Management of adolescents with high caries rates

Multiple existing restorations and/or new or recurrent carious lesions are markers of
adolescents who are at risk for the development of future caries. In particular, caries
development on the proximal surfaces of lower incisors or the cervical areas of the facial and
lingual surfaces indicates high risk. Individuals who continue to develop multiple new
carious lesions between periodic visits also should be classified as high risk. The chronically
ill or immune-compromised patient may develop increased significant caries risk as a result
of the underlying systemic condition or therapy. An in-depth preventive program to control
the caries process is an essential element in the treatment of the high-risk individual. The
program must include all the elements described in the following paragraphs.

Diet analysis and counseling: Initially, the patient needs to be queried about sugar and acid
exposures. If there is suspicion by the dental team that the patient is at elevated risk for dental
caries or erosion, and that the diet is a contributing cause, then it is appropriate to do a formal
diet analysis. The findings from that analysis will become the basis for counseling the patient
about their diet and making recommendations for change.

Oral self-care improvement: Adequate plaque control measures must be instituted and
maintained to reduce caries susceptibility. Proper, timely brushing and flossing are essential
elements of any oral self-care regimen.

Fluoride use: Both professionally applied and self-applied topical fluoride can be helpful in
preventing the development of new lesions and encouraging remineralization of decalcified
surfaces. Daily rinses or self-applied gels in custom trays may be warranted.

Restoration of all active lesions: Active lesions should be excavated and provisional or
definitive direct-fill restorations placed to stop the progression of caries. Reinforced zinc
oxide eugenol (IRM) or glass-ionomer cements can be used effectively in these cases to stop
the site-specific caries process. Restoration of lesions without an intensive preventive
program will almost certainly result in new and recurrent carious lesions and treatment
failure. (For additional management considerations, see Chapter 9 .)

Diagnosis and Treatment Planning in Dentistry

Third Edition

Copyright © 2017 by Elsevier, Inc. All rights reserved.

Book Chapter

Adolescent patients PDF not available through ClinicalKey

 Lorne D. Koroluk

Diagnosis and Treatment Planning in Dentistry, 16, 364-380