Restorative & Materials · patient case question
What is this patient's caries risk level?
Patient case: Seven Restorations and White Lines at the Gumline
Patient: 22-year-old female
Chief Complaint: Routine examination. “My braces came off last year.”
Background: Fixed orthodontic appliances removed 14 months ago. Drinks sweetened iced coffee through the day. Has not been seen for two years. Brushes once daily, does not floss.
Medications: None
Vital Signs: BP 112/70 mmHg · HR 70 bpm · RR 14 · T 98.2°F
Findings: Seven existing restorations. Chalky white demineralized bands along the gingival third of the buccal surfaces of all premolars. Generalized plaque at the gingival margins with marginal erythema. No cavitation.
Show answer and explanation
Correct answer: B. High
- A. 'Extreme' risk is a modifier used for high-risk patients with severe hyposalivation or special needs. There is no evidence of xerostomia here.
- B. CORRECT. HIGH RISK. She has active white-spot lesions (which are active demineralization, not scars), multiple existing restorations, frequent daily sugar exposure, inadequate plaque control and irregular attendance. Under CAMBRA, ANY visible white spot or cavitated lesion in the last three years places a patient in the high-risk category before the other factors are even counted.
- C. Low risk requires no disease indicators, few risk factors and good protective factors — none of which apply.
- D. Moderate risk applies to a patient with risk factors but no active disease indicators. Active white-spot lesions are a disease indicator and override that.
Note: White spot lesions after orthodontics are subsurface demineralization with an intact surface layer. They are REVERSIBLE at this stage — fluoride varnish, CPP-ACP paste, diet change and plaque control can arrest and partially remineralize them. Do not restore them.
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