The caries balance: contributing factors and early detection

The guiding principle (risk factor) questions for this risk assessment tool were as follows:
1. there existing or has there been new untreated cavities in the past two years?
2.Has there been orthodontic appliances or removable partial dentures?
3. there reduced salivary function as measured by stimulated saliva flow less than 0.7 ml/minute?
4. there use of hyposalivatory medications?
5. there frequent ingestion of fermentable carbohydrates (by questioning the patient)?
6. current use of fluoride products inadequate?
7.there high caries bacterial challenge as measured by testing mutans streptococci and lactobacilli?

The number of yes answers to the above questions places the patient into one of three risk categories. If the answers to the first five questions are mostly no, then bac-terial testing is not needed.
If bacterial test-ing is needed, the Ivoclar (Amherst, NY) caries resistance test is used; and results are known in 48 hours. This forms the basis for future monitoring of the effectiveness of antibacterial therapy.

If the person is at high risk, this initiates

Bacterial testing
Fluoride therapy (fluoride office topical followed by higher concentration home use fluoride is used)
Chlorhexidine therapy (0.12 percent chlorhexidine gluconate for two weeks daily every three months); Regular recall to monitor lesion progress or arrestment and antibacterial therapy success.