Name of the Condition

• Risk for Dental Caries, Low (ICD-10-CM Code: Z91.841)

Summary

• Risk for dental caries, low, indicates a lower likelihood of developing tooth decay, also known as cavities. This classification acknowledges individuals at reduced risk due to factors like good oral hygiene and healthy dietary habits.

Causes

• Appropriate oral hygiene
• Regular dental check-ups
• Low sugar intake
• Use of fluoride-containing products

Risk Factors

• Consistent consumption of sugary foods and drinks (absence of which contributes to low risk)
• Poor oral hygiene practices (absence of which contributes to low risk)
• Lack of regular dental visits (absence of which contributes to low risk)

Symptoms

• Not applicable as this classification denotes a low risk rather than a presence of symptoms.

Diagnosis

• Evaluation based on dental history, hygiene practices, diet, and regular dental assessments.

Treatment Options

• For maintaining low risk: Continue regular dental cleanings, brushing, and flossing.
• Use of fluoride treatments or dental sealants as preventive measures.

Prognosis and Follow-Up

• Positive outlook with continued low risk for dental caries.
• Regular dental check-ups remain crucial to maintaining oral health and ensuring risk remains low.

Complications

• Without maintaining good oral hygiene and regular dental care, risk may increase over time leading to potential complications such as caries.

Lifestyle & Prevention

• Maintain regular oral hygiene including brushing twice a day and flossing daily.
• Adopt a balanced diet with limited sugar intake.
• Schedule routine dental visits for preventive care and early detection.

When to Seek Professional Help

• Changes in oral health habits.
• Incurrence of symptoms suggesting increased risk for dental caries, despite initially low risk.

Additional Resources

• American Dental Association (ADA) - www.ada.org
• Centers for Disease Control and Prevention (CDC) Oral Health Resources - www.cdc.gov/oralhealth

Tips for Medical Coders

• Ensure proper coding by confirming patient's low-risk status through documentation of oral health and preventive measures.
• Avoid coding errors by distinguishing between patients with an increased risk and those classified under “low risk”.