Restorative & Materials · patient case question
How is this patient's caries risk classified?
Patient case: Rampant caries on a full-mouth series
Patient: Female, 29 years old
Chief complaint: “A piece of my back tooth broke off.”
History: No systemic disease. Frequent sugared energy drinks. Last dental visit six years ago. Brushes once daily, no floss.
Findings: Full-mouth series shows occlusal and proximal caries in 14 teeth. Tooth #3 has gross coronal destruction extending 2 mm subgingivally on the mesial. No periapical radiolucencies. Salivary flow is normal.
Show answer and explanation
Correct answer: A. High
- A. CORRECT. HIGH risk is defined by ACTIVE DISEASE, not by predicted disease. Any patient with cavitated lesions in the last three years, and particularly one with multiple new lesions, is high risk regardless of the contributing factors. Here the risk indicators stack up: frequent fermentable carbohydrate exposure, inadequate plaque control, six years without professional care, and 14 active lesions.
- B. Low risk means no new lesions in three years, good hygiene, adequate fluoride exposure and low sugar frequency. None applies.
- C. There is no such category. Caries risk is classified low, moderate or high in CAMBRA and in the ADA framework, with an extreme category in some CAMBRA versions reserved for high risk PLUS severe hyposalivation — and salivary flow here is normal.
- D. Moderate risk describes a patient with risk FACTORS but without current active disease, or one lesion in the past three years. Fourteen active lesions puts this well past moderate.
Note: High risk changes management concretely: 5000 ppm prescription fluoride toothpaste, three-month recalls, bitewings every six to twelve months, chlorhexidine or xylitol adjuncts, and dietary counselling focused on FREQUENCY rather than total quantity of sugar.
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