Caries Risk Assessments

Caries Risk assessment is a valuable tool for the prevention and management of dental caries. Dentistry has entered an era of personalized care in which targeting care to individuals or groups based on their risk has been advocated. There are many risk tools and models in the literature.

The International Caries Detection and Assessment System is an evidence-based, preventively oriented strategy that classifies the visual appearance of a lesion (es decir, detection, whether or not disease is present), characterization/monitoring of the lesion once detected (es decir, assessment), and culminates in diagnosis.¹⁰ 

The system is scored on clean, dry teeth and cautions against using sharp explorers or probes in order to prevent damage to the tooth.¹

The International Caries Classification and Management System™ (ICCMS™) takes the results of the ICDAS classification and translates them into a risk-assessed caries management system individualized for the patient: 

ADA CCS⁹ incorporates the ICDAS and other classification systems into a broader classification system that also incorporates radiographic presentation of the approximal surface and the clinical presentation. The ADA CCS is conducted on clean teeth, using compressed air, adequate lighting, and a rounded explorer or ball-end probe. Radiographs should also be available. The ADA CCS is designed to include both noncavitated and cavitated lesions and to “describe them by clinical presentation without reference to a specific treatment approach.” Además, the ADA CCS—contrasted with some caries classification systems—links “clinical lesion presentation to radiographic findings and provides an approach to identify, when possible, caries lesion activity over time.”

ADA Caries Risk Assessment standards categorize a patient’s overall risk of developing caries, based on history and clinical examination. Characteristics that place a patient at high caries risk include:

• Sugary Foods or Drinks: Bottle or sippy cup with anything other than water at bedtime (ages 0 a 6 años) or frequent or prolonged between meal exposures/day (ages >6 años)
• Eligible for Government Programs: WIC, Head Start, Medicaid or SCHIP (ages 0 a 6)
• Caries Experience of Mother, Caregiver and/or other Siblings: Carious lesions in the last 6 meses (ages 0 a 14 años)
• Special Health Care Needs: developmental, physical, medical or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers (ages 0 a 14 años)
• Chemo/Radiation Therapy (ages >6 años)
• Visual or Radiographically Evident Restorations/Cavitated Carious Lesions: Carious lesions or restorations in last 24 meses (ages 0 a 6 años)
• Noncavitated (incipient) Carious Lesions: New lesions in the last 24 meses (ages 0 a 6 años)
• Cavitated or Noncavitated (incipient) Carious Lesions or Restorations (visually or radiographically evident): 3 or more carious lesions or restorations in last 36 meses (ages >6 años)
• Teeth Missing Due to Caries: Any (ages 0 a 6 años) or in the past 36 meses (ages >6 años)
• Severe Dry Mouth (Xerostomia; ages >6 años) or Visually Inadequate Salivary Flow (ages 0 a 6 años)