Two downloadable ADA’s Caries Risk Assessment forms were developed as practice tools to help dentists evaluate a patient’s risk of developing caries. One form is for patients ages 0-6 years of age and the other is for patients over 6 years of age.

As with other forms, this assessment may be only a starting point for evaluating the patient’s health status. This is a tool provided for the use of ADA members. It is based on the opinion of experts who utilized the most up-to-date scientific information available.

ADA Caries Risk Assessment forms 12, 13 categorize a patient’s overall risk of developing caries, based on history and clinical examination. The forms are designated for patients ages 0 to 6 years 14 and older than 6 years. 13 Characteristics that place a patient at high caries risk include:

Management of dental caries should take into consideration a more conservative approach that includes age of the individual, risk for caries progression, active surveillance, application of preventive measures, potential for arresting the disease process, and restoration of lesions with interim therapeutic

approach that includes age of the individual, risk for caries progression, active surveillance, application of preventive measures, potential, for arresting the disease process, and restoration of lesions with interim therapeutic restorations.

Two downloadable ADA’s Caries Risk Assessment forms were developed as practice tools to help dentists evaluate a patient’s risk of developing caries. One form is for patients ages 0-6 years of age and the other is for patients over 6 years of age. Please help us improve the forms by completing a short survey.

Low Risk = no factors checked. Moderate Risk = only moderate risk factors checked. High Risk = at least one condition in high risk checked. Proposed treatment for improved prognosis: The American Dental Association recommends the use of in-office fluoride varnish or a 4 minute (APF) gel every 3–6 months and home use

Caries Risk Assessment Form — Children Age 6 and Over/Adults Patient Name: Chart #: Date: YES = CIRCLE YES YES YES YES Date: YES = CIRCLE YES = CIRCLE Assessment Date: Is this (please circle) base tine or recall Disease Indicators (Any one "YES" signifies likely "High Risk" and to do a bacteria

Universal Caries Risk Assessment Form (ALL AGES) Pa ent’s FirstName: Pa ent’s Last Name: Date of Birth: Provider Name: Date of Assessment: Low Risk (0 Points) Moderate Risk (1 Point) High Risk (2 Points) Contribu ng Condi ons.

2023年1月1日 · Assessment Date: Choose One: Baseline Assessment Follow-up Assessment . Check All That Apply . Assessment through interview and clinical examination . High Risk Moderate Risk Low Risk . 1. Risk Factors (Biological and Behavioral Predisposing Factors) Child sleeps with a bottle containing a liquid other . a. Yes . than water, or nurses on demand