Caries Risk Assessment

Diet Analysis

You are a dentist in general practice. A mother has brought her 6 year old daughter to
your surgery for a routine check-up. The child has had previous restorative work on
her deciduous molar teeth. Please give dietary advice to the mother and child.

Props: Completed 3-day diet sheet.

Answer

The reason for giving dietary advice is to try to minimize dental disease caused by
food and drink (e.g.: decay and erosion). Patients may be unaware of the cariogenic
foodstuffs in their diet. Diet advice needs to be appropriate for the individual, as
everyone is slightly different.

1. Introduce yourself politely to the patient and mother.

2. Establish rapport with the patient and mother.

3. You would start with a diet analysis. This should be for 3-4 dfays and
include at least one weekend day.

4. Explain to the mother that she needs to record the time, the content and
the amount of food and drink consumed as well as the tooth brushing
times.

The examiner tells you the patient /mother has a completed diet sheet.

5. The diet sheet should be checked with the patient and mother.

6. Assess nutritional value of main meals.

7. Highlight all sugar intakes.

8. Highlight any between-meal snacks and assess nutritional value.

9. Keep advice short and simple, as overloading the patient and mother will
be counter-productive.

10.Explain relationship between sugary snacks and drinks between meals

and decay.

11.Possible hints to give:

• Save sweets to a special time of the week e.g.: Saturday morning.

 • Eat sweets in one go rather than spreading them out (i.e.: A
chocolate bar is less harmful than a bag of chocolate).

• Crisps, nuts, etc., although more dentally friendly, are very high
in fat and salt and shouldn't always to be substituted for sweets.

• Chewing gum and cheese will simulate saliva flow and may help
after eating sugary snacks, although chewing gum may not be
appropriate for young children.

• Fizzy drinks contain large amounts of sugar

• Diet fizzy drinks can cause erosion (tooth surface loss) even
though they are sugar free.

• Only drink plain milk or plain water in between meals.

• Do not eat or drink after brushing at night.

• Cheese can provide some protection, but is high in fat.

• Fruit does contain natural sugars, however consuming normal

amounts does not increase any caries

12. Overall aim is to decrease sugary snacks and fizzy drinks between meals.

13. Increase the amount of fresh fruit and vegetables eaten.



 OHI
Question- Please give oral hygiene advice to this adult patient. Shown below
is a plaque distribution chart. Where there was evidence of plaque following
disclosing, a red mark is placed in the triangle relating to the appropriate
tooth surface.
Answer
Adults may be embarrassed by receiving instructions on oral hygiene, so the
method of delivery is important.
1. Introduce yourself politely to the patient.
2. Explain that brushing is important for the prevention and control of tooth
decay and gum disease.
3. Advise that they should aim to brush twice daily with fluoride toothpaste.
Different fluoride preparations have similar efficacy.
4. Explain that they should try to limit rinsing with water after brushing as this
washes the fluoride away.
5. Explain that they should try to brush last thing at night before going to bed.
6. Information on different brushing and hygiene aids is also useful.
You’ll no doubt be aware that brushing your teeth, which removes the plaque
that causes tooth decay and gum disease, is important.

What you may not know is that how often you brush, how long you brush for,
the kind of technique and toothbrush you use all matter too.

To gain the maximum benefit from brushing your teeth, you should be brush-
ing for at least two minutes morning and night, spending roughly 30 seconds
on each quarter of your mouth.

It’s all in the technique, how you brush your teeth matters a great deal. You
should be cleaning your teeth systematically, starting at the back with the
toothbrush bristle at the gum line or at a 45° angle, brushing gently in a cir-
cular motion, and finishing with a spit, not a rinse.

If you have an electric toothbrush, you should be guiding the moving brush
head slowly from tooth to tooth following the contours of the tooth and the
curve of the gums.

Regardless of the brush you use, try to avoid brushing with too much force
as this can damage the surface of your teeth. And as for the toothpaste? You
only need a pea-sized amount to get the job done.

Tools of the trade

You are always best using a soft-bristled toothbrush with a small head and a
flexible neck because this will most effectively remove plaque and debris
from your teeth, without damaging your teeth and gums and drawing blood.
Try to replace your brush at the first sign of wear-and-tear or every three
months, whichever comes first, and if you've just had a cold, replace your
toothbrush so you don’t get reinfected by the germs in the bristles.

If you have braces

It's recommended that you brush after every meal, preferably using a tooth-
brush with a soft head to regularly clean away the food debris and plaque
that can accumulate in the brackets. The best technique is to hold your
brush at a 45-degree angle to the gums, much like a standard brushing
technique, before moving on to brushing downwards to clean the top of the
brackets and brushing upwards to clean the bottom section.

Flossing

Nearly half the surface area of your teeth lies between them.

Why that particular information is important is because if you’re solely relying

on brushing you’re not cleaning a large portion of your teeth, which in turn
can affect how healthy your teeth and gums are.

By removing the plaque from between your teeth, you’re helping to prevent
gum disease, tooth decay and bad breath.

So flossing, or interdental cleaning as it’s officially known, is an essential part

of caring for your teeth and gums, and not some kind of “nice to have”
added extra.

It’s all in the technique

It’s one thing to make flossing a part of your dental health care routine, quite
another to do it properly.

