A retrospective analysis1 of electronic patient records (n=3,810 baseline; n=1,315 with follow-up; years 2009 through 2015) from a university pediatric dental clinic showed that formal caries risk assessment was associated with prediction of future caries risk in patients 6 years of age or younger. The 17 caries risk assessment items are listed in the following table.

Risk Indicators Protective Items Clinical Findings
 Bottle use in bed
 Daily brushing with fluoride dentifrice  Visually obvious tooth decay or white spot lesions
 Continual use of bottle during the day
 Caregiver uses xylitol  Heavy dental plaque
 Bottle use with contents other than milk or water
 Drinks fluoridated water  Presence of restorations placed within last 2 years
 Presence of dental decay in caregiver or sibling(s)
 Fluoride varnish applied in past 6 months
 Snacking >3 times daily
 Lives in a community with a fluoridated water supply
 Inadequate salivary flow
 Low socioeconomic status
 Salivary-reducing medications
 Special care needs (developmental impairment)

The thirteen caries risk assessment items presented in italics in the table were statistically significant indicators of student/resident practitioner designation of caries high risk.  In turn, practitioner-assigned baseline caries risk designation was strongly associated with clinically evident tooth decay at follow-up.  Of all caries risk assessment items, only clinically evident decay or white spots at baseline was independently and statistically significantly associated with evident decay at follow-up.  Limitations of the analysis identified by the authors included how well the findings from the “predominantly urban, low-income population from a fluoridated, high-resource area” could be generalized to other types of populations and whether the behaviors and assessments of the student and resident dental providers at the university-based clinic reflected those of more established dentists or trainees in other university settings.

The ADA has recently updated and expanded the Oral Health Topic resource page on caries risk assessment and management to include discussion of various methods and tools for caries risk assessment, including the ADA Caries Classification System (CCS), and strategies for caries prevention and risk management.


  1. Chaffee BW, Featherstone JD, Gansky SA, Cheng J, Zhan L. Caries Risk Assessment Item Importance: Risk Designation and Caries Status in Children under Age 6. JDR Clin Trans Res 2016;1(2):131-42.

Prepared by: Center for Scientific Information, ADA Science Institute