High-risk patient...

Risk factors and biofilm challenge; approximately 24% of the population. [1]

Roger

1/25/10: Roger is a 51-year-old police officer who has been seeing the same dentist for over 20 years. He hasn’t had any decay in the last 9 years and has two risk factors. He takes a medication for high blood pressure and likes to drink 2 diet sodas a day while on the job and drinks 2–3 alcoholic drinks every night. His dentist had just recently started performing caries risk assessments and CariScreen testing. Roger’s first CariScreen score was 4125. Both he and his dentist were a little surprised at his biofilm challenge as he has had very good oral health throughout his lifetime. His dentist made some therapy recommendations, but as Roger has had good oral health and didn’t feel his risk factors were “that bad,” he opted not to make any therapy changes at this appointment.

8/6/10: Roger returned to his dentist for his next checkup, and none of his risk factors had changed. His CariScreen score at this appointment was 9889. At this point, the dental practitioner recommended a professional rinse and gel. The combination of the two products included antibacterial therapy with 0.2% sodium hypochlorite, pH neutralization, 1.1% neutral sodium fluoride, xylitol, and nanohydroxyapatite for remineralization. His dentist, who had known Roger for a long time, informed him that he had a 38%–69% chance of decay in the next 12 months, and he was concerned that at his age, something could change and he would start developing decay. Roger thanked his “doc” but again opted not to make any home care changes at this time.

6/10/11: Roger missed his regular 6-month appointment scheduled in February for unknown reasons. At this checkup, he did not share any new risk factors and marked his risk assessment form with the same two risk factors as before. His CariScreen score was 8227, and he had 4 new cavities. His dentist asked him if there had been any major changes in his life or any health concerns since his last appointment. Roger shared that he had hurt his back around Thanksgiving of the prior year and had been on pain and muscle relaxant medication for 3½  months while his back healed. But he wasn’t taking the medications anymore. During that time, Roger had experienced minor dry mouth but hadn’t changed any of his other eating or drinking habits because of it. His dentist recommended he get his cavities filled and again recommended a home care change with the combination of the two products with antibacterial therapy, pH neutralization, 1.1% neutral sodium fluoride, xylitol, and nanohydroxyapatite for remineralization (such as CTx4 Treatment Rinse and CTx4 Gel 1100. Roger decided it was time to follow his dentist’s advice and began the therapy regimen.

12/15/11: Roger returned for his 6-month checkup and informed his dentist he had been using the therapy products 2 times daily for the last 6 months as he had recommended. The two risk factors of antihypertensive medication and drinks other than water more than 2 times daily were present. His CariScreen score was still elevated at 3460, but he had no new cavities. His dentist also noted that his gums looked healthier. Roger is still using the prescribed homecare regimen daily.

Jennifer

5/16/11: Jennifer is an active 32-year-old mother of 2 and works as a paralegal. She has not had any issues with dental decay since she was a child. When she was 5 years old, she had three fillings in her primary teeth but has had no issues since. She ran track in high school and has always enjoyed distance running. She has had the same dentist for 12 years. On her first caries risk assessment, she had two risk factors, frequent snacking and drinks other than water more than 2 times daily. She had a CariScreen score of 5870 but did not have any cavities at this appointment.

Jennifer’s dental professional shared with her how the snacking and drinks increased her risk for dental decay and that her high CariScreen score was a concern. Jennifer responded that she was preparing for her first half marathon, and part of the preparation included a frequent intake of protein and carbohydrates. Also while running, she focused on maintaining her hydration and energy level by consuming sports drinks and small packets of honey with caffeine in them. As she was dedicated to her sport and felt the diet and drinks were necessary, she was not willing to make changes to her risk factors. She was concerned about her biofilm challenge and, as an individual who focused on making healthy choices, felt adding the prescription/professional home care products to her dental home care program was the right choice for her at this time. She decided to follow her dental professional’s recommendation and start using an antibacterial rinse with 0.2% sodium hypochlorite, fluoride, xylitol, and pH neutralization, followed by a toothpaste/gel with 1.1% neutral sodium fluoride, xylitol, pH neutralization, and nanoparticles of hydroxyapatite 2 times daily. She scheduled a follow-up appointment in 3 months to reassess how her therapy choices were working.

8/21/11: Jennifer returned for her reassessment appointment, and none of her risk factors had changed. She had finished her first half marathon over the summer and was training for a full 26.2-mile marathon. Her CariScreen score at this appointment was 7762. Initially, she thought that maybe the therapy hadn’t been working. But upon further discussion, she shared that her meals and drinks intake had increased with her workout increase. Her dental professional also shared that unless the risk factors were decreased, it might take multiple therapy cycles to lower her biofilm challenge. Second, if Jennifer added any additional risk factors while her biofilm challenge was so high, decay might develop. Jennifer chose to continue with the therapy and began another 3-month cycle.

11/17/11: Jennifer returned for her 6-month recare appointment. Nothing had changed with regard to her risk factors and lifestyle. Her CariScreen score was 4736, and she had no new decay. The dental professional noted that her gums did appear healthier than her last recare appointment, and Jennifer decided to continue with another cycle of therapy products (CTx3 Rinse and CTx4 Gel 1100).

2/20/12: Jennifer came in for a caries reassessment appointment. She had continued running, eating, and drinking at elevated levels, including 5 small meals per day with one snack and 10–12 energy drinks and 3–4 energy packets per week while working out. Her CariScreen score was 1544, and while her score was still elevated (above 1500), her dental professional was glad to see her moving in the right direction and was less concerned about her caries risk. Jennifer’s dental professional suggested that Jennifer switch to a slightly different rinse that did not contain an antibacterial ingredient but still contained pH neutralization, xylitol, and fluoride (such as CTx3 Rinse) and continue the toothpaste/gel with 1.1% neutral sodium fluoride, xylitol, pH neutralization, and nanoparticles of hydroxyapatite (such as CTx4 Gel 1100) 2 times daily. As Jennifer’s lifestyle will continue to include risk factors, her dental professional informed her that in order to avoid decay, Jennifer would need to continue using additional protective factor pH neutralizing products with xylitol, fluoride, and remineralization agents for as long as her risk factors were present (such as CTx2 Spray or CTx2 Xylitol Gum).


  1. Based on a private practice study of 3,125 patients, http://carifree.com/dentist/learn/our-systems/data-study.html