Managing the High-Risk Caries Patient: A Brief Clinical Guide

Early detection and systematic caries risk assessment are the foundation of targeted intervention. A patient can be grouped as high-risk for dental caries if they show one or more of the following indicators:

• Multiple carious lesions or restorations in recent years.

• Xerostomia or reduced salivary flow

• Special healthcare needs affecting oral hygiene

• Previous history of rapid caries progression

• Low fluoride exposure

• Frequent sugar intake or snacking habits (high cariogenic diet)1
  
  

It has been observed that most high-risk dental caries patients have severe dietary and dental behaviour problems, and so, there is an urgent need for dental education and extensive use of fluoride in them.

Low-risk patients are characterised by

• No active carious lesions

• Low-cariogenic diet

• Sufficient fluoride exposure to prevent caries

Dental caries is a multifactorial, biofilm-mediated disease influenced by diet, microbial activity, saliva, and fluoride exposure. Modern care emphasises risk-based, preventive, and minimally invasive strategies rather than the traditional “drill-and-fill” approach.²

Dentists can use the Caries Management by Risk Assessment (CAMBRA) protocol to categorise and manage dental caries in children and adults.¹ According to the CAMBRA protocol, the management of high-risk patients involves a multi-modal preventive strategy that significantly reduces disease progression, followed by a recall interval of four to six months:

• Nutritional counselling for control of dental disease

• Prescription-strength high fluoride dentifrices (over 5,000 ppm F) twice daily for very high-risk cases³

• Use of 0.05% sodium fluoride mouth rinse daily

• 0.12% chlorhexidine gluconate mouth rinse daily for one week each month

Assess for hyposalivation, as decreased salivary flow can increase the risk of caries.

Clinical interventions must be reinforced with sustained behavioural modification.

Patients must be counselled to:³

• Reduce the frequency of fermentable carbohydrate intake

• Limit sugary snacks between meals

• Encourage daily interdental cleaning

• Reinforce twice-daily brushing compliance

• Follow the at-home instructions given by the dentist thoroughly

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It has shown to reduce germs:

• 38.3% on teeth

• 39.7 on tongue

• 35.4% on cheeks

• 25.9% on gums

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