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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