At my practice we recommend fluoride toothpaste, oral hygiene techniques, xylitol, and diet changes for those at high risk of decay. I also consider dry mouth. However, I often feel like we are going in circles with no changes noted. Any suggestions?
What a great question! We have all had patients who struggle to control their dental caries. Personalized care in this situation means that we as health professionals understand what puts the individual at high risk for decay so we can make recommendations targeted to his or her specific needs.
Caries risk assessments can be useful in identifying what elevates your patients’ caries risk as well as what protective factors they have against caries. I suggest using a caries risk assessment for particularly troubling patients. The American Dental Association, American Academy of Pediatric Dentistry and other organizations offer assessment tools.
Even in the presence of other risk factors, we know that the single most important change patients can make is decreasing the fermentable carbohydrates and sugary beverages in their diet.1 A systematic review found a higher incidence of caries in populations where carbohydrate intake was greater than 10% of the total diet compared to those with an intake of less than 10%.2
It sounds like you are already advising your patients about diet, but do you ask them to keep a food diary to help identify how their food intake is contributing to caries risk? Some smartphone apps you may consider are See How You Eat, MyPlate app, and FoodLog. Multimedia recording incorporated into food diary apps has been shown to increase patient compliance.3
If you have your patients complete a food diary, you need to review it with them.4 Talk with them about the type of carbohydrates, the amount, frequency of intake, and the time that carbohydrates stay on the tooth surface undisturbed.2,5,6
In addition to the fluoride, some promising caries-prevention options are on the horizon. New research shows that a 10% povidone iodine application may reduce the incidence of caries.7 A noninvasive, regenerative caries therapy has also been developed to prevent caries. As science evolves, keep your eye on the efficacy of these and other agents.
For patients with active caries, the application of silver diamine fluoride (SDF) has shown to be an effective noninvasive treatment. SDF arrests caries where the other fluoride products are designed to prevent caries.7,8 SDF should be used without removing existing caries so dental hygienists can apply it in many states depending on their rules and regulations.
- American Dental Association. Nutrition and Oral Health. Available at: ada.org/resources/research/science-and-research-institute/oral-health-topics/nutrition-and-oral-health. Accessed April 11, 2023.
- Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93:8–18.
- Aizawa K, Maeda K, Ogawa M, et al. Comparative study of the routine daily usability of foodlog: a smartphone- based food recording tool assisted by image retrieval. Diabetes Sci Technol. 2014;8:203–208.
- Davies N. The role of food diaries in diabetes self-care. Today’s Dietitian. 2013;16:11,14.
- Moynihan P. Sugars and dental caries: evidence for setting a recommended threshold for intake. Adv Nutr. 2016;7:149–156.
- World Health Organization. Guideline: Sugars Intake for Adults and Children. Available at: who.int/publications/i/item/9789241549028. Accessed April 11, 2023.
- Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc. 2016;44:16–28.
- Contreras V, Toro MJ, Elías-Boneta AR, Encarnación-Burgos A. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent. 2017;65:22–29.
From Dimensions of Dental Hygiene. May 2023; 21(5):46.