There are some basic tips you can follow:

Tip 1: Wind about 45cm of floss around your middle fingers and rest it
across your thumbs and index fingers.

Tip 2: Always insert the floss gently using a gentle side-to-side motion to
avoid traumatising the gums.

Tip 3: To clean the “neck” of the tooth, which is the point at which it meets
the gums, curl the floss and insert it gently under the gum.

If sticking your fingers into your mouth with a cord of thin filaments strung
between them isn’t your idea of fun, then consider using either a less inva-
sive floss threader or floss pick to do the job.

Make flossing a routine

Flossing should be an integral part of your dental health routine along with
brushing. You should be flossing once a day, either in the morning or night,
or even after lunch, for at least two minutes..

But it’s not just adults who need to floss. Kids should start cleaning between
their teeth as soon as they have two teeth in contact but until the age of 10,
it’s best if the parent does the flossing as younger kids don’t have the manu-
al dexterity needed to floss effectively.

If you have braces

Flossing is more important than ever in tis instance, playing an integral role in
clearing out food particles and plaque. Using the usual flossing tape can
prove to be a bit of a challenge, so you might find something like a floss
threader and interdental brushes will work better for you. Always floss gently
and slowly since too much pressure and speed can damage your braces.

7. Chemical plaque removal with mouthwashes:

a) Chlorhexidine works by preventing development of supragingival plaque. It
does not affect established gingivitis where subgingival plaque is present. It
also has some side-effects such as altered taste and staining of teeth, so is
not recommended for long-term use except in special circumstances.
b) Pre-brushing rinses are available but their value is debatable.
 Fluoride Advice

You are a dentist in a general dental practice. A mother has brought her 2 year old son
to see you for his first dental appointment. The mother is unsure whether she should
give her son fluoride supplements, as they live in a non-fluoridated area.

Please give fluoride advice to this mother and her son and explain your reasons for
the advice given.
Answer

1. Introduce yourself politely to the patient and parent.

2. Establish rapport with the patient and parent.

3. Explain to the examiner that you would carry out a caries risk assess-
ment for the child. This would involve assessing:

• Diet and sugar intake, including bottle- or breast-feeding.

• Exposure to fluoride.

• Motivation of the mother and family.

• Socioeconomic group.

• Any relevant medical history.

4. Fluoride drops or tablets should not be taken (swallowed) directly by an

adult or child. They must be added to drinking water to achieve a fluoride con-
centration of 1mg/L. (optimal conc. of FL in water)

5. In order for people in non-fluoridated areas to obtain the benefits of fluoride in

water it is recommended that people buy bottled water with fluoride at approximately
1mg/L for drinking.

6. Children 18 months to less than 6 years—tooth paste containing 500 to 550 ppm
(0.5-0.55 mg/g), a small pea-sized amount applied to a child size tooth brush, twice
daily if the risk of caries is low.

7. For children who do not consume fluoridated water or who are at elevated risk
of developing tooth decay for any other reason, guidelines about toothpaste usage
must be varied, as needed, based on dental professional advice. Variations could in-
clude more frequent use of fluoridated toothpaste, commencement of toothpaste use
at a younger age, or earlier commencement of use of standard toothpaste containing
1mg/g fluoride (1000ppm). This guideline may apply particularly to preschool chil-
dren at high risk of tooth decay.

8. Fluoride mouth rinses must not be used by children under the age of six years due
to the possibility that they will ingest some of the product and increase their risk of
dental fluorosis.
9. Explain that fluoride has been shown to reduce caries experience (tooth decay) by
50%.

10. Fluoride can work on those teeth already erupted in the mouth, but will also have
a beneficial effect on developing teeth (i.e.: beneficial for the adult teeth).

11. There is an optimum level of fluoride ingestion. Exceeding this level can lead to
problems of fluorosis, ranging from white opacities on the teeth to more severe dis-
colouration and actual pitting of the teeth. Higher levels of fluoride ingestion can lead
to toxicity and even death, so people must not exceed the advised dose. It is therefore
important to know the level of fluoride in the drinking water supply before any fluo-
ride supplements are prescribed.

12. The popular press has caused people to think that fluoride will cause cancer-there
is no documented evidence to support this claim.

13. The child must spit out after brushing, Rinsing with water after brushing will re-
move some of the fluoride.

Application of Topical Fluoride

Concentrated forms of fluoride should only be applied by suitably qualified dental

practitioners and should only be used after taking into account an assessment con-
ducted by a dentist of an individual’s tooth decay risk.
Fluoride varnish should be used for people who have elevated risk of tooth decay,
High concentration fluoride gels and foams (those containing more than 1.5 mg/g
fluoride ion) may be used for people who are at increased

Further Notes:

• For people aged six years or more, the teeth must be cleaned twice a day or more
frequently with standard fluoride toothpaste containing 1 - 1.5 mg/g fluoride (1000–
1500 ppm). People aged six years or more should spit out, not swallow, and not
rinse.
• For teenagers, adults and older adults who are at elevated risk of developing tooth
decay, dental professional advice should be sought to determine if they should use
toothpaste containing a higher concentration of fluoride (i.e. greater than
1000-1500 ppm up to 5000 ppm of fluoride).