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Caries risk assessment

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Caries risk assessment

All children are at risk of developing dental caries and, therefore, require preventive intervention. However, many children are at increased risk of developing caries. Identifying these children enables more intensive, enhanced prevention to be delivered to them. For each child, an individualised personal care plan comprising preventive and, if necessary, restorative care can be planned which is based on the child’s likelihood of developing caries.

Several factors are known to be associated with development of caries and, therefore, knowledge of them can inform a prediction of the risk of a child developing caries in the future. These factors include:23

  • clinical evidence of previous disease
  • dietary habits, especially frequency of sugary food and drink consumption
  • social history, especially socioeconomic status
  • use of fluoride
  • plaque control
  • saliva
  • medical history

Although several tools for caries risk assessment exist, there is no consensus on which is most effective and comparisons have proved difficult to conduct because of the low quality of the studies relating to different tools.35,36 The collective performance of risk assessment tools remains to be proved although there is evidence for the effective performance of individual tools in some situations/populations.36,37 Amongst the risk factors listed above, previous caries experience (decayed, missing due to caries or filled teeth) appears to be the more reliable predictors of caries risk. For delivery of community prevention, area-based socioeconomic status is often used.23,38-42 Therefore, any child who is resident in an area of relative disadvantage or who has decayed, missing or filled teeth is considered to be at increased risk of developing caries. Recently an association between caries and obesity has been identified but no causal relationship has been established between the two.43 A child’s risk of developing caries can change over time and therefore it is important to review the caries risk assessment regularly.

Regard any child who is resident in an area of relative disadvantage or who has any decayed, missing (due to caries) or filled teeth as at increased risk of developing caries.

  • The home postcode can be used to identify whether a child lives in a relatively disadvantaged area. For example, in Scotland, Quintiles 1-3 of the Scottish Index of Multiple Deprivation (SIMD) are considered to be relatively disadvantaged. A SIMD postcode lookup is available on the Public Health Scotland website.

Based on consideration of the other risk factors, your knowledge of the child and the history taken, use your subjective clinical judgement to assess whether or not the child is at increased risk of developing caries.

Use the caries risk assessment to inform the frequency of review radiographs (see Assessing carious lesions), provision of preventive interventions (see Caries prevention) and frequency of recall (see Recall).

Reassess the child’s caries risk at each assessment.