Policy on use of a caries-risk assessment tool (CAT) for infants, children, and adolescents.

Background Over the past 15 years, strategies for managing dental caries increasingly have emphasized the concept of risk assessment. However, a practical tool for assessing caries risk in infants, children, and adolescents has been lacking. While assessment of caries risk undoubtedly will benefit from emerging science and technologies, the AAPD believes that sufficient evidence exists to support the creation of a framework for classifying caries risk in infants, children, and adolescents based on a set of physical, environmental, and general health factors. The table on page 20 represents a first step toward incorporating available evidence into a concise, practical tool to assist both dental and nondental health care providers in assessing levels of risk for caries development in infants, children, and adolescents. The AAPD intends this to be a dynamic instrument that will be evaluated and revised periodically as new evidence warrants. Clinicians using this tool should: 1. be able to visualize adequately a child’s teeth and mouth and have access to a reliable historian for nonclinical data elements; 2. assess all 3 components of caries risk–clinical conditions, environmental characteristics, and general health conditions; 3. be familiar with footnotes that clarify use of individual factors in this instrument; 4. understand that each child’s ultimate risk classification is determined by the highest risk category where a risk indicator exists (ie, the presence of a single risk indicator in any area of the “high-risk” category is sufficient to classify a child as being at “high risk;” the presence of at least 1 “moderate-risk” indicator and no “high-risk” indicators results in a “moderate-risk” classification; and a child designated as “low risk” would have no “moderate-risk” or “high-risk” indicators). Users of the AAPD caries-risk assessment tool (CAT) must understand the following caveats: 1. CAT provides a means of classifying dental caries risk at a point in time and, therefore, should be applied periodically to assess changes in an individual’s risk status. 2. CAT is intended to be used when clinical guidelines call for caries-risk assessment. Decisions regarding clinical management of caries, however, are left to qualified dentists (ideally, the dentist responsible for the child’s “dental home”). 3. CAT can be used by both dental and nondental personnel. It does not render a diagnosis. However, clinicians using CAT must be familiar with the clinical presentation of dental caries and factors related to caries initiation and progression. 4. Since clinicians with various levels of skill working in a variety of settings will use this instrument, advanced technologies, such as radiographic assessment and microbiologic testing (shaded areas), have been included but are not essential for using this tool.