Table 3 (Part 2).

Caries risk assessment guidelines for ages 6 years through adult.

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 can assist in the process. Determining the caries risk as low, moderate, high or extreme - guiding principles 1. Low risk. If there are no disease indicators, very few or no risk factors and the protective factors prevail, the patient is most likely at low risk. Usually this is obvious. 2. Moderate risk. If the patient is not obviously at high, or extreme risk and there is doubt about low risk, then the patient should be allocated to moderate risk and followed carefully, with additional chemical therapy added. An example would be a patient who had a root canal as a result of caries 4 years ago, and has no new clinical caries lesions, but has exposed tooth roots and only uses a fluoride toothpaste once a day. 3. High and extreme risk. One or more disease indicators most likely signals at least high risk. If there is also hyposalivation the patient is likely at extreme risk. Even if there are no positive disease indicators the patient can still be at high risk if the risk factors definitively outweigh the protective factors. Think of the caries balance: visualize the balance diagram as illustrated below. 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 = −8 to −2; Moderate = −1 to +2; High = +3 to +17; Extreme = +18 to +30 and/or is a high risk level plus measured or observed hyposalivation. Use the caries balance to visualize the overall result and determine the risk level for the individual patient.

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. Record number and type of daily snacks, drinks and juices used.

Oral hygiene and fluoride (F) toothpaste use. At each visit note frequency and amount used.

Record all recommended therapy such as F toothpaste, F varnish, chlorhexidine and usage by patient.

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 or adult has developmental problems or special care needs (CHSCN).

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

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