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Flashcards in Oral Risk Assesment Deck (25)
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1

Oral health in the news

•IADR/AADR publish article on the global economic impact of dental diseases

•Direct treatment: US$298 billion yearly (___% of global health expenditure).

•Indirect costs US$144 billion yearly, corresponding to economic___s within the range of the 10 most frequent global causes of death

•IADR/AADR publish article on the global economic impact of dental diseases

•Direct treatment: US$298 billion yearly (4.6% of global health expenditure).

•Indirect costs US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death

2

Oral health in the news

•“A new study has confirmed that regular smokers have a significantly ____ risk of tooth loss.”

•“Male smokers are up to ___ times more likely to lose their teeth than ___ ___, whereas female smokers were found to be ___ times more likely.”

 

•“A new study has confirmed that regular smokers have a significantly increased risk of tooth loss.”

•“Male smokers are up to 3.6 times more likely to lose their teeth than non-smokers, whereas female smokers were found to be 2.5 times more likely.”

•T. Dietrich, C. Walter, K. Oluwagbemigun, M. Bergmann, T. Pischon, N. Pischon, H. Boeing. Smoking, Smoking Cessation, and Risk of Tooth Loss: The EPIC-Potsdam Study. Journal of Dental Research, 2015

3

What is oral health risk assessment?

•Based on the principle that everyone has___ ____ to disease

•With a proper risk assessment we can ___ the ___ plan towards individual needs of the patient

•Information is collected with a __ with formulated, validated ___-based questions

•Example: an individual that had a ___ ___ in the __ ___is considered to be more susceptible to caries than an individual who never had a lesion

•Based on the principle that everyone has different susceptibility to disease

•With a proper risk assessment we can tailor the treatment plan towards individual needs of the patient

•Information is collected with a form with formulated, validated evidence-based questions

•Example: an individual that had a carious lesion in the past year is considered to be more susceptible to caries than an individual who never had a lesion

4

Dental treatment customized based on the
patient’s risk levels for:
 

• ____

• ___ ___

• __ __

Dental treatment customized based on the
patient’s risk levels for:
 

• caries

• periodontal disease

• oral cancer

5

Why is it important?

•Without risk assessment, treatment plan is based on the ___/___ and not patient’s ___ to disease

•Without risk assessment, treatment plan is based on the lesion/disease and not patient’s risk to disease

6

Oral Health Risk Assessment

•Early___  and ___

•Treatment based on ___, early intervention, and ___ therapy

•Long-term ____ of teeth

___ economic burden

•Improved __ ___

•Early diagnosis and intervention

•Treatment based on prevention, early intervention, and targeted therapy

•Long-term retention of teeth

•Lower economic burden

•Improved oral health

7

Individual susceptibilit to disease

Let’s take a look at this diagram that summarizes the complex and multifactorial caries process. A disease that is really dynamic: you have a combination of factors and the population is susceptible to this disease throughout their lives.

Individual susceptibility

 to disease

Let’s take a look at this diagram that summarizes the complex and multifactorial caries process. A disease that is really dynamic: you have a combination of factors and the population is susceptible to this disease throughout their lives.

8

__ __
__
__ __
(CAMBRA)

 

•Introduced in ___

•___ ___ Association Journals

•Applying ___ principles to __ practice

 

 

They published their CAMBRA in California Dental Association Journals

Caries Management
by
Risk Assessment
(CAMBRA)

 

•Introduced in 2003

•California Dental Association Journals

•Applying scientific principles to daily practice

 

 

They published their CAMBRA in California Dental Association Journals

9

Patient’s caries risk level will determine:
 

•___ ___

•__ __

__ _

Patient’s caries risk level will determine:
 

•Treatment plan

•Caries Prevention

•Caries Management

10

Caries Disease Process

Caries is an infectious, progressive disease starting with incipient changes in the ___crystals in the mouth, to a visible __ __ lesion, ___ involvement and finally ___.

1. Sound tooth surface

2. White spot lesion: This is where we want to intervene

3. Lesion further developed. Lesion with a soft floor

4. Tooth restored but demineralization continues and lesion is surrounding the restoration.  Also called secondary caries.

5. Demineralization progresses and undermines the tooth

6. Tooth has fractured

Caries is an infectious, progressive disease starting with incipient changes in the apatite crystals in the mouth, to a visible white spot lesion, dentin involvement and finally cavitation.

