IAPD Webinar | Caries Risk Assessment and Care Pathways

 IAPD Webinar | Caries Risk Assessment and Care Pathways

By Norman Tinanoff

Prof Norman Tinanoff

Prof. Norman Tinanoff received his dental degree from the University of Maryland in 1971. After receiving his certificate and master’s degree in pediatric dentistry at the University of Iowa, he spent another year at the V.A. Hospital in Iowa City in a research fellowship. Prof. Tinanoff’s two-year military service was at the Army Institute of Dental Research at Walter Reed Army Medical Center. For 23 years, he was at the University of Connecticut Health Center, where he was director of the Pediatric Dentistry Graduate Program for 16 years. In 1999, he became chairman of the Department of Pediatric Dentistry at the University of Maryland School of Dentistry. Prof. Tinanoff has authored or co-authored over 200 publications, primarily on fluoride mechanisms, antimicrobials, caries risk factors, early childhood caries and prevention. His recent books/monographs include: “The Oral Cavity” in Nelson Textbook of Pediatrics and “Use of Fluorides”, in Early Childhood Oral Health.

Questions and Answers

Before placement of SDF a radiograph should be taken and there should be no signs of irreversible pulpitis (pain, abscess, tooth mobility). I believe that such a diagnosis is within the training of general dentists.

Most people consider yearly reassessment of a child’s caries risk.

I am only aware of only one study that showed flossing reduces caries incidence. In this study dental flossing was conducted daily by trained dental hygienists. Other studies that did not have professional daily flossing did not show an effect.

The published studies on SDF mainly are concerned with applying it to cavitated lesions. I am not sure of its effect on enamel lesions.

You are so correct – the IAPD Caries Care Pathway has inadvertently left out enamel defects as a risk factor. We will make that correction.

Yes, different countries may have different risk factors, but certainly some may be universal risk factors, such as high frequency sugar consumption, parent has untreated caries, patient already presents with cavities, child has enamel defects.

Just a word about potassium iodide treatment to mask the discoloration from SDF.  Chemically, combining iodine with silver produces a yellow insoluble precipitate which may temporarily mask the discoloration. The question is:  Does potassium iodide affect the activity of silver in the lesion?


Studies have shown that semi-annual applications are more effective than annual applications.

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