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ADA form helps dentists evaluate caries risk

In an effort to lower the incidence of dental disease in young children, the ADA Board of Trustees approved user-friendly caries risk assessment forms for dentists and patients at its December 2008 meeting.

The ADA councils on Scientific Affairs and Dental Practice developed the forms as practice tools to help dentists evaluate patient risk for developing caries. Two forms were developed, one for patients 0-6 years and one for patients over 6 years of age.

The forms are available for downloading on, and dentists are encouraged to use them as a communication tool with the patient or the patient's family/guardian as appropriate, to highlight potential risk factors. Members are urged to check for updates.

"Dental treatments or preventive measures have always been based on risk assessments of one form or another, either empirical or data-based. As more information becomes available and clinical tools are developed to facilitate the use of that information, it's important for dentistry to take a leadership role in implementing patient-centered, evidence-based clinical decision-making for dental caries, for the periodontal diseases, for oral changes related to oral cancers, indeed, for all oral maladies," said Dr. Michael P. Rethman, CSA chair.

Although the forms are tailored to address specific concerns in children under 6 and patients over 6 years of age, both take into consideration contributing conditions such as fluoride exposure and whether or not the family has a dental home, as well as general health and existing clinical conditions. They also factor in general health conditions such as developmental, physical, medical or mental disabilities that prevent or limit oral health care.

Clinical conditions measured by the forms include whether the patient already has a history of caries that have been restored, untreated caries, teeth missing due to caries and visible plaque.

The under 6 form emphasizes the importance of acid exposures associated with sippy cups and non-meal time bottles while the form for patients over 6 years of age includes the assessment of medications associated with reduced salivary flow and the presence of exposed root surfaces.

"The Council on Dental Practice wanted to devise a form that could be easily incorporated into a busy practice and could help organize treatment and communicate with the patient/guardian," said CDP chair, Dr. Frank Graham. "Colors were assigned to indicate risk levels. This makes it easy for dentists to coordinate with the ADA clinical recommendations on Professionally Applied Topical Fluoride."

Green indicates a low risk, yellow for moderate and red indicates the patient is at high risk for caries. The colors also give another indicator to the patient/guardian: which behaviors or findings are more associated with caries risk. A risk score was devised to make it easy for the dentist to compare the patient's risk at subsequent examinations and help communicate that to the patient/guardian.

In addition to the CSA and CDP, representatives from the ADA Council on Access, Prevention and Interprofessional Relations were part of the intercouncil working group that developed the forms. The American Academy of Pediatric Dentistry and the Western Caries Management by Risk Assessment Coalition also weighed in on the importance of bringing forward a tool that will be beneficial for the profession.

"The AAPD is working diligently with the ADA to assemble a clinically relevant, scientifically supportable caries risk assessment tool," said Dr. John Rutkauskas, AAPD executive director.

Dr. Douglas Young, who represents the CAMBRA Coalition, which includes the East, Central and West groups said, "We're thrilled the ADA is taking this on. Getting the support of the ADA is monumental in how we manage this disease and a step in the right direction to serving the underserved."

The ADA stresses that the risk assessment tool is only a beginning. Its purpose is to aid the dentist in tailoring and coordinating guidelines and therapies based on the patient's risk and the dentist's clinical judgment. The forms also tell dentists, "It's important to realize that the scientific evidence related to caries risk assessment continues to develop" and as is the case with all ADA forms, there will be periodic updates based on member feedback and advances in science.