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Elements of our New Patient Exam – Caries Risk Assessment

One of the most important elements of our dental exam is the time we take to assess a patient’s caries risk (risk for dental decay). By looking at signs within the mouth and speaking with patients about their dental history and habits, we can begin to understand their risk for future problems and make appropriate recommendations regarding treatment and prevention. If risk is identified, efforts are made to not only fix the problems, but even more importantly identify and address the cause of the problems so that future issues are resolved as well.

At its basic level, dental decay occurs because of the presence of bacteria called streptococcus mutans, which excretes harmful acid when exposed to simple sugars. The accumulation of bacteria is called plaque. Removing the bacteria, neutralizing the acid, or reducing the amount of sugar in the oral environment are all effective techniques in addressing caries risk. Conversely, a patient who has a lot of plaque, has an acidic oral environment, and routinely eats sugary sweets has a significant risk for dental cavities.

Factors that can increase a patient’s risk for decay include:
• The presence of active decay.
• Restorations that were placed within the past three years.
• High sugary diets including candy, sweets, carbonated beverages, and energy drinks.
• Poor oral hygiene habits or abilities.
• Dry mouth (xerostomia).
• The presence of orthodontics including braces and clear aligners.
• Radiation or chemotherapy treatment affecting the salivary glands.
• Drug or alcohol abuse.
• Eating disorders.
• Special care needs.

To reduce or minimize risk, patients are encouraged to brush their teeth at least twice a day with a fluoridated toothpaste, and floss daily. Prescription toothpastes are available for high risk patients including products like Prevident 5000, ClinPro 5000, and MI Paste. These products contain ingredients like fluoride, which helps to make tooth structure more resistant to acid breakdown, and calcium phosphate, which helps to buffer the saliva to make it less acidic. Potassium Nitrate is an ingredient that helps to make teeth less sensitive, but has no impact on dental decay.

Xylitol is a sugar substitute that cannot be processed by streptococcus mutans. Chewing gum or eating mints with xylitol can help to prevent decay; however, five grams of xylitol are necessary each day to make an impact. At about 0.25 grams of xylitol in Trident gum, one would need to chew twenty pieces of gum a day. Fortunately, there are other products available that contain larger percentages of xylitol and can be an effective adjunct to fighting tooth decay.

It has been suggested too that tooth whitening can help to reduce risk for decay. Professional tooth whitening gels work first by removing the film of saliva from the surface of the teeth before they penetrate to whiten them, and it is within this film that the plaque bacteria resides. To have a positive effect, it is recommended that patients whiten with a 10% tray bleaching material for just thirty minutes a week.

Lastly, products can be used in the dental office to prevent tooth decay like fluoride varnishes, fluoride releasing glass ionomer restorative materials, chlorhexidine varnishes, and sealants which seal the small pits and fissures on the surfaces of teeth. Patients are encouraged to visit the dentist routinely so that small issues if present can be identified before they have a chance to get bigger, and dental x-rays can be evaluated to screen for issues between the teeth.

If you have questions about this article, or if you are looking for a dentist in Winter Park, Florida, please call us at (407)644-2700 or visit our website.

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