Managing Treatment Expectations

How long does treatment take?

There are many confounding factors that influence caries risk treatment time and the potential results a patient and practitioner can expect. Each patient’s oral biofilm is as uniquely specific to them as their fingerprint, and no two patients will respond exactly alike to therapy and remineralization agents. It is important to remember that high-risk patients may require therapy modification throughout the treatment phase to reach a state of balance. Many patients may require ongoing therapy agent usage during the maintenance phase. Perhaps for life, if risk factors are unmodifiable or still present. The good news is that professional/prescription dental products have also improved at treating both the pH imbalance and the bacterial condition that may be present. Professional/prescription products are also capable of remineralization under the right conditions. Take-home professional therapy should be recommended in 3- to 6-month increments, and reassessment should take place as soon as the prescribed therapy is finished.


Factors Influencing Treatment Time and Results

Time. The length of time a patient has been experiencing issues with dental decay should be considered when setting therapy expectations. A patient who has experienced symptoms of the imbalance (cavities) for years is probably going to require more therapy over a longer period of time than a patient with their first cavity. This is why caries risk assessment is vital. The earlier a patient can be identified at risk, and the sooner intervention can be initiated, the shorter the duration of treatment will likely be.

Number of risk factors. The number of risk factors plays an important role in treatment time and effort. Patients with multiple risk factors will likely face a greater challenge to lower their risk and reduce the incidence of signs/symptoms than patients with one risk factor. Many risk factors, when combined, can cause a compounding effect on a patient’s risk. For example, frequent snacking combined with low saliva flow can make the acid challenges a patient experiences longer and more intense, placing a greater challenge on the effectiveness of therapeutic agents and strategies. The more risk factors a patient has, the more therapy may be required.

Modifiable versus unmodifiable risk factors. If the risk factors driving the disease progression for a patient are unmodifiable, such as life requiring prescription medications that cause reduced salivary flow, it will increase the length of time a patient will require therapy. If the risk factors driving the patient’s disease are behavioral habits, and the patient is not yet ready to change those behaviors, more therapy and time may be required. Modifying and eliminating risk factors is the most cost-effective method of therapy, and an essential part of reducing a patient’s caries risk.

Risk factor severity. Patients may need to rely on their dental professionals’ expertise to define the severity of specific risk factors, such as salivary flow or biofilm challenge. As an example, a patient taking a single medication daily (while it is an important risk factor to consider) is probably not as severe as a patient taking ten different types of medications daily. For some patients, the severity of their risk factors can create a dramatic barrier to reaching a state of oral health balance.

Risk factor frequency. The frequency a patient is being exposed to risk factors should be analyzed when considering treatment time and expectations. If a patient is consuming one snack per day, the frequency may not be of as much concern as a patient who snacks 3 or more times per day between meals. Patients who are experiencing a higher frequency of exposure to risk factors will require more time and effort to reach a state of oral health balance.

Presence of symptoms. If a patient’s disease has progressed to the point of experiencing signs/symptoms of the oral imbalance such as visible cavitations, white spot lesions, or cavities identified on x-rays, they have reached a later stage of the disease and have a longer treatment time than a patient who has yet to express signs/symptoms.

Severity of signs/symptoms. The severity of the signs/symptoms should also be an indicator of the amount of time and effort required to reach a state of oral health balance. A patient with one new cavity is not in as severe a condition as a patient with several new cavities.

Timely restorations. The capability of therapy products to modify a biofilm and help move a patient toward health will be hindered by unrestored sites of disease. While remineralization is possible for early lesions that have not progressed beyond the DEJ (dentin-enamel junction), or E2 lesions, once the lesion depth has penetrated the DEJ and is a D1 or D2 lesion, the enamel surface is cavitated and the tooth requires surgical removal of the lesion followed by restoration. Cavitations that have reached a depth requiring restoration must be restored in a timely manner, and potential sources of the infection must be removed, if an oral health balance is to be achieved.

Level of therapy. Patients have choices when moving forward with prescription/professional therapy, and the level of therapy they choose partially dictates the length and expectations of therapy. For example, if the recommended therapy for a high/extreme-risk patient is a professional home care kit for 3 months, and the patient chooses an over-the-counter preparation, the patient’s expectations need to be appropriately adjusted. The patient may experience no change or only experience a slowing progression of signs/symptoms or biofilm challenge rather than a meaningful reduction or reversal. However, choosing to do something rather than doing nothing is always a smarter move toward health.

Patient therapy compliance/adherence/participation. While it may seem fundamental, lack of patient follow-through with medical recommendations is one of the primary reasons diagnosed medical conditions continue to progress. The majority of prescriptions written in the United States never even make it to the pharmacy to get filled, much less get taken on a regular basis as prescribed. It is essential that patients continue to use the therapy they have been prescribed, as prescribed, for the duration of the therapy time recommended. If the patient has been prescribed 3 months of therapy product but reassessment with their dentist has not been scheduled for 6 months, the patient should get another 3-month supply as directed after the initial therapy product has been used, or risk regression of their disease risk status.

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