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

by Dr. V Kim Kutsch


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.

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