Risk Assessment

Overview

Caries risk assessment (CRA) is regarded as a cornerstone in modern preventive dentistry for clinical decision-making. CRA is defined as the process of establishing the probability of an individual patient to develop carious lesions over a certain period of time, or the likelihood that there will be a change in size or activity of lesions already present [1]. Caries risk assessment can also be applied to populations or groups of patients.

Use and Application

CRA can be informal and intuitive (“educated guess”) or performed with the aid of various models/tools based on preformed checklists or interactive computer programs. A caries risk assessment should be done at the patients first dental clinic visit and then regularly throughout life at scheduled recalls.

Effectiveness and Efficacy

Past dental caries experience is the best single predictor of future dental caries but multivariate models tend to display better accuracy than single predictors [2]. The best accuracy comes from models combining biological, behavioural and lifestyle-related factors. There is however no perfect method to predict caries and no evidence to support the use of one model over another. The ability to predict future caries is greater among preschool and schoolchildren than later in life, with an accuracy that can exceed 80% [2]. Validated tools for root caries prediction are lacking. There is emerging evidence that preventive interventions based on CRA can increase patient behavioural adherence and reduce the onset of new caries.

Safety

There is no safety issues associated with CRA. A high proportion of false positives and false negative cases increase the risk of overtreatment and undertreatment. Stigmatizing effects might occur for individuals highlighted as high risk or borderline patients.

Cost Effectiveness

CRA aims to allocate resources to those with the highest need. The risk assessment should be followed by a structured action plan of preventive measures tailored to the individual risk level. Patients’ willingness to pay and the cost-effectiveness is yet to be determined in long-term prospective trials.

Recommendations

The beneficial effects of CRA clearly outweigh harm and should therefore be strongly recommended.

Key Further Reading

Guidance Document

ACFF Members can download the full reference document for Risk Assessment.

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