Pattern Recognition: A Pragmatic Approach to Treating Dental Caries

How does an experienced dentist determine how to approach a patient’s dental disease? Caries Management by Risk Assessment is the standard for most of us who have been treating the disease and not just filling teeth, but with all of the information available, what is a practical approach to assessing and treating patients? Dr. Kutsch consistently uses and teaches others to rely on pattern recognition.

 

“The current recommendation is to implement a risk assessment based medical model to diagnose and treat dental caries. Unfortunately, many of the suggestions of CAMBRA have been overly complicated and confusing for practitioners. The risk of caries, however, is usually related to just a few common factors and understanding these factors makes CAMBRA more clinically adaptable.” (Kutsch V K. Dental caries: An updated medical model of risk assessment. J Prosthet Dent 2014 April 111(4):280-5)

 

According to Kutsch, there is a simple way to assess patients. He looks for 4 “usual suspects” that could be causing a patient’s disease: saliva, diet, bacteria and or genetics. Once you determine which “usual suspects” are involved, treatment and behavioral counseling can be targeted. Below are some telling facts about each:

 

Saliva

Patient with saliva issuesMayo Clinic Study 2013 Journal Mayo Clinic Proceedings state:

  • 70% Americans take one medication that causes dry mouth
  • 50% take two or more
  • 20% take five or more

 

Diet

Extreme risk patientAmericans eat 22.7 tsp of sugar per day

HFCS Americans are #1 at 51 lb per year

 

Bacteria

Over 54 bacteria now identified as potential cariogens

Most recent Proprionibacterium acidifaciens

 

Genetics

Genetic sequenceNumerous genes now associated with dental caries, >17 studies in past 5 years have identified 34 genes

Within each of the 4 usual suspects there is of course much to know, however, identifying which of the usual suspects is involved with a patient is the best and most pragmatic starting point in your diagnosis and treatment process.

 

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