Finding Balance: Dr. Kutsch’s Caries Protocols for Low, Moderate and High Risk Patients

written by CariFree


My approach to talking to patients about their dental health has changed dramatically over time. I have moved away from telling patients what they ‘have’ to letting them know ‘what I find’. It has made all the difference in the world. Specifically, when discussing caries risk, I have adopted the scripted statements and questions below:

Here are the risk factors that are causing your cavities

Which one do you want to work on first?
What is your plan?
What support would you like from me?

When we talk about these things, we talk about it objectively and without judgement. Remember we can only make one behavioral change at a time. Don’t try and do too much at once. I used to be invested in telling the patient ‘my way'; telling them what to work on first, second etc. Now, I let them choose. They are far more successful that way. Ask them where they want to start.  When it comes to restorations, of course there is a logical order however, when it can be up to the patient, let it be up to them. Let the patient come up with the plan and let YOU know what it is.


What about intervention?

Intervention and treatment needs to target and be specific to the patient’s risk factors. When the patient has decided they are ready to move forward with treatment, let them know the appropriate level of intervention based on your assessment.


Suspects (Risk Factors) Drive the Treatment Strategies

Bacteria: Antimicrobial and/or Behavior

Diet: Limit sweets versus Limit snacking

Saliva: Hydration, Neutralize support the pH

Genetic: Minimize acid exposure, support wellness


Treatment Strategies per risk level

Dr. Kutsch’s Protocol for Low Caries Risk

Caries Risk Assessment with Biometric

Offer 12 month Fluoride Varnish

Offer pH, Xylitol, Nano-HA, Fluoride

Educate about Risk Factors


Dr. Kutsch’s  Protocol for Moderate Caries Risk

Caries Risk Assessment with Biometric

Recommend 6 month Fluoride Varnish

Recommend pH, Xylitol, Nano-HA, Fluoride

Behavioral Coaching targeted to Risk Factors


Dr. Kutsch’s Protocol for High Caries Risk

Caries Risk Assessment with Biometric

3 month Fluoride Varnish (Always)

pH, Xylitol, Nano-HA, Fluoride (Always)

+/- Antimicrobial strategy

+/- Silver Diamine Fluoride

Behavioral Coaching for Risk Factors

At the end of the day it all comes down to balance. A healthy balance in your mouth comes from healthy saliva, healthy diet and healthy home care. Your body cannot be healthy if your mouth is not in balance.


What about you? How do you approach treatment?

One Response to “Finding Balance: Dr. Kutsch’s Caries Protocols for Low, Moderate and High Risk Patients”

  1. Richard Schoenbaum, D.D.S.

    This simplified approach is very workable. Documentation and Follow-up evaluation for treatment effectiveness requires time and preparation for Recall appointments. If one is serious caries and perio risk assessment and management there are many challenges. Make sure the whole team is on board to let the patient know the advanced dental care they are receiving.
    Establishing a fair fee for these services is very important, as well. It does not happen overnight.

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Category: Education