Two downloadable ADA’s Caries Risk Assessment forms were developed as practice tools to help dentists evaluate
a patient’s risk of developing caries. One form is for patients ages 0-6 years of age and the other is for patients
over 6 years of age.
Please help us improve the forms by completing a short survey.
The forms can also be used as communication tools with the patient or patient’s guardian to highlight potential risk
factors. Dental offices are encouraged to share this form with their patients. The Caries Risk Assessment Forms may
be downloaded, reproduced and republished for non-commercial purposes without first obtaining written permission
from the ADA. All other ‘Terms of Use’ apply.
The forms were developed through the efforts of the Councils on Dental Practice (CDP) and Scientific Affairs (CSA),
along with cariology subject matter experts, and with input from the Council on Access, Prevention and Interprofes-
sional Relations (CAPIR). The ADA thanks these volunteer members for their efforts in developing the forms.
The caries risk assessment forms are not intended to include all possible risk factors. The risk factors selected are
intended to provide patient with information that may help them lower the caries risk over time, while also provid-
ing a form that can be integrated into a busy practice setting. It is important to recognize that the scientific evidence
related to caries risk assessment continues to develop. Some information included in these tools is based on expert
opinion. The ADA will periodically update these forms based on: 1) member feedback regarding their usefulness,
and; 2) advances in science. ADA member-users are encouraged to share their opinions with the Councils on Dental
Practice or Scientific Affairs.
These forms are not a substitute for a dentist’s clinical judgment. The assessments cannot address every aspect of
a patient’s health, and should not be used as a replacement for the dentist’s experience and judgment. Additional or
more focused assessment may be appropriate for patients with specific oral health concerns. As with other forms,
this assessment may be only a starting point for evaluating the patient’s total health status.
Find more information on caries risk factors at: http://ebd.ada.org/SearchResult.aspx?Search=caries%20risk
General Instructions:
The forms are designed to include factors that are easily observed or discovered during routine oral health evaluations.
The first two sections, “Contributing Conditions” and “General Health Conditions,” can be completed by a dental team
member as determined by the dentist. “Clinical Conditions” should be determined by the dentist.
Colors are used to indicate low risk (green), moderate risk (yellow) or high risk (red). For each risk factor, circle or
check the boxes of the conditions that apply under the low, moderate or high risk columns. Low Risk = only conditions
in “Low Risk” column present; Moderate Risk = only conditions in “Low” and/or “Moderate Risk” columns present; High
Risk = one or more conditions in the “High Risk” column present. Changes in the risk level may be tracked using the
form with implementation of risk reduction strategies and with therapeutic intervention.
A patient’s observed risk level may be modified (increased or decreased) based on the dentist’s clinical
judgment, review of the form and other pertinent information. For example, the observation of teeth missing due
to caries may not be regarded as high risk for a follow- up assessment. Alternatively, the presence of risk factors not
listed on the forms may indicate an increase in the overall risk of caries.
ADA Caries Risk Assessment Form Completion Instructions