Caries Risk Assessment and Personalised Prevention: Clinical Guide

Caries risk assessment estimates the likelihood of new or progressing lesions by combining current disease indicators, biological and behavioural risk factors, and protective factors. It should lead to a documented, personalised prevention and review plan—not remain a form completed without action.

Contents

1. Assessment
2. Workflow
3. Risk table
4. Review
5. FAQs
6. References

What should be assessed?

Recent cavitated or active non-cavitated lesions, restorations placed because of caries, visible plaque, frequent fermentable carbohydrate exposure, fluoride exposure, saliva-related conditions, exposed roots, appliances and social or medical barriers all inform risk. Previous disease is a particularly important predictor, but professional judgement must consider the complete pattern.

A practical clinical workflow

1. Detect and assess lesion activity using clean, dry teeth and appropriate radiographs.
2. Identify disease indicators, risk factors and protective factors.
3. Assign a provisional risk category and explain the main drivers to the patient.
4. Agree achievable changes in fluoride use, diet, plaque control and professional prevention.
5. Manage existing lesions according to activity, cleansability, depth and restorability.
6. Set recall and radiographic review according to risk, then reassess rather than carrying the category forward indefinitely.

Risk-to-action table

Measure whether the plan is working

At review, compare lesion activity, plaque, behaviours, fluoride use and any new restorations with the baseline. A risk category can rise or fall. Avoid using a checklist as a diagnostic test with perfect accuracy; risk assessment supports shared decisions and should be updated when circumstances change.