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Caries risk assessment form for 0- to 5-year-olds[1,2] (for nondental health care providers)

Caries risk assessment form for 0- to 5-year-olds[1,2] (for nondental health care providers)
Factors High risk Moderate risk Protective
Social/biological risks
Mother/primary caregiver has active cavities Yes    
Parent/caregiver has life-time of poverty, low health literacy Yes    
Child has >3 between-meal sugar-containing snacks or beverages per day Yes    
Child uses a bottle or non-spill cup containing natural or added sugar frequently, between meals, and/or at bedtime Yes    
Child has special health care needs   Yes  
Child is a recent immigrant   Yes  
Protective
Child receives optimally fluoridated drinking water or fluoride supplements     Yes
Child has teeth brushed daily with fluoridated toothpaste     Yes
Child receives topical fluoride from health professional     Yes
Child has dental home/regular dental care     Yes
Clinical findings
Child has white spot lesions or enamel defects Yes    
Child has visible cavities or fillings or missing teeth due to caries Yes    
Child has plaque on teeth Yes    
Circling those conditions that apply to a specific patient helps the health care worker and parent/caregiver understand the factors that contribute to or protect from caries. Risk assessment categorization of low, moderate, or high is based on preponderance of factors for the individual. However, clinical judgment may justify the use of one factor (eg, frequent exposure to sugar-containing snacks or beverages, visible cavities) in determining overall risk.
Overall assessment of the child's dental caries risk:
  High
  Moderate
  Low
References:
  1. Ramos-Gomez FJ, Crall J, Gansky SA, et al. Caries risk assessment appropriate for the age 1 visit (infants and toddlers). J Calif Dent Assoc 2007; 35:687.
  2. American Dental Association Councils on Scientific Affairs and Dental Practice. Caries Risk Assessment Form (Ages 0-6). American Dental Association: Chicago, 2008.
Copyright © 2013-14 by the American Academy of Pediatric Dentistry and reproduced with their permission.
Updated with information from: Caries-risk assessment and management for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry; 2020:243.
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