Caries Risk Assessment Systems Overview

Caries Risk Assessment Systems

• Caries Risk Assessment (CRA) includes the ADA Caries Risk Assessment, AAPD Caries Risk Assessment Tool (CAT), Cariogram, and Caries Management by Risk Assessment (CAMBRA).

ADA Caries Risk Assessment

• Evaluates factors such as fluoride exposure, sugary food/drink consumption, family caries history, and dental visitation frequency.
• Takes into account general health conditions and clinical variables.
• Classifies risk levels into low, moderate, and high.

AAPD Caries Risk Assessment Tool (CAT)

• Designed exclusively for infants, children, and adolescents.
• Assesses biological factors like sugary snacks intake, special healthcare needs, recent immigration, low socioeconomic status, and caregiver's active caries.
• Protective factors include fluoride exposure, daily brushing, topical fluoride, and regular dental care.
• Clinical findings focus on decayed or missing teeth, white spot lesions, and plaque presence.
• Risk levels categorized as low, moderate, and high.

AAPD Caries Risk Management Protocol

• Structured using evidence-based literature and expert panel insights.
• Takes into account risk levels and the level of cooperation from patients and parents.
• Tailored to the child's age, including diagnostics, interventions, and restorations.

Cariogram

• Provides a visual representation showing the relationship between caries and various etiological factors.
• Predicts future caries risk based on multiple variables.

Factors in a Cariogram

• Considers bacteria levels, dietary habits, susceptibility factors (fluoride exposure, saliva secretion), and past caries experiences.
• Displays risk in a pie chart format indicating the percentage chance of avoiding new caries.

CAMBRA Development

• Developed post two conferences in California starting in 2003, with large-scale pilot tests leading to modifications in assessment forms in 2007.

CAMBRA Assessment Forms

• Separate forms for ages 0-6 and for ages 7 to adult.

Risk Categories for Ages 7-Adult

• Includes disease indicators, risk factors, protective factors, and classifies risk levels as low, moderate, high, or extreme.

CAMBRA Foundation

• Based on assessing risk level and clinical judgment.

CAMBRA Protocols

• Comprises diagnostics, intervention, and restorative measures.
• Compliant patients show a significant reduction in caries.

International Caries Classification and Management System (ICCMS)

• Developed from extensive literature analysis and global expert consensus.
• Acts as a systematic guide for clinicians to devise management plans based on caries risk.

ICCMS Protocols by Risk Level

• Varies based on risk level and includes diagnostics, interventions, and restorations.

Care Planning for Low Caries Risk

• Focuses on primary prevention and positive feedback/education to sustain oral health.
• Encourages reviewing habits that contributed to low risk and recommends continued care.

Care Planning for Moderate Caries Risk

• Addresses factors that heighten caries risk; supports current protective factors.
• Emphasizes motivational interviewing for behavior change, dietary improvements, and enhancing daily biofilm removal.
• Recommends dietary additions like xylitol products and caries preventive foods.

Care Planning for High and Extreme Caries Risk

• Advocates improved biofilm removal and dietary counseling.
• Recommends xylitol product use and antimicrobial therapy.
• Initial fluoride varnish applications suggested, followed by applications every 3-4 months.

Continued Care Assessment

• Involves biofilm control assessment, caries risk reassessment, clinical detection for demineralization, and compliance evaluation.
• Incorporates radiographs based on risk level and adjustments to the caries management protocol.

X-ray Frequency Based on Caries Risk

• Extreme high risk: Every 6 months
• High risk: Once a year
• Moderate risk: Every 18 months
• Low risk: Every 2-3 years