Minimally Invasive Dentistry Series: Caries Risk Assessment

Abstract

Dental caries continues to be a major public health problem in Ireland and worldwide. Untreated dental caries in permanent teeth is the most common health condition in the world according to the Global Burden of Disease 2019 study.1 Dental team members are acutely aware of the negative impacts of untreated dental caries on the health and well-being of our patients, not to mention the wider societal and economic consequences.2 In Ireland each year, approximately 7,000 children are referred for dental extractions under general anaesthesia.3 Although perceived by many as a disease of childhood, the risk and consequences of caries continue into adulthood, and indeed may initiate a lifetime burden of care. Dental caries is a multifactorial disease, which progresses when pathological factors outweigh preventive factors by tipping the ‘caries balance’ towards demineralisation and breakdown of the dental hard tissues (Figure 1). While restorative dental techniques for caries management and tooth retention have improved significantly over the years, it is clear that preventing dental caries is still preferable to cure.4,5 Successful management of dental caries requires both preventive measures and behaviour change, in addition to clinical intervention, preferably using a minimally invasive approach. Caries risk is the likelihood of a patient developing new caries lesions in the near future. Assessment of a patient’s caries risk level can aid clinicians in predicting development of new caries lesions and allow for an individualised approach to caries management. This is in keeping with the concept of minimal intervention dentistry (MID), which deals with the causes of dental disease and not just the outcomes. The aim of MID is to maintain as much healthy tooth structure as possible and keep teeth functional for life.