Caries Risk Assessment
A caries risk assessment (CRA) is used to determine the patients’ risk for dental caries. Patients who are in certain socioeconomic factors (such as low income and low educational level), have health issues, or epidemiologic factors (having a past caries experience, especially in recent years) are the groups that are most vulnerable to dental caries. The key to preventing or managing caries is to determine potential risk factors and establish an individual treatment plan for each patient. Several CRA tools has been used in dentistry such as the American Dental Association (ADA), the caries management by risk assessment (CAMBRA), the American Academy of Pediatric Dentistry (AAPD) form, and Cariogram (computerized program). Evidence showed that CRA process is often not standardized in clinics, therefore making them less efficient to determine the correct caries risk level of patients. Due to the lack of specific instructions and calibration, different clinicians might utilize CRA tools differently than others and thus lower the accuracy of CRA process. The purpose of this article is to emphasize the CRA guidelines in order to improve the performance and accuracy in clinics.
The original CRA form was created and published in the Journal of the California Dental Association in 2003 – known as CAMBRA CRA form (Figure 1A and 1B). There are three sections in CAMBRA CRA form: disease indicators, risk factors and protective factors. Figure 2 shows the caries balance/imbalance diagram which represents the CAMBRA CRA.
Disease indicators – is referred to clinical observation of the presence of current or past dental caries disease activity. These signs do not describe what initially caused the disease or how to treat it, but it only serves as a predictors of dental caries disease. Disease indicators can be visible cavities (decay), x-ray pictures, white spot lesions, and recent restorations.
Risk factors – are biological factors that increase the chance of having new caries. Patient with low caries risk will have low chance of getting new caries lesion in the future and vice versa. They may be linked to caries disease but do not necessarily cause it. Risk factors include 1) bacteria that cause caries, 2) visible plaque, 3) frequent snacking, 4) deep pits and fissures 5) recreational drug use, 6) absence of saliva, 7) saliva-reducing factors, 8) exposed roots, and 9) oral appliances.
Protective factors – are biological factors that prevent caries lesions in the future. The protective factors include fluoridated water; regularly using fluoridated toothpaste, low-fluoride oral rinses and xylitol; and receiving topical applications of fluoride, chlorhexidine, calcium phosphate agents, and adequate saliva flow.
Time has proven that this disease cannot be controlled by restoration alone. Assessment of the caries risk of the individual patient is a critical component in determining an appropriate and successful treatment. CRA tools support clinicians in making decisions based on research, clinical expertise, and the patient’s preferences and needs. Motivating patients to adhere to professional recommendations is also an important key in achieving successful outcomes in caries management. Along with fluoride, new products are available to assist clinicians with noninvasive management strategies.
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Young DA. Caries management by risk assessment – Guidelines to improve caries risk level assignments. Journal of California Dental Association. Jan 2019;47:49-55.