Important Therapy Milestones: 3, 6 and 12 Months

Assuming a patient has chosen to move forward with some form of therapy or preventive product with pH neutralization, 0.2% sodium hypochlorite, 0.5% or 1.1% fluoride, xylitol, and nanoparticles of hydroxyapatite and the therapy has been supplied in 3-month increments (such as CTx Kits), it is advisable to reperform a full caries risk assessment and each subsequent reassessment appointment at 3-month intervals. The number, frequency, and severity of risk factors can change substantially between appointments.

 

Three months

Depending on the level and severity of the patient’s risk, some practitioners may wish to reassess the patients risk and therapy level at 3 months, while most have the patient continue the therapy for 6 months. Many patients (if compliant) show some form of progress at the 3-month appointment (See Figure 18). Although it may not be enough to lower the patient’s therapy requirements yet, the progress can encourage both the patient and the practitioner that the patient is on the right therapy program. Some examples of progress might be remineralization of early white spot lesions or areas of demineralization, improved visual soft tissue health and appearance, decrease in bleeding gums when flossing or probing, reduction in sensitivity, decreased incidence of halitosis (bad breath), a feeling of “cleaner” teeth, reduced noticeable plaque buildup, “hardening” of tooth enamel, improved tooth luster, etc. Some patients with a high biofilm challenge at the initial appointment may see a reduction in their biofilm challenge at the 3-month reassessment. The patients likely to see a reduction in their biofilm challenge at this point are patients that initially presented with limited risk factors, no severe risk factors, and no disease indicators and who were compliant with professional recommendations.

 

Examples of caries therapy progress
  • Reduced biofilm challenge/plaque build-up
  • Lower CariScreen ATP test or CFU’s by culture
  • Lower decay rate
  • Remineralization of early white spot lesions or areas of demineralization
  • Improved visual soft tissue health and appearance
  • Decrease in bleeding gums when flossing or probing
  • Reduction in sensitivity
  • Decreased incidence of halitosis (bad breath)
  • A feeling of “cleaner” teeth
  • Reduced noticeable plaque build-up
  • “Hardening” of tooth enamel
  • Improved tooth luster

A practitioner’s goal at the 3-month reassessment should be to identify any kind of progress and verify patient participation or compliance. If progress is identified, it is recommended that the patient continue with the current level of therapy. If no progress is identified, it is recommended that the patient either increase their level of therapy, continue with the current level of therapy with modified expectations, or continue with the current level of therapy and modify one risk factor.

 

Six months

Most patients (if compliant) will show progress at the 6-month appointment, and the progress may be adequate to lower the patient’s therapy level. Some examples of progress might be remineralization of early areas of demineralization, improved soft tissue health on inspection, decrease in bleeding gums when flossing or probing, reduction in sensitivity, decreased incidence of halitosis (bad breath), feeling of “cleaner” teeth, reduced plaque buildup, “hardening” of tooth enamel, improved tooth luster, and/or reduced incidence of cavities. Some patients with a high biofilm challenge at the initial appointment may see a reduction in their biofilm challenge at the 6-month reassessment. The patients most likely to see a reduction in their biofilm challenge at this point are patients that initially presented with limited risk factors, no severe risk factors, and no disease indicators or limited disease indicators. A practitioner’s goal at the 6-month reassessment should be to identify progress of any kind, verify adherence, and if the practitioner or patient is not satisfied with the progress, recommend an increase in the patient’s level of therapy. If the patient assesses at a lower level of risk, suggest the recommended level of therapy for that new risk level and caution the patient that relapse is a possible outcome until multiple healthy appointments have been established. Therapy recommendations should be made for the next 6 months. Keep in mind during these reassessment appointments the factors influencing treatment time and results such as the amount of time the patient has had the issue; the number, frequency, and severity of risk factors; the presence and severity of symptoms; the restorative treatment plan; and the level of compliance.

 

Twelve months

Approximately 80–90% of compliant patients will see substantial progress by the 12-month appointment. Examples of progress would be reduced progression of biofilm challenge or decay, lower incidence of decay, lower biofilm challenge (See Figure 19), improved soft tissue health on inspection, decrease in bleeding gums when flossing or probing, improved enamel luster, reduced plaque buildup, etc. Patients who may have yet to see substantial progress are patients with severe or unmodifiable risk factors, patients who were not successfully adherent or have gaps in their treatment regimen, and patients with a long history of severe decay.

Biolfilmchallenge chartAgain, the practitioner’s goal at the 12-month reassessment should be to identify progress of any kind and verify adherence to the recommended therapeutic regimen. If the practitioner or patient is not satisfied with the progress, there should be a recommendation to increase the patient’s level of therapy. If the patient has been assessed at a lower level of risk, suggest the recommended level of therapy for that new risk level and caution the patient that relapse is a possible outcome until multiple healthy appointments have been established. Therapy recommendations should be made for the next 6 months. Keep in mind during these reassessment appointments the factors influencing treatment time and results such as the amount of time the patient has had the issue; the number, frequency, and severity of risk factors; the presence and severity of symptoms; the restorative treatment plan; and the level of participation or adherence.

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