Moderate Risk Patient Case Study
Risk factors; approximately 23% of the population.*
9/11/08: Jeff is a 26-year-old construction worker who often works long hours building homes. He has not had a single cavity in his entire life. He recently moved in with his fiancé and has plans to get married in 9 months. With his upcoming marriage, he wants to know about professional tooth whitening before his wedding. During his caries risk assessment, his dental practitioner found that he has a couple of risk factors for caries. With his long work hours, Jeff has been regularly drinking energy drinks throughout the day and does notice some plaque buildup every once in a while between brushings. His CariScreen score was 127, and he has no current cavities or other disease indicators. Due to his risk factors, he is moderate risk and has a 38.6% chance of new decay in the next 12 months.
Jeff’s dental practitioner’s concern regarding Jeff’s caries risk was low, with his lack of cavities in the past and a couple of risk factors. But the practitioner suggested he cut back, if at all possible, on the energy drinks as they are highly acidic (pH 2.8–3.3) and contain sugar, but didn’t see an issue performing the professional tooth whitening. Jeff said he didn’t think stopping the energy drinks was an option right now with his heavy work hours and instead opted to use a pH neutralizing gum with xylitol (such as CTx2 Xylitol Gum) after the energy drinks and meals. With his upcoming wedding, he didn’t need an added dental expense or issue with his smile. He made a recall appointment as well as a separate whitening appointment. No history exists on Jeff past this appointment.
2/24/10: Elana is a 44-year-old high school teacher. She has not had any dental decay problems in the last 11 years. She had a low CariScreen score of 844 and no current disease indicators or cavities, but she had quite a few risk factors. She has been taking birth control and blood pressure medications for years and was recently diagnosed with moderate acid reflux. She has been taking 3 daily medications for the last 4 months and has felt like her mouth gets dry during her class lectures as well as at night. Because of the dry mouth, she has taken to drinking coffee and juices more often during the day. Not only did she notice some plaque buildup between brushings but the dental hygienist noted it as well. Elana reports that she brushes and flosses twice daily.
Statistically, Elana has a 38.6% chance of dental decay in the next 12 months, but the list of risk factors was a concern for her dental practitioner. Since Elana recently started some new medications that may be causing dry mouth and that these medications cannot be changed, the dental practitioner recommended that Elana use a 1.1% neutral sodium fluoride gel with xylitol, pH neutralization, and nanoparticles of hydroxyapatite (such as CTx4 Gel 1100) along with a daily pH neutralizing spray with xylitol (such as CTx2 Spray) as needed for dry mouth. Elana said she was not interested in any therapy products at this time as they were not covered by her insurance.
9/15/10: Elana came back today for her 6-month checkup. Since her last appointment, she has increased her intake of juices and “other drinks” due to dry mouth, even though it causes her acid reflux to flare. Her CariScreen score was 1460, and she had two new cavities the dentist identified on her x-rays. The lack of saliva and frequent intake of acidic beverages were obviously making Elana more susceptible to infection. The dental practitioner made new therapy recommendations due to her increased caries risk and the presence of symptoms (cavities), but Elana again chose to decline as her fillings were covered by her dental insurance but the treatment products were not.
*Based on a private practice study of 3,125 patients