CARIES-RISK ASSESSMENT TOOL (CAT)

Caries-risk indicators	Low Risk	Moderate Risk	High Risk
Clinical conditions	No carious teeth in past 24 months No enamel demineralization (enamel caries “white-spot lesions”) No visible plaque; no gingivitis	Carious teeth in the past 24 months 1 area of enamel demineralization (enamel caries “white-spot lesions”) Gingivitis*	Carious teeth in the past 12 months More than 1 area of enamel demineralization (enamel caries “white-spot lesions”) Visible plaque on anterior (front) teeth Radiographic enamel caries  High titers of mutans streptococci  Wearing dental or orthodontic appliances† Enamel hypoplasia‡
Environmental characteristics	Optimal systemic andtopical fluoride exposure§ Consumption of simple sugar or foods strongly associated with caries initiation primarily at mealtimes|| High care giver socioeconomic status¶ Regular use of dental care in an established dental home	Suboptimal systemic fluoride exposure with optimal topical exposure§ Occasional (i.e., 1-2) between-meal exposures to simple sugars or foods strongly associated with caries Midlevel caregiver socioeconomic status (i.e., eligible for school lunch program or SCHIP) Irregular use of dental services	Suboptimal topical fluoride exposure§ Frequent (i.e., 3 or more) between-meal exposures to simple sugars or foods strongly associated with caries Low-level caregiver socioeconomic status (i.e., eligible for Medicaid) No usual source of dental care
General health conditions			Children with special health care needs# Conditions impairing saliva composition/flow**
Reproduced with permission from the American Academy of Pediatric Dentistry from Pediatric Dentistry Reference Manual 2003–2004(25)7:18–20.

 

*Although microbial organisms responsible for gingivitis may be different than those primarily implicated in dental caries, the presence of gingivitisis an indicator of poor or infrequent oral hygiene practices and has been associated with caries progression.

†Orthodontic appliances include both fixed and removable appliances, space maintainers, and other devices that remain in the mouth continuously or for prolonged time intervals and which may trap food and plaque, prevent oral hygiene, compromise access of tooth surfaces to fluoride, or otherwise create an environment supporting dental caries initiation.

‡Tooth anatomy and hypoplastic defects, such as poorly formed enamel, developmental pits, and deep pits, may predispose a child to develop dental caries.

§Optimal systemic and topical fluoride exposure is based on the American Dental Association/American Academy of Pediatrics guidelines for exposure from fluoride drinking water and/or supplementation and use of a fluoride dentifrice.

||Examples of sources of simple sugars include carbonated beverages, cookies, cake, candy, cereal, potato chips, French fries, corn chips, pretzels, breads, juices, and fruits. Clinicians using caries-risk assessment should investigate individual exposures to sugars known to be involved in caries initiation.

¶National surveys have demonstrated that children in low-income and moderate-income households are more likely to have dental caries and more decayed or filled primary teeth than children from more affluent households. Also, within income levels, minority children are more likely to havecaries. Thus, sociodemographic status should be viewed as an initial indicator of risk that may be offset by the absence of other risk indicators.

#Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

**Alteration in salivary flow can be the result of congenital or acquired conditions, surgery, radiation, medication, or age-related changes in salivary function. Any condition, treatment, or process known or reported to alter saliva flow should be considered an indication of risk unless proven otherwise.

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