Orthodontics +
Caries Risk
Assessment
Caries Risk Assessment
A caries-risk assessment is essential for all patients, in order to determine
their risk of developing caries, and specific preventative advice and
treatment. All of these factors should be considered when assessing a
patients caries-risk.
This is particularly important in orthodontic patients, as their caries-risk is
increased solely by the presence of orthodontics.
Patient factors
Suboptimal oral hygiene
Diet high in sugary/acidic foods
Frequent snacking
Previous caries history
Family history of caries (eg. parents/siblings)
Social deprivation
Dental anxiety
Dental factors
Low saliva flow or xerostomia
Orthodontics or orthodontic appliances
Crowding
Dental anomalies such as molar-incisor hypomineralisation
Lack of fluoride
Medical factors
Medication (eg. non-sugarfree versions)
Medical considerations (such as limited mobility or lack of cooperation)
Medical conditions (such as diabetes and cystic fibrosis)
, Orthodontics +
increased caries risk increase
Wearing an orthodontic appliance increases the risk of caries developing. The
presence of brackets, wires, retainers and appliances makes toothbrushing more
complicated. It also increases the amount of time it takes for sufficient plaque
removal, due to the increased surface area where plaque can accumulate.
Prior to orthodontic treatment, it is essential to ensure:
The patient has excellent oral hygiene
The patient is motivated to ensure oral hygiene is maintained
The patient has adequate mobility and cooperation so that good oral hygiene
can be maintained long term
This can be confirmed using:
Disclosing tablets
Plaque free score
Prevention appointments with dental therapist or orthodontic therapist
Diet sheets
Excellent oral hygiene can be achieved using:
Adequate toothbrushing
Interdental brushes
Mouthwash
Appliance hygiene
Removal of appliances for cleaning
If oral hygiene is not maintained during orthodontic treatment, the following can
occur:
Demineralisation
White spot lesions
Active caries
Periodontal issues
In severe cases, removal of the appliances may indicated if oral hygiene remains
poor, and development of further caries is a risk.
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