In spite of decades of a significant decline in incidence, dental caries remains a global public health burden with statistics indicating approximately 44% of all people worldwide suffering from untreated caries in their primary and/or permanent teeth. It is therefore obvious that the focus and efforts on effective caries prevention and minimally invasive operative carious lesion management must be intensified. In this context, a caries risk/susceptibility assessment (CRA) of populations, groups and individuals is thought to be a cornerstone of preventive dentistry in order to allocate time and resources to those with the greatest need. Even though CRA is implicit in the daily delivery of good quality oral health care by many oral health care practitioners, questions still remain unanswered as to whether or not formalized, documented evidence-based CRA is possible, feasible or even desired in the environment of general oral healthcare practice. The aim of this chapter is to summarize the science and quality of evidence that exists for CRA and discuss some of the complexities associated with its use. Caries risk assessment (CRA) can be defined as “the clinical process of establishing the probability of an individual patient to develop carious lesions over a certain period of time or the likelihood that there will be a change in size or activity of lesions already present.

Most oral healthcare professionals seem to perform an informal and intuitive caries risk assessment (“educated best guess”) when taking a case history and examining their patients. The most commonly used single variables for individuals are past caries experience and level of oral hygiene, while the level of fluoride exposure seems to be considered less important. The accuracy of any caries risk assessment can only be established at a group level following prospective trials without targeted interventions. A troublesome concern is that few CRA models are validated longitudinally and a systematic review, based on 18 publications, was unable to identify studies with low risk of bias, without methodological limitations concerning study design. Consequently, the quality of evidence on the validity of the methods used for caries risk assessment must be graded as low. Some general conclusions can be drawn however. In general, multivariate models seem to perform better than single predictors and the accuracy is higher among pre-school children compared to later in life. Most powerful single factor in caries prediction for all age groups is “previous caries experience. The accuracy was regarded as “good” for pre-school children and “limited” for school children, while for adults there remains a knowledge gap. Multivariate caries prediction models perform better than single predictors but it must be stressed that these models, with few exceptions, are validated among children and adolescents only.

The ideal method for caries risk assessment in everyday practice should be quick, simple, inexpensive, reliable and easy to understand for both the professional and patient or their parents alike. One problem is that there is no consensus, or definition, of moderate/high caries risk categories. This makes comparisons between different studies difficult and the term “high risk groups” problematic. Although the quality of evidence to support caries risk assessment as an integrated component in effective caries management is low, it is concluded that the benefits outweigh harm. There is currently no single tool or method with perfect accuracy, but multivariate models in general perform better than single predictors, with an accuracy exceeding 80%. The ability to predict future caries susceptibility is greater among pre-school and school children when compared to older patients. Models for root caries prediction are lacking. Emerging evidence suggest that caries risk assessment in general practice assists clinical decision-making and increases patients’ understanding and adherence to preventive care regimes.

Regards
Sarah eve

Editorial Assistant

Journal of Oral Hygiene and Health