Table 2 (Part 2).

Caries risk assessment guidelines 0–6 years.

The dental caregiver has the responsibility of making a caries risk assessment and then deciding on a caries management plan for the patient that leads from the risk assessment and a personalized assessment of the needs of the individual patient. These guidelines for assessing the risk as low, moderate, high or very high can assist in the process. 1. Low risk. If there are protective factors, very few or no risk factors, no disease indicators, and the protective factors prevail, the patient is at low risk. 2. Moderate risk. If there are no disease indicators and the risk factors and protective factors appear to be balanced then a moderate caries risk determination is appropriate. If in doubt move the moderate to a high classification. 3. High risk. If there is a “YES” in column 3 (one or both disease indicators) the patient is very likely at high risk. Even if there are no “yes” disease indicators the patient can still be at high risk if the risk factors definitively outweigh the protective factors. Parent or caregiver with current or recent dental decay most likely indicates high caries risk for the child. 4. Very high risk. If the above process indicates high risk and the existing or recent decay is severe and/or extensive a designation of “very high” caries risk is appropriate and will guide a more aggressive caries management plan. Any items checked “yes” should also be used as topics to modify behavior or determine additional therapy.

Use the following modified caries balance to visualize the overall result and determine the risk level. It may be helpful to allocate scores for each “yes” checked on the risk assessment form with a score of−1 for yes's in column 1, and +2 and +3 respectively for yes's in columns 2 and 3. The final total will help guide the risk level decision. Low = −4 to −1; Moderate = 0 to +3; High = +4 to +13; Very high = +14 to +18 and/or is a high risk level plus extensive and/or severe recent or existing decay.

Additional caries-related components for caries management and caregiver/patient counseling.Record in patient chart at each visit.

Dietary counseling to reduce frequency and amount of fermentable carbohydrates, especially sucrose, fructose (high fructose corn syrup) and continual fruit juice (e.g., apple juice). Record number and type of daily snacks, drinks and juices used.

Bottle used continually, bottle used in bed or nursing on demand. Record details provided.

Fluoride (F) toothpaste use. Note frequency and amount used at each visit.

Record all recommended therapy such as F toothpaste, F varnish, use of silver diamine fluoride in appropriate cases. Record usage provided by parent/caregiver.

Record medications at each visit and check for changes.

Record participation in assistance programs such as “school lunches,” “head start,” appropriate to the state or country.

Child has developmental problems/child has special care needs (CHSCN).

Inadequate saliva flow and related medications, medical conditions, or illnesses.

Discuss self-management goals with parent/caregiver and set two goals together at each visit. Provide in writing.