American Academy of Pediatric Dentistry Caries Risk Assessment Tool (CAT)

	Low Risk	Moderate Risk	High Risk
Clinical Conditions	No carious teeth in past 24 months No enamel demineralization (enamel caries "white spot lesions") No visible plaque; no gingivitis	Carious teeth in the past 24 months One area of enamel demineralization (enamel caries "white spot lesions") Gingivitis	Carious teeth in the past 24 months More than one area of enamel demineralization (enamel caries "white spot lesions") Visible plaque on anterior (front) teeth Radiographic enamel caries High titers of mutans streptococci Wearing dental or orthodontic appliances Enamel hypoplasia
Environmental Characteristics	Optimal systemic and topical fluoride exposure Consumption of simple sugars or foods strongly associated with caries initiation primarily at mealtimes High caregiver socioeconomic status Regular use of dental care in an established dental home	Suboptimal systemic fluoride exposure with optimal topical exposure Occasional (i.e., 1-2) between-meal exposures to simple sugars or foods strongly associated with caries Mid-level caregiver socioeconomic status (i.e., eligible for school lunch program or SCHIP) Irregular use of dental services	Suboptimal topical fluoride exposure Frequent (i.e., 3 or more) between meal exposures to simple sugars or foods strongly associated with caries Low- level caregiver socioeconomic status (i.e., eligible for Medicaid) No usual source of dental care Active caries present in the mother
General Health Conditions			Children with special health care needs Conditions impairing saliva composition/flow

Complete AAPD Policy Statement with CAT

Each child's overall assessed risk for developing decay is based on the highest level of risk indicator circled above (i.e., a single risk indicator in any area of the "high risk" category classifies a child as being "high risk").
Apply fluoride varnish according to risk status: Low - not needed; Moderate - 2 times/year; High - 4 times/year