1. Sound tooth surface

2. White spot lesion: This is where we want to intervene

3. Lesion further developed. Lesion with a soft floor

4. Tooth restored but demineralization continues and lesion is surrounding the restoration.  Also called secondary caries.

5. Demineralization progresses and undermines the tooth

6. Tooth has fractured

11

Documentation of risk assessment

•___ ___•

•___ ___

•___

  Empowering ___s to be ___s in oral health!

•Risk assessment

•Disease management

•Outcomes

  Empowering patients to be partners

in oral health!

12

Conservative Caries Management

___ caries ___

••Assessment of individual’s risk of caries ___

•Use ___ to enhance remineralization and/or reduce the bacterial challenge by the use of ____ therapy•

•Use __ ___e restorative procedures to ___ tooth structure.

Conservative Caries Management

•Early caries detection

•Assessment of individual’s risk of caries progression

•Use fluoride to enhance remineralization and/or reduce the bacterial challenge by the use of antibacterial therapy

•Use minimally invasive restorative procedures to conserve tooth structure.

13

Non-cavitated lesions

•Opportunity for r____

•Explorer should be used ____

•Nomenclature: avoid the term “___”

 

Explorer should be used carefully. 

Non-cavitated lesions

•Opportunity for remineralization

•Explorer should be used carefully

•Nomenclature: avoid the term “watch”

 

Explorer should be used carefully. 

14

Incipient decay - ____

•“ A caries lesion with a surface that has___t its original ___r/integrity, within an ___l lesion, and/or a very small c___ with no detectable ___ at the base”

•Possible to___ with ___ ___t or f___

•Will also benefit of ___n strategies

Incipient decay - microcavitation

•“ A caries lesion with a surface that has lost its original contour/integrity, within an enamel lesion, and/or a very small cavity with no detectable dentine at the base”

•Possible to restore with fissure sealant or flowable

•Will also benefit of remineralization strategies

15

Extensive decay

•Patient a ___h risk of caries

•Important to achieve __ ___

Extensive decay

•Patient at high risk of caries

•Important to achieve disease control

16

  2.1.  Caries susceptibility test

1.  Indicate the level of ___/___ bacteria

n

2.____ determination of bacteria in the dental plaque

n

3. ___

n

4. __ __ test

  2.1.  Caries susceptibility test

1.  Indicate the level of healthy/unhealthy bacteria

n

2. Quantitative determination of bacteria in the dental plaque

n

3. Simple

n

4. Chair-side test

17

CariScreen

The meter we use at UTSD is by Carifree—there may be others on the market.

___is an extremely predictive biomarker for __c and ___ organisms.

These bacteria survive and thrive in acidic pH environments because they have the ability to pump the __ __ (protons) ___ of their cell. This requires a tremendous expenditure of ___.(2) Therefore ATP bioluminescence provides a clear look into the acidic nature of the biofilm and its potential to cause the net __ ___associated with cavity formation.

“Bacteria produce proteins and the meter measures ATP which has been correlated with levels of S. mutans and Lactobacilli.  I will have it after the presentation for anyone interested”

You simply take a ___ sample of the ___ from your patients' teeth, which when combined with special bioluminescence reagents within the swab, will create a reaction which is then measured with the meter. The CariScreen will give a score between _____. A score under ____ is considering relatively healthy, while above that shows considerable risk for decay.

CariScreen

The meter we use at UTSD is by Carifree—there may be others on the market. ATP is an extremely predictive biomarker for acidogenic and aciduric organisms. These bacteria survive and thrive in acidic pH environments because they have the ability to pump the hydrogen ions (protons) out of their cell. This requires a tremendous expenditure of ATP.(2) Therefore ATP bioluminescence provides a clear look into the acidic nature of the biofilm and its potential to cause the net mineral loss associated with cavity formation.

“Bacteria produce proteins and the meter measures ATP which has been correlated with levels of S. mutans and Lactobacilli.  I will have it after the presentation for anyone interested”

You simply take a swab sample of the plaque from your patients' teeth, which when combined with special bioluminescence reagents within the swab, will create a reaction which is then measured with the meter. The CariScreen will give a score between 0 and 9,999. A score under 1,500 is considering relatively healthy, while above that shows considerable risk for decay.

