Treatment Considerations for the Extreme Caries Risk Patient
Presentation Category
Supportive Therapies
Introduction/Context/Diagnosis
Caries risk assessment is becoming a critical component of the patient examination process. Risk level is determined by evaluating the balance between risk factors and protective factors. Patients who present with hyposalivary function are immediately classified as extreme caries risk. This clinical report describes a 75-year-old Caucasian male presenting with numerous medical conditions. Patient’s medication list includes anti-hypertensives, diuretics, anti-depressants, and anti-anxiolytics, all of which are associated with xerostomia. During the course of 4 recall appointments, caries progression was noted at a rapid rate. This required considerable treatment modifications to address the patient’s risk level.
Methods/Treatment Plan
The first encounter included treatment of tooth #15 with recurrent decay at the margin of a gold crown. Patient chose to defer treatment for 2 months. When the patient returned for treatment, tooth #15 was deemed non-restorable due to severity of decay - potentially encroaching the nerve and extending to the alveolar crest. A 3-month recall rate and early intervention was encouraged moving forward. Patient was prescribed high fluoride toothpaste and xylitol gum. Recurrent caries was noted on 4 more crowns along with subgingival root caries. 3 applications of silver diamine fluoride (SDF) was rendered to arrest carious lesions.
Results/Outcome
SDF treatment was successful on 2 out of the 4 teeth. The 2 teeth with persisting carious lesions were planned for replacement of the crowns. Several direct restorations were also placed which successfully controlled caries progression. Overall, the patient was not referred for extraction of any teeth besides #15 and despite the amount of interventions required, patient is well managed.
Significance/Conclusions
Patients who present with extreme caries risk should be evaluated on a regular basis, preferably a 3-month regimen. This allows lesions to be discovered in their incipient states, when they are more easily managed. It is crucial to utilize selective CAMBRA products that the patient will comply with as a preventative measure. This case showed some success with the use of SDF to arrest caries either as a substitute or an adjunct to restorative intervention. Caries risk assessment is a critical tool in deciding treatment options for patients and is quickly becoming the standard of care.
Format
Event
Treatment Considerations for the Extreme Caries Risk Patient
Caries risk assessment is becoming a critical component of the patient examination process. Risk level is determined by evaluating the balance between risk factors and protective factors. Patients who present with hyposalivary function are immediately classified as extreme caries risk. This clinical report describes a 75-year-old Caucasian male presenting with numerous medical conditions. Patient’s medication list includes anti-hypertensives, diuretics, anti-depressants, and anti-anxiolytics, all of which are associated with xerostomia. During the course of 4 recall appointments, caries progression was noted at a rapid rate. This required considerable treatment modifications to address the patient’s risk level.
