Patients come into the office for their check-up and prophy, and many times have no idea of the other needs they might have. These patients may brush on a regular basis and may be flossing and not think there is any reason for additional evaluation. These same patients may have new carious lesions at each appointment and have no idea why they continue to have problems or why the dentist is always finding something.
Our goal as prevention specialists is to provide information to patients to help prevent disease and its progression. Identifying a patient’s caries risk level is one additional way to educate them and helps us provide tailored home care recommendations. In 2018, the Academy of General Dentists indicated that dental caries is the most common chronic disease affecting both children and adults in the United States. It is our responsibility as dental professionals to address the needs of each patient and to recommend necessary care to prevent disease.
Introducing the assessment
As clinicians, we are challenged every day with time management in regard to our patient’s appointment. There are things we would love to do; however we find it difficult to add minutes into the time we have. Having efficient tools helps us educate our patients and reinforce treatment recommendations. One of the reasons the AGD noted risk assessments are not performed is the additional time needed. The ADA has developed a form to assist in determining a patient’s caries risk level. Becoming familiar with this form and learning how to interview a patient in conversation can reduce the time needed to “fill out” paperwork. The form can be printed out and used as a guide. Combining the information obtained by talking to patients can help us to make proper recommendations.
Patients who have never received a CRA before may be surprised that you are doing one. If that's the case, you could explain that this will help you give them personalized recommendations to help maintain their oral health, based on their current situation and risk of getting cavities. We can also explain that sometimes things change, such as diet or medication use, and that this is the reason to perform a CRA at regular intervals over time to see if changes in recommendations and care are needed.
The CRA is divided into three parts. Starting an effective conversation with a patient on our findings doesn’t have to be formal and impersonal. When we are performing the medical history, we should be reviewing all medications the patient is taking. A patient’s medication list can give us insight into what we may see clinically. Reduced salivary flow, which is associated with many medications, can increase risk for dental caries.
As we perform our hygiene care, we should be looking at the big picture of what we are seeing. Does the patient present with erosion or pitting of the occlusal surfaces? This could be a sign of repeated ingestion of acidic drinks or foods, and if they are also high in fructose or other sugars they could contribute to dental caries. Dietary habits are included in the contributing conditions portion of the CRA, such as when and how often sugary drinks and snacks are ingested. The third part of the assessment is on clinical findings. This is something we are already doing, and doesn’t need to take any additional time during the patient's appointment.
Having information and choosing not to apply it is a pointless task. Anytime you provide any type of assessment you should ask yourself, “What am I going to do with this information?” The information you gather can then be used to properly recommend in-office and at home fluoride therapies.
Recommendations on topical fluorides are provided in the Journal of the American Dental Association (JADA) and are based on caries risk level. These recommendations were the result of an in-depth review of clinical trials in patients of different age groups and caries risk to evaluate the evidence on the use of topical fluorides. The chart provided in JADA and the patient’s personal information can help you discuss the need to apply in office fluoride and the importance of at home compliance with prescription strength fluoride toothpaste for patients at risk for dental caries.
Colgate PreviDent Varnish is recommended by the ADA as an in-office fluoride, and Colgate PreviDent 5000 is a prescription strength home use fluoride that is effective for caries prevention. Patients of all ages who are at risk for dental caries can benefit from fluoride therapy.
It is our responsibility as clinicians to provide recommendations based on the needs of each patient. Performing a CRA helps you determine your patient's specific risk level and to know what preventive care can best be recommended. When a patient has been given supporting information on why recommendations are specifically for them, and why they are important, they are more likely to follow through. Patients will also be appreciative of this forward-thinking approach to maintaining their oral health.