Modules
Module 5: Caries Treatment and Recall IntervalsCaries Risk Classification Table

5.3 Treatment of Population Groups

Ages 5 and Over

Patients at Low Risk

Pit-and-fissure cariesPit-and-fissure caries places a patient in the moderate risk category.

Treatment plans for patients who are at low risk for dental caries include the same preventive strategies as those for children from birth to age 4 who are at low risk. As always, education and reinforcement should be tailored to the patient, and education for young patients should include the parent as well as the child. For patients in this risk category, surgical restoration is needed only for defective fillings or fractured teeth. Recall intervals are from 24 to 36 months but should be shorter for children and adolescents.

Patients at Moderate Risk

Patients who are at moderate risk for dental caries have an active carious infection and are defined as having at least one active cavitated smooth-surface lesion or pit-and-fissure lesion at examination. Modifying factors such as incipient or white spot lesions can also place a patient at moderate risk for dental caries.

In addition to education and reinforcement advising the use of fluoridated toothpaste, and possibly prescribing fluoride supplements, treatment should include applying dental sealants to non-carious and incipient pits and fissures that can harbor odontopathic bacteria, preventive strategies such as topical fluoride application to control the infection, and restorative treatment of carious lesions teeming with odontopathic bacteria.

Depending on the number of dental sealants and restorations that are needed as well as on the need for an oral hygiene cleaning, treatment could take between two and five appointments to complete. Each appointment should be used as an opportunity to check the patient’s compliance with preventive strategies and to provide education and reinforcement. The recall interval for patients at moderate risk ranges from 6 to 24 months, depending on the rate of caries progression and protective or harmful modifying factors present. If after several recall visits the patient has no new lesions, reclassifying that patient to the low-risk category and extending the recall interval is appropriate.