Quality Resource Guide
l
Caries Risk Assessment and Management for Adults
3
www.metdental.com
•
The ADA CRA
(for those older than 6)
<
Science%20and%20Research/Files/topic_
caries_over6.ashx
>
•
The CAMBRA Collation Tool Kit
(with
several risk assessment forms)
<
>
•
The Cariogram
<
Odontologiska-fakulteten/Avdelning-och-
kansli/Cariologi/Cariogram/
>
Caries Detection and Assessment:
Evidence
indicates that previous caries experience is the only
consistently reliable caries indicator.
17,18
Indicators
are the signs of the disease. White spot lesions or
initial lesions, cavitated lesions or recent restorations
are all considered risk indicators for dental caries.
Early caries detection is essential to properly assess
the patient’s current and future risk before there
is frank evidence of disease. Visual examination
of a clean dry surface is necessary to optimize
detection.
3
Surfaces that are covered in biofilm or
saliva may appear to be sound and early signs of the
disease may be missed (see
Figure 2
).
Because not all dental caries lesions progress to
cavitation,
19,20
determining caries lesion activity is of
utmost importance and closely tied to caries risk.
Determining which lesion will progress to cavitation
has been a challenge that at this time can only
be solved by longitudinal monitoring. However,
monitoring of these lesions has to go beyond
placing non-cavitated lesions on “watch”. Using
visual criteria that categorize lesions beyond “watch”
and “cavitated” allows the clinician to detect early
changes and adjust management accordingly.
21
Some recent reports suggest that visual examination
with the
International Caries Detection and
Assessment System
(ICDAS)
4
(see
Figure 3
) can
provide some indication of the probability of a
lesion progressing towards cavitation based on
their clinical characteristics.
19,22-29
Recent data
indicate that ICDAS scores can be used to predict
lesion progression and the rate of progression.
19
Using
a
subjective
assessment
of
activity
(
Figure 4
) Ferreira Zandona,
et al
.
19
found that
a greater percentage of lesions at all ICDAS
scores that were considered active at baseline
progressed to cavitation. This can be a valuable
tool to determine treatment decision and prognosis
in clinical practice.
19
The ADA Caries Classification
Code, which is based on collapsed ICDAS
codes can make the use of a visual criteria more
easily administrated in a busy dental practice.
30
(see
Figure 3
).
Figures 2 a & b
First molar covered in saliva and after drying. Note the widening of the fissure and the white opacity
at the entrance of the fissure on the distal portion visible once the surface is dried.
Figure 3
ICDAS and ADA Caries Criteria
An e-learning tool is available for training on the
ICDAS criteria: <
www.iccms-web.com
>.
Saliva
Assessment:
Saliva
assessment
is
often overlooked by clinicians. Adult patients,
especially those taking certain medications can
be at increased risk for hyposalivation, which
significantly increases caries risk. An unstimulated
saliva flow assessment provides the most accurate