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How do I know if I’m a high risk or clinically vulnerable patient?

Person having a dental check up

Whilst at the dentist, they will be doing a risk assessment for you. This will help them to develop a plan and tailor any advice they give to you. These risk assessments include:

  • Tooth decay (dental caries) risk.
  • Gum disease (periodontal disease) risk.
  • Oral cancer risk.
  • Tooth wear risk.

Some other risk assessments may be done, depending on your dentist, your job and many other factors. 

You will be put into a high, medium, or low risk category. The risk category helps to plan how often you need checkups, helps plan treatments required (if any), and helps your dental professional to give you oral health advice specific to you.

To decide which category you fall into, your dental professional will ask you questions about your dietary and cleaning habits. They will also look at your dental history and whether there is any active disease present. Other factors which are taken into account include family history of disease, and smoking and alcohol intake.

If you are at low risk for tooth decay and gum disease, you could consider using a manual toothbrush and dental floss. With correct use, these are sufficient for cleaning, and have less impact on the environment. They are also cheaper.

If you are at higher risk for tooth decay and gum disease, you should focus on optimum cleaning. This includes using an electric toothbrush and interdental brushes. These are more effective at plaque removal, which is key to preventing dental diseases. The investment you make in buying these tools will pay off when it comes to avoiding dental treatment.

You can discuss this with your dental professional and ask them where you fall in terms of risk for dental diseases.

The table below gives a brief summary of the low risk vs high risk category. This IS NOT a complete risk assessment, but simply gives an idea of the main risk factors you may be aware of)

Higher riskLow risk
Tooth decay (dental caries) risk.Has needed fillings in last 12 months
Added sugar in diet (in hot drinks, snacks between meal times, more than one sweet snack per day)
Poor cleaning – not brushing twice daily, no interdental cleaning
Using a fluoride free toothpaste or using a fluoride containing toothpaste only once daily
No fillings
Low sugar diet
Good plaque control
Brushes twice daily
Daily interdental cleaning
Use of fluoride toothpaste twice daily
Gum disease (periodontal disease) risk.Signs and symptoms of active mild gum disease (gingivitis) or bone loss seen on xrays
Poor plaque control – not brushing twice daily, no interdental cleaning
Family history of tooth loss due to gum disease
Smoking or chewing tobacco, or recreational drug use
Certain medical conditions and medications e.g. diabetes, blood pressure medications
Healthy gums and no bone loss on x-rays
Good plaque control
Brushes twice daily
Daily interdental cleaning
Oral cancer risk.Relevant family history
Tobacco use – smoking, chewing and vaping
Increased alcohol intake (above government recommended limits)
HPV infection
Tooth wear risk.High acid intake from food and drink
Over-brushing (e.g. scrub brushing with a manual toothbrush)
Medical conditions e.g. gastric reflux or regular vomiting
Low acid intake
Good brushing technique

You could look at these factors to help you decide whether you are low risk or not. Ultimately the only way to know if you are at high risk or dental diseases or clinically vulnerable, is to discuss this with a dental professional.

Useful resources to find out more:

About Gemma Wheeler

GDC number: 259369. Gemma qualified from Cardiff University School of Dentistry with BDS(Hons) in 2015. She went on to complete her Foundation Training and a further two years in the Armed Forces, primarily based around Wiltshire. She now works in a private practice in Plymouth.

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