July 1st, 2009 by admin

The distribution of caries is highly uneven among contemporary popu-
lations. How convenient it would be if those at risk of developing carious
lesions could be identified, both at the level of the individual in the surgery
and the population. The dentist could then target expensive non-operative
treatments appropriately and at a community level preventive effor ts could
also be targeted. This is called a ‘high risk strategy’.
Although this concept seems both logical and laudable, it does not actu-
ally work. At the individual patient level, the best predictor of caries risk is
current caries experience. Thus, the patient presenting with lesions is at risk
of caries progression and developing new lesions.
This is obvious, but
5
slightly frustrating because there is an element of ‘shutting the stable door
after the horse has bolted’!
To assess caries activity in an individual patient, note how many lesions
are present (both cavitated and non-cavitated) and where they are located.
6
If a history of recent caries activity is available (number of lesions and fillings
over the last 2–3 year s) this is also valuable. A yearly increment of two or
more lesions, detected clinically and/or radiographically, would indicate a
high rate of lesion progression. The formation of lesions in areas such as
lower incisors and buccal surfaces of molars, where salivary  ow is relatively
rapid, also indicates a high risk of caries progression