1.4 Modifying Factors

Oral Hygiene

Although there is conflicting evidence in the literature for the effectiveness of oral hygiene procedures in improving caries outcomes, dentists generally believe that oral hygiene is invaluable and that the time it takes to perform oral hygiene tasks is well spent.46–48 Toothbrushing is an effective fluoride-delivery mechanism and disrupts colonization of the tooth’s surface by infected plaque.

White spot lesions, the first visual diagnostic point for dental caries, occur in areas where infected plaque accumulates. Poor oral hygiene practices should be identified as a risk factor. Dentists should place patients with this risk factor in the next-higher risk category or should shorten the recall interval until it has been established through recall that observed plaque is not populated by cariogenic bacteria. White spot lesions on tooth surfaces where plaque can be seen are an indicator that the plaque is infected with acidogenic bacteria.

Family Socioeconomic Status

Low socioeconomic status (SES) is a risk factor for dental caries and is associated with poor oral health status.49–52 However, it is important to recognize that the key factor driving caries risk assessment is the presence of active cavitated smooth-surface lesions at the time of the examination and that low SES is only one of many risk factors.

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