by Rhoda P. Kublickis, RDH, MHSc, FAADH
Dr. Evangeline Jordon, a pediatric dentist stated, “Dental caries is a preventable disease
of childhood, due to incorrect diet and lack of hygiene.” Additionally she predicted, “In 25 years, the demands of intelligent people will not be for bridges and inlays, but for perfect teeth preserved by the physiology of prevention.” Dr. Evangeline Jordon was in dental school during 1898. Can you imagine if she were here today to attend the CAMBRA Coalition with the Xylitol Educator team in 2016?
Historically there have been different theories on what caused dental decay. By 2002 there was a consensus statement published in the Journal of the California Dental Association on Caries management by risk assessment (CAMBRA). Four years later the American Dental Association created downloadable forms to list the risk factors for caries. Then in 2009, the ADA endorsed the use of caries risk assessment as standard of care. As a result, three CDT codes describing the low, moderate, and high risk for caries were created in 2014. These risk-assessment CDT codes are a distinct procedure requiring proper dosing of specific products to increase the patients’ protective factors to prevent disease.
As dental professionals we need to start coaching our patients toward prevention. CAMBRA, is a tool that has been developed by a group of experts who copiously sorted through the scientific literature to first determine each patients’ risk factors of an infectious disease.
As hygienists we are also detectives, trying to discover which of the patients’ behaviors are causing cavities. We need to ask the patients open-ended, engaging questions. Dr. Brian Novy who has been part of the CAMBRA coalition suggests to start with these questions:
- Where do your patients live?
As the dental professional you should know if your patient base lives in an area with fluoridated water.
- What do your patients have next to their bed?
Determining if your patients have snacks, candies, or water next to their can help you understand why they may have more cavities or even what other problems they could be dealing with like xerostomia.
- What are your patients' healthy snacks?
- Do your patients crave sugars?
It is important to not judge the patients' answers – you want the patients to establish a rapport with you.
- Is their plaque thick, saliva stringy, bubbly or frothy?
This is better than asking if they have a dry mouth as stated by Dr. Pamela Maragliano-Muniz.
Different Caries Risk Assessment (CRA) forms list other questions as a guide for us. Sometimes too much information can overwhelm a patient and they just complete the form by checking the “No” column.
Additionally, there are quantitative ways to determine the number of bacteria in a patient’s mouth such as the CariScreen Caries Susceptibility Test used chairside. We can also detect by disclosing solution, which has different shades to visually demonstrate to the patient where the acid producing plaque is located and needs to be removed. Determining patients resting pH is also another tool to see if they need to add xylitol and calcium phosphate products to help rebuild what is diminished by the acidic challenges during the day.
Once you determine the imbalance on the seesaw risk factor of disease, we can focus on health. In order to reduce infection we need to disrupt the number of bacterial colonies by chewing six to ten grams of xylitol throughout the day. Xylitol has a bacteriostatic effect, this is especially important for the caregivers of infants and children. Establishing a healthy microbiota for the caregiver, and family members before the infant’s first tooth erupts is essential in reducing the transmission of the cycle of disease. With several generations living in the same household, we also need to protect the grandparents. The most vulnerable elders need topical fluoride varnish or chlorhexidine varnish along with six to ten grams of xylitol daily. Statistically 91% of 65 year olds suffer from the dental decay.
As dental professionals we are to uphold the standard of care by determining the risk factors, determining the risk level, diagnose the disease, lesion and codes in our assessment, and documentation for those patients we care for on a daily basis. Edwin J Zinman and attorney stated during the CAMBRA coalition, “No matter how many do it wrong never makes it right.” We need to make an ethical obligation to be up-to-date on the best evidence for intervention for our patients. We can only give informed consent if the patient fully understands the procedure as we explain it to the best of our expertise.