Dental CARMA (Caries Assessment, Risk Management Application) is the latest in diagnostic and preventative approach to assessment, treatment and control of dental disease. The primary purpose of CARMA is to assess the patient’s risk for caries and to determine appropriate preventive and therapeutic approaches. The assessment tool is a part of an overall approach to prevent and treat the caries infection and is composed of the following sections:
- Caries disease indicators – nutritional i.q.; development problems; low SES (socioeconomic status); and presence of cavities, white spots, and restorations placed in the previous 3 years
- Caries risk factors – type and quantity of Mutans streptococci (MS) and lactobacilli (LB); visible plaque; exposed roots; saliva reducing factors and inadequate saliva flow; frequent snacks; deep pits and fissures; and orthodontic appliances
- Caries protective factors – systemic and topical fluoride sources; adequate saliva flow; and regular use of chlorhexidine, xylitol, and calcium and phosphate paste
- Clinical examination – presence of white spots, decalcification, restorations, and plaque; and bacterial culture and saliva flow tests
1. Determine the overall caries risk as low, moderate, high, or extreme risk
Low risk – no dental lesions, no visible plaque, optimal fluoride, regular dental care
Moderate risk – dental lesion in previous 12 months, visible plaque, suboptimal fluoride, irregular dental care
High risk – one or more cavitated lesions, visible plaque, suboptimal fluoride, no dental care, high bacterial challenge, impaired saliva, medications, frequent snacking
Extreme risk – high risk patient with special needs or severe hyposalivation
2. Perform bacteria and saliva testing as indicated by risk level
3. Determine the plan for caries intervention and prevention
Patients age 0 to 5 – consider the following for the caregiver and patient based on risk level: saliva and bacterial testing; antibacterials; fluoride consumption, use, and professional application of fluoride varnish; frequency of radiographs; frequency of periodic examinations; oral hygiene instructions; xylitol and/or baking soda; sealants; and existing lesions.
Patients age 6 through adult – consider the following based on patient risk level: frequency of radiographs; frequency of caries recall examinations; oral hygiene instructions; saliva and bacterial testing; antibacterials such as chlorhexidine and xylitol; fluoride use and professional application of fluoride varnish; pH control; calcium and phosphate; and sealants.
4. Discuss home care recommendations based on risk level
5. Provide follow-up care and reassess risk level
We are proud to be able to offer the latest in caries assessment and diagnosis. With a simple swab of a q-tip along the back of the bottom front teeth we can measure the amount of cavity causing bacteria. A lot of bacteria means cavity susceptible; a few bacteria can mean a caries free mouth. Look Ma, no cavities!!
See how quickly bacteria colonize on teeth when not brushed: