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Caries Risk Assessment Tool

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