Caries Risk Assessment Form

How to use this form:

Circling those conditions that apply to a specific patient helps the practitioner, patient, and their grown-up understand the factors that contribute to or protect from caries. Classification as low, moderate, or high caries risk is based on combination of factors for the individual patient. However, clinical judgment may justify the use of one factor (e.g. frequent exposure to sugar-containing snacks or beverages) in determining overall risk.