of incipient lesions
engaged) - Baseline with fluoridated - Restore cavitated
analysis of toothpaste lesions
salivary mutans - Topical treatment
streptococci every 6 months
bacteria levels
High Risk - Recall every 3 -Twice daily Counseling with - Active surveillance
(Parent not months supervised brushing limited - Restorecavitated
engaged) - Baseline with fluoridated expectations lesions with interim of
analysis of toothpaste definitive restorations
salivary mutans - Topical treatment
streptococci every 6 months
bacteria levels
Increase
the Protective
Factor
Managing
the Biofilm
C
 Problem Solution Result

TEACH PARENT TOOTHBRUSH

MECHANICAL PLAQUE
CONTROL
Berkumur / obat kumur

(Youtube : Yuk, sikat gigimu! (Non-fluoride caries preventive agen

Idgai.jatim) JADA 2011,142(9))
Managing the Diet Hati2 Sticky sugar

Treatment
Diet Counseling
• Masing-masing individu berbeda
• Alternatif substitusi sugar
• Mengurangi freksensi snack di antara 2 waktu
makan
• 3x makan, 2 snack (termasuk minuman).
Feeding
when
sleeping
Managing the saliva
Treatment – increase saliva protective factors

- Pastikan tidak dehidrasi

5-8thn 4 gelas/ 1 ltr per hari
9-12 thn  6 gelas / 1,5 ltr per hari
>13thn  8 gelas / 2 ltr per hari
Remineralization
Microscopic improvements 2-3 week  shiny, hard enamel
improved
Casein PhosphoPetides
Amorphous Calcium Phosphate
Casein PhosphoPetides
Amorphous Calcium Phosphate
Managing the Fluoride Exposure
• Fluoride promotes remineralization & repair

• Fluoroapatite resists demineralization (merubah pH

menjadi basa)

• Fluoride inhibits bacteria metabolism

Fluoride
Type 0-2 years 2-3 years 3-13 years >13 years
Dietary fluoride Not indicated 0.25 mg F daily 0.5 mg F daily Not indicated
supplement
Operator – applied APF topical solution or APF topical solution or APF topical solution or APF topical solution or
topical fluoride gel, 1.23% F, applied gel, 1.23% F, applied gel, 1.23% F, applied gel, 1.23% F, applied
four times a year four times a year four times a year four times a year
Self-applied topical Not indicated Not indicated Self-application of gel- Self-application of gel-
fluoride tray daily for tray daily for
approximately 4 approximately 4
weeks; thereafter weeks; thereafter
continue with a daily continue with a daily
fluoride rinse (0.05% fluoride rinse (0.05%
NaF) NaF)
Fluoride dentrifice Brush with F- Brush with F- Brush with F- Brush with F-
containing dentrifice containing dentrifice containing dentrifice containing dentrifice
Fluoride treatment -
Professional
• Pasta gigi berfluor < 12bulan, meningkatkan resiko
flluorosis
• ADA merekomendasi, fluoride pada pasta gigi untuk anak
3 tahun ke atas
•  topikal aplikasi oleh Professional
VARNISH
MI Varnish
Sealant and surface protection
Beberapa penelitian menunjukkan bahwa fissure sealant
sangat efektif mencegah karies (kesuksesannya 90%)
CARIES
VACCINE
Kesuksesan
Penaganan Karies

TERGANTUNG
Manajemen Resiko Karies