18

Salivary Flow Assessment

•An ABNORMAL (caries risk related) unstimulated flow rate is generally considered to be ___ ml/minute

•An ABNORMAL stimulated flow rate is generally considered to be __ ml/minute

Salivary Flow Assessment

•An ABNORMAL (caries risk related) unstimulated flow rate is generally considered to be <0.1 ml/minute

•An ABNORMAL stimulated flow rate is generally considered to be <0.7 ml/minute

19

Medical risk factors for hyposalivation and caries risk

»  Diseases:__ ___ ____  diseases, ____, __, ___, ___

 

»  Medications: ___, ___, ___s, ___, ___

»  Additional risk factors: ___y; head and neck radiation therapy;____;

___ damage and___ 

Medical risk factors are collected while asking your patient about his medical history.  If the patient has one or more of these medical conditions – and this list is not exhaustive – he might be at increased risk for caries and that will prompt you to make treatment decisions such as adequate fluoride therapy, sealants. 

Medical risk factors for
hyposalivation and caries risk

»  Diseases: chronic inflammatory auto-immune diseases, malnutrition, infections, endocrine, neurological

»  Medications: antidepressants, antihypertensives, antihistamines, diuretics, antipsychotics

»  Additional risk factors: chemotherapy; head and neck radiation therapy; mouthbreather;

  nerve damage and tumor

 

Medical risk factors are collected while asking your patient about his medical history.  If the patient has one or more of these medical conditions – and this list is not exhaustive – he might be at increased risk for caries and that will prompt you to make treatment decisions such as adequate fluoride therapy, sealants. 

20

Future Directions

•Health professionals working together______ oral and general health

•_____ advances for the ___ detection of caries, i.e., f___e and advanced optics

•Treatment planning decisions based on __ __ and __ __

••Moving away from the traditional___model

Future Directions

•Health professionals working together integrating oral and general health

•Technology advances for the early detection of caries, i.e., fluorescence and advanced optics

•Treatment planning decisions based on disease prevention and arresting progression

•Moving away from the traditional surgical model

21

Conclusions

•Caries disease is a complex, ___y but in most cases ___ disease

•Treatment planning based on a ___-only approach does not guarantee that disease is __ ___

•Patients and oral health professionals need to be informed of the evidence-based knowledge in cariology and __ __ management of caries

•Caries disease is a complex, costly but in most cases preventable disease

•Treatment planning based on a restorative-only approach does not guarantee that disease is under control

•Patients and oral health professionals need to be informed of the evidence-based knowledge in cariology and non-surgical management of caries

22

Periodontal risk assessment

•“Periodontal disease is a __ __y disease that affects the ___ tissue and__ supporting the teeth”  (American Academy of Periodontology)

•Extent and ___ of its clinical manifestation varies as a function of __ __

Periodontal risk assessment

•“Periodontal disease is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth”  (American Academy of Periodontology)

•Extent and severity of its clinical manifestation varies as a function of individual risk

23

An example of individuals with different trajectories of chronic periodontitis progression, as measured by tooth loss at different ages, is shown for a longitudinally monitored population in Sri Lanka (Löe et al., 1986). Approximately 8% exhibited generalized moderate to severe periodontitis (Path A); 81% exhibited mild to moderate periodontitis (Path B); and 11% did not develop periodontitis (Path C). Stage 1 is ___ to clinical signs of periodontitis. Stage 2 represents e__ ___of disease, and Stage 3 represents the period of ___m disease ___

An example of individuals with different trajectories of chronic periodontitis progression, as measured by tooth loss at different ages, is shown for a longitudinally monitored population in Sri Lanka (Löe et al., 1986). Approximately 8% exhibited generalized moderate to severe periodontitis (Path A); 81% exhibited mild to moderate periodontitis (Path B); and 11% did not develop periodontitis (Path C). Stage 1 is prior to clinical signs of periodontitis. Stage 2 represents early expression of disease, and Stage 3 represents the period of maximum disease acceleration.

24

Oral Cancer Risk Assessment

•___ exposure

•___s tobacco exposure

___ consumption

___  history

Information collected during the ___ history interview!•

Oral Cancer Risk Assessment

•Tobacco exposure

•Smokeless tobacco exposure

•Alcohol consumption

•Family history

Information collected during the medical history interview!•

25

Oral health risk assessment

•Is oral health risk constant over a lifetime?

___

–May get reduce in ___, ___

•Which factors can modify risk?

___ ___

•At what point in your treatment should you perform an oral health risk assessment?

–When you doing your t___ ___(when you __)

Oral health risk assessment

•Is oral health risk constant over a lifetime?

–NO!

–May get reduce in saliva, medication

•Which factors can modify risk?

–Stop fluoridation

•At what point in your treatment should you perform an oral health risk assessment?

–When you doing your treatment plan (when you start)