ADA Caries Risk Assessment Forms (ages 0-6 and over 6): the one-page grid that turns risk factors into low, moderate or high

What it says#

Each form is a single page with a patient block (name, birth date, date, age, initials), three sections and three columns headed Low Risk, Moderate Risk and High Risk, which the ADA's instructions say are colored green, yellow and red. The user circles or checks the conditions that apply, and the rule at the bottom does the arithmetic: Low Risk = only conditions in the Low Risk column present; Moderate Risk = only conditions in the Low and/or Moderate Risk columns present; High Risk = one or more conditions in the High Risk column present. An overall assessment line (Low, Moderate, High) and a space for instructions to the caregiver or patient finish the page. The clinical judgment of the dentist may justify a change of the patient's risk level, increased or decreased, based on the form and other information; the example the ADA gives is that missing teeth may not be regarded as high risk for a follow-up patient.

The 0-6 form has twelve items. Contributing Conditions: fluoride exposure through drinking water, supplements, professional applications or toothpaste (yes is low, no is moderate); sugary foods or drinks, including juice, soft drinks, energy drinks and medicinal syrups (primarily at mealtimes is low, frequent or prolonged between-meal exposures per day is moderate, a bottle or sippy cup with anything other than water at bedtime is high); eligible for government programs, WIC, Head Start, Medicaid or SCHIP (yes is high); caries experience of mother, caregiver and/or other siblings (no carious lesions in the last 24 months is low, lesions in the last 7 to 23 months is moderate, lesions in the last 6 months is high); dental home, an established patient of record in a dental office (no is moderate). General Health Conditions: special health care needs, developmental, physical, medical or mental disabilities that prevent or limit adequate oral health care by the patient or caregivers (yes is high). Clinical Conditions: visually or radiographically evident restorations or cavitated carious lesions (none in the last 24 months is low, any in the last 24 months is high); noncavitated, incipient, carious lesions (new lesions in the last 24 months is high); teeth missing due to caries (yes is high); visible plaque (yes is moderate); dental or orthodontic appliances, fixed or removable (yes is moderate); salivary flow (visually adequate is low, visually inadequate is high).

The over-6 form has eighteen items. Contributing Conditions: fluoride exposure (no is moderate); sugary foods or drinks (primarily at mealtimes is low, frequent or prolonged between-meal exposures per day is high); caries experience of mother, caregiver and/or other siblings, for patients ages 6 to 14 (7 to 23 months is moderate, last 6 months is high); dental home, an established patient of record receiving regular dental care (no is moderate). General Health Conditions: special health care needs (yes over age 14 is moderate, yes ages 6 to 14 is high); chemo or radiation therapy (yes is high); eating disorders (yes is moderate); medications that reduce salivary flow (yes is moderate); drug or alcohol abuse (yes is moderate). Clinical Conditions: cavitated or noncavitated carious lesions or restorations, visually or radiographically evident (none new in the last 36 months is low, 1 or 2 new in 36 months is moderate, 3 or more in 36 months is high); teeth missing due to caries in the past 36 months (yes is high); visible plaque, unusual tooth morphology that compromises oral hygiene, one or more interproximal restorations, exposed root surfaces, restorations with overhangs or open margins or open contacts with food impaction, and dental or orthodontic appliances (each yes is moderate); severe dry mouth, xerostomia (yes is high).

The instructions document explains a few of the choices. No fluoride exposure is regarded as a moderate risk. Sugars hide in processed foods under many names (the document lists brown sugar through table sugar, from the USDA 2020-2025 guideline). Reduced salivary flow may be a side effect of more than 400 medications, and the document names the classes: antihistamines, decongestants, central analgesics, sedatives, ACE inhibitors and calcium channel blockers, muscle relaxants, incontinence and Parkinson's drugs, antidepressants and antacids among them. And the point of repeating the form is stated plainly: a patient's risk for developing caries is a moving target, the form determines the risk on a particular day, and changes in the level may be tracked with risk reduction strategies and therapeutic intervention.

Who it applies to#

Every patient, split at age 6, and every member of the team. The ADA's instructions say the forms were designed to include factors that are easily observed or discovered during routine oral health evaluations; the first two sections can be completed by a dental team member as determined by the dentist, and Clinical Conditions should be determined by the dentist. The forms can also be used as communication tools with the patient or guardian to highlight risk factors, and dental offices are encouraged to share them with patients.

They are a member tool, not a mandate. The form says it is provided for the use of ADA members and is based on the opinion of experts using the most up-to-date scientific information available; the instructions say the forms may be downloaded, reproduced and republished for noncommercial purposes without written permission. They are also explicitly incomplete: not intended to include all possible risk factors, with some items based on expert opinion, and not a substitute for a dentist's clinical judgment.

What changed#

The forms themselves have not: both carry copyright 2009 and 2011, the ADA's instructions say it plans to periodically update them based on member feedback and advances in science, and the version on the topic page, last updated July 18, 2023, is that 2011 edition. What has changed is the guidance around them, which the ADA's topic page now summarizes in one place: the 2013 topical fluoride recommendations (2.26% fluoride varnish, or 1.23% acidulated phosphate fluoride gel, or prescription-strength 0.5% gel or paste or 0.09% rinse for patients 6 and older, and only 2.26% varnish for children under 6); the 2016 ADA and AAPD sealant guideline, which found sealants prevent and arrest pit-and-fissure caries and can minimize progression of noncavitated occlusal lesions; the CDT code D1354 adopted in 2016 for interim caries arresting medicament application, which the page says allows coding the off-label use of silver diamine fluoride; and the 2018 clinical practice guideline on nonrestorative treatments with its 11 recommendations by lesion type, surface and dentition. The form supplies the risk level those documents are addressed to.

Where the source is#

The link under the title is the ADA's Caries Risk Assessment and Management page in its Oral Health Topics library, last updated July 18, 2023, which links both forms, the educational version of the 0-6 form and the nine-page completion instructions document, all free PDFs on ada.org; the row-by-row column placements above were read from the form PDFs themselves, including the position of each yes and no on the page. The ADA's terms allow the forms to be downloaded, reproduced and republished for noncommercial purposes without written permission; the JADA patient pages the instructions recommend are for handout photocopying only.