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Dental Decay Assessment

Post check-up, children are divided into four categories i.e. low, moderate, high and very high risk. This has been done on the basis of caries risk classification.

Early risk assessment allows for identification of child who are at risk for caries and will benefit from early preventive intervention. The ultimate goal of early assessment is the timely delivery of educational information to populations at high risk for developing caries in order to prevent the need for later surgical intervention.

Tooth decay, also known as caries or cavities, is an oral disease that affects many people. Unlike other diseases, however, caries is not life-threatening and is highly preventable, though it affects most children to some degree during their lifetime.

Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods and produces acids. These acids damage tooth enamel over time by dissolving, or demineralizing enamel, which weakens the teeth and leads to tooth decay.

Foods containing carbohydrates (starches and sugars), such as soda pop, candy, ice cream, milk, and cake, and even some fruits, vegetables, and juices, may contribute to tooth decay. Therefore early risk assessment is very important for early preventive intervention as suggested in the table given below.

Age Risk Category Preventive Strategies Advised follow-up in
Birth to Age 4 Low
No active lesions of any type at examination.
Education and reinforcement
Fluoride toothpaste
Dental sealants (behaviour permitting), if patient has deep or uncoalesced pits and fissures
6–12 months
High
Any cavitated or white spot lesions at examination, continued bottle feeding after age 12 months, or family caries history.
Education and reinforcement
Fluoride toothpaste (supervised)
Dental sealants (behaviour permitting)
Fluoride supplements
Professionally applied topical fluorides (varnish)
Restorative treatment
3–6 months
Age 5 and Over Low
No active cavitated or non-cavitated lesions at examination.
Education and reinforcement
Fluoride toothpaste
Dental sealants if newly erupted and deep or uncoalesced pits and fissures
Fluoride supplements
24–36 months; more often for children and adolescents
Moderate
1 active cavitated smooth-surface lesion at examination, or any number of pit-and- fissure lesions.
Education and reinforcement
Fluoride toothpaste
Dental sealants and preventive resin restoration
Fluoride supplements
Home-use fluoride rinses and professionally applied topical fluorides
Restorative treatment
6–24 months
High
2–5 active cavitated smooth-surface lesions at examination, or 2 new lesions of any type with a history of smooth-surface lesions in permanent teeth.
Education and reinforcement
Fluoride toothpaste
Dental sealants
Fluoride supplements
Home-use fluorides and professionally applied topical fluorides
Dietary counseling
Xylitol gum, if available and patient chews gum
Restorative treatment
Chlorhexidine rinse
3–12 months
Very High
6+ active cavitated smooth-surface lesions at examination.
Education and reinforcement
Fluoride toothpaste
Dental sealants
Fluoride supplements
Home-use fluorides and professionally applied topical fluorides
3 - 6 months
Dietary counseling
Xylitol gum, if available and patient chews gum
Restorative treatment
Chlorhexidine rinse
Eliminate cavitated lesions as soon as possible (2 or fewer appointments)
Assess compliance and/or Mutans streptococci levels

Dental assessment

Ten is an important age in a young person’s dental development. Many of the baby teeth or first teeth, have already been lost and the second, permanent teeth are coming through. It is the phase of dental development when abnormalities are picked up at a dental appointment and referred to an orthodontist for an assessment.

The orthodontist makes a diagnosis and decides whether any intervention is needed and reports back to the referring dentist. The most common problem will be a poor bite or misaligned teeth, otherwise known as a malocclusion. There are three types of malocclusion which will require braces at the right time in a child’s development.

Tooth decay, also known as caries or cavities, is an oral disease that affects many people. Unlike other diseases, however, caries is not life-threatening and is highly preventable, though it affects most children to some degree during their lifetime.

Other kinds of problems commonly picked up at an orthodontic assessment are:

Misplaced or impacted canines:This is when the eye teeth are trapped – usually in the palate - and fail to descend as they should. As a result, the primary teeth don’t fall out at the normal time, hiding the problem which lies beneath.

Missing teeth:Some children do not have the full complement of teeth, either because they are congenitally absent or due to a rare syndrome.

If problems such as these are picked up and dealt with by a specialist, the child may be spared surgery or complicated restorative treatment at a later date. Misplaced canines, for instance, can be dealt with very simply when diagnosed at the right time, simply by taking out the first teeth to make room for the permanent teeth to descend.

On the other hand, if the misplaced canines are not diagnosed until later, they will need to be exposed surgically and then pulled further into place by a brace. Similarly, with missing teeth, if the problem is identified at the right time, the child’s remaining secondary teeth can be guided into a new position which, with a bit of specialist help, can disguise the gaps and provide a natural smile.