- erosion;
- orofacial trauma.
The rationale for risk assessment is to target resources to those who most need them!
Ideally, any preventive or operative treatment programme should be directed by an
appreciation of the patient's risk status, thus ensuring that service delivery is both
effective and cost-efficient. Risk assessment is also relevant when determining an
optimum recall interval, as not all patients need to be seen with the same frequency.
Furthermore, a child's risk status is not static; it may change due to any number of
changes in personal circumstances. It is therefore important to continually re-assess
risk status at future visits.
3.6.1 Caries
The aim of caries risk assessment is to predict whether the disease is likely to develop
in an as yet caries-free individual, or to determine the rate of disease progression in a
patient who already has some caries experience. It has been proposed that a
reasonable model for caries risk assessment should have a combined sensitivity and
specificity of 160% where:
- sensitivity = proportion of people actually with a disease who have a positive test
result; - specificity = proportion of people without a disease who have a negative test result.
In general, caries prediction models have higher specificity than sensitivity. However,
the 'science' of caries risk assessment is still in its developmental stages and, to date,
no single model provides a 100% accurate prediction of caries risk. Indeed, due to the
complex nature of caries, it may not be possible to devise the perfect risk assessment
model for clinical use.
Interestingly, research has shown that the experienced clinician can actually achieve a
high level of prediction simply on the basis of a socio-demographic history and
clinical examination. Thus the need for specific testing, such as microbiological
investigation, may not confer significant additional benefit. In particular, past caries
experience has proved to be the most useful clinical predictor of caries risk.
Additionally, poor oral hygiene (visible plaque on maxillary incisors) in very young
children has also been found to be a reliable indicator of high caries risk. Table 3.3
highlights the key risk factors that should be taken into consideration when
conducting a risk assessment.
Very simply, children may be categorized as low, moderate, or high caries risk
according to the following criteria:
- low risk⎯intact dentition, good oral hygiene, well-educated affluent family
background, good dietary control, and use of fluoride regimens; - moderate risk⎯1-2 new lesions per year, poor oral hygiene, and non-optimum
fluoride use; - high risk⎯three or more new lesions per year, poor oral hygiene and dietary
control, significant medical history, immigrant status, poverty, low education, and
poor uptake of fluoride regimens.