1.4 Modifying Factors

Frequency of Dental Visits

Patients who routinely seek oral health care usually have higher total caries experience scores (decayed, missing, and filled teeth [DMFT] or decayed, missing, and filled surfaces [DMFS]) but lower activity scores (decayed teeth or decayed surfaces), compared with those who do not routinely seek care.52 That is, among patients with the same DMFT scores, those who routinely seek care will have higher filled teeth scores. The ways in which these scores break down affect risk categories and recall intervals.

For example, take three patients, each of whom has a DMFT score of 4. One has four decayed teeth, one has four filled teeth, and one has two decayed teeth, one missing tooth, and one filled tooth. These patients may be in different caries risk categories and may require different recall intervals, even though their DMFT scores are the same. It is important, therefore, not to rely solely on DMFT or DMFS scores as a whole in ascertaining risk categories or setting recall intervals.

Patients who visit the dentist regularly are usually at lower risk for future caries experience, compared with those who do not visit the dentist regularly. However, a patient with no new caries at examination is at low risk for dental caries, even if he or she has not visited a dentist in a long time.

Salivary Properties

Salivary properties such as viscosity, volume, pH, and mineral content are important to consider when determining a patient’s caries risk. Saliva has a tremendous acid buffering capacity and for many patients is protective against caries.11,53–55 When flow, ion content, and/or pH decreases, saliva’s buffering capacity is lost. Without an adequate volume and consistency of saliva and its protective buffering, teeth are subjected to longer and more frequent bacterial acid attacks. The result is more, larger, and faster-progressing carious lesions. Certain prescription and over-the-counter medications and dehydration can affect salivary properties.

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