Quick Reference Guide © Scottish Intercollegiate Network, 2000

47. Targeted prevention of dental caries in the permanent
teeth of 6-16 years olds presenting for dental care

Primary Prevention: Keeping children's teeth healthy before disease occurs
Targeting is important as decay is unevenly distributed in the population:
		9% of 5-year-olds and 6% of 14-year-olds have 50% of disease
B	An explicit caries risk assessment should be made for each child presenting for dental care. The following factors should be considered:

Risk Factors		Risk Category
		High Risk	Low Risk
Clinical evidence		- New lesions	- No new lesions
		- Premature extractions	- Nil extractions for caries
		- Anterior caries or restorations	- Sound anterior teeth
		- Multiple restorations	- No or few restorations
		- No fissure sealants	- Restorations inserted years ago
		- Fixed appliance orthodontics	- Fissure sealed
		- Partial dentures	- No appliance
Dietary habits		- Frequent sugar intake	- Infrequent sugar intake
Social history		- Social deprivation	- Social advantage
		- High caries in siblings	- Low caries in siblings
		- Low knowledge of dental disease	- Dentally aware
		- Irregular attendance	- Regular attendance
		- Ready availability of snacks	- Limited availability of snacks
		- Low dental aspirations	- High dental aspirations
Use of fluoride		- Drinking water not fluoridated	- Drinking water fluoridated
		- No fluoride supplements	- Fluoride supplements used
		- No fluoride toothpaste	- Fluoride toothpaste used
Plaque control		- Infrequent,ineffective cleaning	- Frequent,effective cleaning
		- Poor manual control	- Good manual control
Saliva		- Low flow rate	- Normal flow rate
		- Low buffering capacity	- High buffering capacity
		- High S mutans and lactobacillus counts	- Low S mutans and lactobacillus counts
Medical history		- Medically compromised	- No medical problems
		- Physical disability	- No physical problems
		- Xerostomia	- Normal salivary flow
		- Long term cariogenic medicine	- No long term medication

Individuals who do not clearly fit into high or low risk categories are considered to be at moderate risk
KEY	A	B	C	Indicates grade of recommendation		Good practice point

Primary Prevention in Children At High Caries Risk
Behaviour Modification
A	Dental health education advice should be provided to individual patients at the chairside as this intervention has been shown to be beneficial.
A	Children should brush their teeth twice a day using toothpaste containing at least 1000 ppm fluoride. They should spit the toothpaste out and should not rinse out with water
C	The need to restrict sugary food and drink consumption to meal times only should be emphasised.
B	Dietary advice to patients should encourage the use of non-sugar sweeteners, in particular xylitol, in food and drink.
B	Patients should be encouraged to use sugar-free chewing gum, particularly containing xylitol, when this is acceptable.
B	Clinicians should prescribe sugar-free medicines whenever possible and should recommend the use of sugar-free forms of non-prescription medicines.
Tooth Protection
A	Sealants should be applied and maintained in the tooth pits /fissures of high caries-risk children.
B	The condition of sealants should be reviewed at each check-up.
B	Glass ionomer sealants should only be used when resin sealants are unsuitable.
B	Fluoride tablets (1 mg F daily) for daily sucking should be considered for children at high risk of decay.
B	A fluoride varnish (e.g.Duraphat) may be applied every four to six months to the teeth of high caries risk children.
B	Chlorhexidine varnish should be considered as an option for preventing caries.
	Consistent preventive messages should be reinforced by the dental practice team and by other health care professionals.

Secondary and Tertiary Prevention of Dental Caries
Secondary prevention:Limiting the impact of caries at an early stage. Tertiary prevention:Rehabilitation of the decayed teeth with further preventive care.
Diagnosis of Dental Caries
A	Bitewing radiographs are recommended as an essential adjunct to a patient 's first clinical examination.
B	The frequency of further radiographic examination should be determined by an assessment of the patient's caries risk.
Management of carious lesions
Occlusal caries
A	If caries extends clinically into dentine, carious dentine should be removed and the tooth restored. If only part of the fissure system is involved, the treatment of choice is a composite sealant restoration.
C	Dental amalgam is an effective filling material which remains the treatment of choice in many clinical situations.There is no evidence that amalgam restorations are hazardous to general health.
Approximal caries
A	Preventive care, e.g. topical fluoride varnish, rather than operative care is recommended when approximal caries is confined to enamel.
Smooth surface caries
	Management of smooth surface caries (non cavitated) should be as for approximal lesions confined to the enamel.
Operative management of carious lesions alone cannot be relied on to prevent further disease. Primary preventive measures must be continued.
Re-Restoration
B	The diagnosis of secondary caries is extremely difficult and clear evidence of involvement of active disease should be ascertained before replacing a restoration.
	If only part of a restoration is judged to have failed, consideration should be given to repairing rather than replacing it.

© Scottish Intercollegiate Guidelines Network, 2000.This guideline was issued in December 2000
and will be reviewed in 2002
Derived from the national clinical guideline recommended for use in Scotland by the Scottish Intercollegiate
Guidelines Network (SIGN), Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ

You may download copies of the Quick Reference Guidelines and the full Guidelines
from the Scottish Intercollegiate Network site.

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