1.3 Caries Risk Classification

The concept of risk-based dental caries management is based on the belief that dentists can use clinical indicators to classify caries risk status to predict future caries experience, as well as on the assumption that preventive services and recall frequency can be planned more appropriately with that information in mind. Although a number of caries risk classification schemes are available,12–19 there is no single system of caries risk assessment that has been shown to be valid and reliable.20

Nevertheless, risk-based caries management is a practical and important concept for safety net dental clinics where demand often exceeds resources, which must be prioritized. For example, setting short recall intervals for patients at low risk for dental caries does not benefit the patient and drains clinic resources. Similarly, failing to provide enhanced prevention services for patients at higher risk at more frequent recall intervals may result in dental caries that could have been prevented and also unnecessarily draws down a clinic’s restorative care capacity.

This caries risk classification table is adapted from a caries risk classification and management model developed by the Indian Health Service (IHS).21 In developing its model, IHS drew heavily upon a tool developed by the American Dental Association (ADA).14 ADA has since introduced a revised caries risk assessment tool for use by its members.22,23

Risk Assessment

Sound clinical judgment is necessary to determine dental caries risk and appropriate care. Gathering information from and about patients is critical in determining caries risk. The key factor driving caries risk assessment is the presence of active cavitated smooth-surface lesions at the time of the examination. The IHS caries risk classification model identifies risk categories based on active caries, preventive strategies, and recall frequency. In this model, dentists consider other factors that may modify what a patient’s risk level and recall interval would be based on active caries status alone.

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