Identification of At-risk Individuals for Oral Disease

Patients demonstrate different susceptibility to oral disease and these susceptibility levels may change throughout life. Adequate assessment of risk factors for caries and periodontal disease is critical to targeting adequate recommendations for individual patients.

Caries

Dental caries affect nearly all adults in the U.S. and worldwide, with a large number having untreated decay.58,59 Despite the widespread prevalence of this disease, a large proportion of dental caries, particularly untreated disease, occur in a small select high-risk subset of individuals, including those with lower socio-economic status.58 Caries risk assessment should include an evaluation of: 1) food and beverage intake, including types, frequency, and quantities of foods/beverages consumed, 2) salivary flow/consistency, 3) history of previous carious lesions and restorations, 4) assessment of current oral hygiene methods and dexterity, 5) dental plaque accumulation calculation, 6) systemic medical conditions, 7) current medications, 8) history of dental visits and dental care, and 9) other factors that may influence dental caries rates.60-64

Dental caries prevention requires the treatment of active carious lesions; regular cleansing of the teeth, including both professional therapy and home care; limiting dietary sugar intake; fluoride application; and mitigation of other factors that may increase the rate of caries suceptibiltiy.63 Interventions for higher risk individuals can include removal and reduction of plaque biofilm, alteration of dietary habits to reduce bacterial substrate, and utilization of interventions that encourage remineralization and the bioavailable fluoride ions available during the remineralization process. The ADA Caries Risk Assessment protocol provides assessment criteria for children 0-6 years and patients over 6 years old.65,66 The Caries Management by Risk Assessment (CAMBRA) system may also be employed to identify at-risk children and adults and to identify proper treatment recommendations for those individuals.67

Periodontal Disease

Periodontal disease risk is related to both the amount and type of bacteria/bacterial plaque present intraorally7,8 as well as myriad host and environmental factors.68 Smoking is the largest modifiable risk factor for periodontal disease progression and attachment loss, and it appears to have a dose-dependent effect on periodontal disease progression.69,70 Other factors associated with periodontal disease risk include: age, race/ethnicity, socioeconomic status, diabetes mellitus, psychosocial stress, immune deficiency, gingival bleeding, and a history of previous periodontal attachment loss.68,69 Careful assessment of the overall and oral health of a patient as well as identification of possible risk factors for disease allow for a more tailored approach to recommendations for oral hygiene and professional care.

Several risk assessment tools may be used to evaluate periodontal disease risk, although there are no foolproof strategies to improve care (Figure 3). The UniFe tool uses five parameters: 1) smoking status, 2) diabetes status, 3) number of sites with PD ≥ 5mm, 4) number of sites with bleeding on probing (BOP), and 5) bone loss/age to assign risk categories to patients.71 Using similar parameters, the Periodontal Risk Assessment (PRA) hexagonal diagram allows a visual imagery of the overall risk for a patient based upon BOP, number of PD ≥ 5mm, number of teeth lost, bone loss/age, systemic and genetic factors, and environmental factors (smoking status).72 The BEDS CHASM model uses a scoring system that can be compared with average scores to estimate an odds ratio.73 In this system, patients are scored on BMI, ethnicity, diabetic status, stress levels, education, oral hygiene, age, smoking status, and male gender.74 All of these tools, modifications of these assessments, and other commercially available risk assessment tools may have utility in providing a periodontal risk analysis for the patient.

Figure 3. Three currently used periodontal risk assessment tools.70-73

Image of Three currently used periodontal risk assessment tools.