Implementing Caries Risk Assessment to Better Serve Patients

Sept. 1, 2012
For some dentists, preventive care is not the primary focus of each day, not because they think it’s unimportant, but simply because many treat a patient population that is not particularly high-risk.

By Mark Kleive, DDS

For some dentists, preventive care is not the primary focus of each day, not because they think it’s unimportant, but simply because many treat a patient population that is not particularly high-risk.

But in some parts of the country, preventive care is a pressing need that dental practitioners must face. I learned this firsthand after moving from Minnesota to North Carolina and seeing the change in the needs of the patient population. I quickly realized that if I continued to practice the same way I had in Minnesota, I was not going to be successful at helping patients reach and maintain their oral health goals. If the only tool I had at my disposal was a dental handpiece, I knew that I would not be able to serve patients appropriately.

This realization led me to research Caries Management by Risk Assessment (CAMBRA) protocols and to shift my practice to treat decay as a bacterial infection. The keystone of this approach is a patient risk assessment, which is performed with each new patient or with existing patients as the protocol is implemented.

A number of risk assessment forms are available, such as those developed by the ADA and the California Dental Association. I developed a risk assessment evaluation tool to help simplify the process and to customize it to fit my patient and practice needs.

Now, based on patients’ answers to a series of yes or no questions, we can classify patient needs as low-, moderate-, or high-risk for caries. We can then recommend treatments and lifestyle changes and easy additions to their daily routines that will help them become lower risk. The addition I prefer to include in my practice is Clinpro™ 5000 Anti-Cavity Toothpaste (3M ESPE).

By assessing patients individually and reviewing their dental histories with them, we can make convincing arguments for where we think that each patient’s dental health is headed. We tell patients what we predict will happen if they continue current habits, as well as what we hope to achieve with more aggressive targeting of caries. For patients who are moderate- to high-risk, we provide extra counsel on the types of treatments that can help them get their caries under control.

We have also developed a cavity control checklist, which is specifically designed to be simple for patients to follow. I believe that if you ask patients to adapt their lifestyles to include new products and habits, you have to make it as easy as possible for them.

Therefore, our take-home materials are designed with clear visuals of the preventive products we dispense and simple instructions about how to use them, how much, and how often.

Our goal in this method of treatment is to be a coach for patients and facilitate a process for them to be successful. Given that we only see most patients two to four times per year, we try to impress upon them that it is within their power to take care of their oral health for the other 361 days.

We’ve found that once we make patients aware of their risk assessment and explain the choices available to them, they are more likely to take ownership of the recommended changes. When patients think that they have made a decision, rather than a dentist having told them, “You need to do this,” they are more likely to make the changes part of their lives.

I have spoken with many dentists who have considered implementing a formal risk assessment program, but have struggled with how to begin. I advise these dentists to simply look at the tools available to them and start a program, even if it is with only a few patients at a time. By using our protocol, we have seen patients breaking the cycle of presenting with decay every six months. This is a powerful tool for building practice loyalty and empowering patients.

To view the risk assessment evaluation chart that Dr. Mark Kleive has developed and customized to fit his patient and practice needs, go to cavity-control-checklist.html. The chart is available via PDF at this URL.

Mark Kleive, DDS, earned his DDS with honors in 1997 from the University of Minnesota School of Dentistry. After practicing in Minnesota for 13 years, Dr. Kleive and his family moved to the Asheville, N.C., area where he owns a fee-for-service practice. You can reach Dr. Kleive at [email protected].

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