1.4 Modifying Factors

Root Exposure

Exposed roots may be more susceptible to caries than the crowns of teeth because roots lack the protective enamel covering found on crowns. In addition, the bell shape of the tooth tends to protect exposed roots from toothbrush bristles, making them more difficult to clean. However, some patients brush too aggressively, which can result in root abrasion.

A patient with extensive toothbrush abrasion may need restorations; however, it should be noted in the patient’s record that the restorations are for abrasion. A patient requiring multiple restorations for abrasion or other conditions such as abfraction (loss of tooth structure from flexural forces) but who has no caries may be at low risk for caries, despite the need for restorative treatment.

Mutans Streptococci Levels

The virulence factors associated with MS are adhesion, acidogenicity, and acid tolerance.56 Patients with low MS levels usually do not have active caries. Patients with active caries have high MS levels. Some patients with high MS levels have no caries, which may be due to the genotype of the resident bacteria.57 There is little evidence of the ability to predict caries by looking at MS levels.58

Neither patients without active caries nor those with active caries need MS levels checked. It is valuable to check MS levels in patients who have undergone treatment for active caries infections. In this case, the dentist checks MS levels to ensure that the interventions to control the infection have been successful.

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