Caries Risk Assessment Template

Caries Risk Assessment Checklist
Dentist’s name: _________________ Date: _________
Child’s name: ___________________ School: ________ First assessment Y / N
Risk Factors/Indicators
A “YES” in the shaded section indicates that the child is likely to
be at high risk of or from caries
Please circle the
most appropriate
answer
Age 0–3 with caries (cavitated or non-cavitated) Yes No
Age 4–6 with dmft>2 or DMFT>0 Yes No
Age 7 and over with active smooth surface caries (cavitated or
non-cavitated) on one or more permanent teeth
Yes No
New caries lesions in last 12 months Yes No
Hypomineralised permanent molars Yes No
Medical or other conditions where dental caries could put the
patient’s general health at increased risk
Yes No
Medical or other conditions that could increase the patient’s risk of
developing dental caries
Yes No
Medical or other conditions that may reduce the patient’s ability to
maintain their oral health, or that may complicate dental treatment
Yes No
The following indicators should also be considered when
assessing the child’s risk of developing caries
Age 7–10 with dmft>3 or DMFT>0 Yes No
Age 11–13 with DMFT>2 Yes No
Age 14–15 with DMFT>4 Yes No
Deep pits and fissures in permanent teeth Yes No
Full medical card Yes No
Sweet snacks or drinks between meals more than twice a day Yes No
Protective Factors
A “NO” in this section indicates the absence of protective
factors which may increase the child’s risk of developing caries
Fissure sealants Yes No
Brushes twice a day or more Yes No
Uses toothpaste containing 1000 ppm F or more Yes No
Fluoridated water supply Yes
No/Don’t
know
Is this child at high risk of or from caries? YES NO
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