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Everything You Need to Know About the Caries Risk Assessment

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As of two Fridays ago, I had the pleasure of performing a Caries Risk Assessment on one of my classmates in our Intro to Clinic class. The Caries Risk Assessment is a tool that one of our professors, Dr. Sharples, is extremely enthusiastic about. For those of you who do not know what this is, the Caries Risk Assessment is a preventative tool used to help prevent the demineralization of tooth structure. In the past, using traditional GV Black dentistry, dentists were preventing cavitations and treating existing cavitations surgically and the mentality was “to cut is to cure”. Now, in addition to treating existing caries surgically, dentists are also preventing the progression of caries with a therapeutic model of managing the disease which is where this assessment comes into play. 



The Caries Risk Assessment is a series of questions that takes about five minutes to complete and review but helps the dentist determine the recall interval and course of preventative measures. The first five questions are designed to identify indicators that are commonly associated with a high risk. These include: frequent or prolonged between meal exposure/day to sugary or starchy food or drinks, visibly cavitated lesion or radiographic penetration of the dentin, 3 or more cavitated or non-cavitated lesions or restorations in the last 24 months, teeth missing due to caries in the past 24 months, and severe dry mouth (xerostomia). If a patient has any of these, an “x” is placed in the box to the right of the category and will count as 10 points towards the total risk score. The remaining 14 questions indicate factors that can contribute to increased risk but are not as significant. These include: no fluoride exposure through drinking water, does not receive regular dental care in a dental office, special health care needs (over age 14), eating disorders, smokeless tobacco use, medications that reduce salivary flow, drug/alcohol abuse, 1 or 2 cavitated or non-cavitated carious lesions or restorations in the last 24 months, deep pits and fissures/unusual tooth morphology, exposed root surfaces present, visible plaque, restorations with overhangs and/or open margins, dental/orthodontic appliances (fixed or removable), and interproximal restorations (1 or more). These factors score 1 point for each “x” and require multiple yes answers to lead to moderate or high risk if no high risk indicators are present. The total score is then derived by simply adding the number of indicators (10 points each) and factors (1 point each) to determine if the patient is at low (total score of zero), moderate (score 1-9) or high risk (score >10).


Once the score is determined, the dentist must make recommendations to the patient to help prevent the demineralization progression. Patients at low risk are recommended to get bitewing radiographs every 24-36 months, recall exams every 6-12 months, and OTC fluoride toothpaste twice daily. Moderate risk patients are recommended to have bitewings every 12-24 months, recall exams every 4-6 months, xylitol gum or candies, OTC fluoride toothpaste twice daily, and OTC 0.05% NaF rinse daily. High risk patients should have bitewings taken every 6-18 months, recall exams every 3-4 months, xylitol gum or candies, Rx 1.1% NaF toothpaste twice daily, and Rx chlorhexidine gluconate 0.12% rinse once daily. At the bottom of the form are additional recommendations which include varnishes and other prescribed treatments if the dentist feels they would be necessary. The patient receives another sheet to take home with their recommendations and each assessment has four columns for the dentist to make additional changes during recall appointments.


Although there is no way to eliminate caries, I believe that the Caries Risk Assessment is a great tool to begin the process of minimizing caries progression. Through completing this assessment and having my partner complete it on myself, it was evident that almost everybody has at least a moderate risk to caries. However, with the recommended guidelines and through promoting great oral hygiene, we all can help slow the progression of caries one tooth at a time.