Caries Risk Assessment - Is it possible?

Epidemiological data shows that dental caries is not equally distributed amongst the population. In Germany 70.1% of 12-year-olds are caries free, whereas other children of the same age group already show up to 14 teeth affected by caries. Obviously the oral conditions relevant to caries development vary widely in the population. In order to prevent caries even in children with high caries risk it is desirable to know about the existence of a risk and how much prevention is needed to keep the patient healthy. The first approach to the problem should be the development of a screening test which is suitable to distinguish between patients with and without caries risk.

Several attempts to develop reliable tools for caries risk-screening have been made over the years. According to the multicausal aetiology of caries, different approaches have been used: microbiological, biochemical, anamnestic and clinical approaches. In prospective clinical studies, white spot lesions and discoloured fissures on first molars where found to be the most reliable discriminating parameters in 6- to 12-year-old children. Until now the detection and enumeration of mutans streptococci and lactobacilli was not proven to be a reliable screening tool for caries risk. A high concentration of lactobacilli in saliva is more likely to be the result of cavities than its cause. On the other hand the detection of mutans streptococci can provide useful information. For example it was shown that the presence of these bacteria in saliva and plaque of 5-year-old caries free children is associated with an elevated relative risk to get new caries lesions. Even if this finding does not yet allow a reliable discrimination between children “at risk” and “not at risk”, it shows that the detection of caries related micro-organisms may go in the right direction. The detection of the “right micro-organisms” with a reliable method may be a step forward to develop a reliable caries-risk assessment.