CLINICAL FINDINGS
a Whitespotsorvisible decalcificationsinthepast12 months n Yes n No
a Obviousdecay n Yes n No
a Restorations(fillings)present n Yes n No
• Visibleplaqueaccumulation n Yes n No
• Gingivitis(swollen/bleeding gums) n Yes n No
• Teethpresent n Yes n No
• Healthyteeth n Yes n No
Caries Risk:n Low n HighCompleted:n AnticipatoryGuidancen FluorideVarnishn DentalReferral
Self Management Goals: n Regulardentalvisits n Weanoffbottle n Healthysnacksn Dentaltreatmentforparents n Less/Nojuice n Less/Nojunkfoodorcandyn Brushtwicedaily n Onlywaterinsippycup n Nosodan Usefluoridetoothpaste n Drinktapwater n Xylitol
RISK FACTORS
a Motherorprimarycaregiverhad activedecayinthepast12 months n Yes n No
• Motherorprimarycaregiverdoes nothaveadentist n Yes n No
• Continualbottle/sippycupuse withfluidotherthanwater n Yes nNo
• Frequentsnacking n Yes n No
• Specialhealthcareneeds n Yes n No
• Medicaideligible n Yes nNo
ASSESSMENT/PLAN
PROTECTIVE FACTORS
• Existingdentalhome n Yes n No
• Drinksfluoridatedwaterortakes fluoridesupplements n Yes n No
• Fluoridevarnishinthelast 6months n Yes n No
• Hasteethbrushedtwicedaily n Yes n No
AdaptedfromRamos-GomezFJ,CrystalYO,NgMW,CrallJJ,FeatherstoneJD.Pediatricdentalcare:preventionandmanagementprotocolsbasedoncariesriskassessment.J Calif Dent Assoc. 2010;38(10):746–761;AmericanAcademyofPediatricsSectiononPediatricDentistryandOralHealth.Preventiveoralhealthinterventionforpediatricians.Pediatrics. 2003;122(6):1387–1394;andAmericanAcademyofPediatricsSectionofPediatricDentistry.Oralhealthriskassessmenttimingandestablishmentofthedentalhome.Pediatrics. 2003;111(5):1113–1116.Therecommendationsinthispublicationdonotindicateanexclusivecourseoftreatmentorserveasastandardofmedicalcare.Variations,takingintoaccountindividualcircumstances,maybeappropriate.Copyright©2011AmericanAcademyofPediatrics.AllRightsReserved.TheAmericanAcademyofPediatricsdoesnotrevieworendorseanymodificationsmadetothisdocumentandinnoeventshalltheAAPbeliableforanysuchchanges.
Treatment of High Risk ChildrenIfappropriate,high-riskchildrenshouldreceiveprofessionallyappliedfluoridevarnishandhavetheirteethbrushedtwicedailywithanage-appropriateamountoffluoridatedtoothpaste.Referraltoapediatricdentistoradentistcomfortablecaringforchildrenshouldbemadewithfollow-uptoensurethatthechildisbeingcaredforinthedentalhome.
Oral Health Risk Assessment ToolTheAmericanAcademyofPediatrics(AAP)hasdevelopedthistooltoaidintheimplementationoforalhealthriskassessmentduringhealthsupervisionvisits.ThistoolhasbeensubsequentlyreviewedandendorsedbytheNationalInterprofessionalInitiativeonOralHealth.Instructions for UseThistoolisintendedfordocumentingcariesriskofthechild,however,tworiskfactorsarebasedonthemotherorprimarycaregiver’soralhealth.Allotherfactorsandfindingsshouldbedocumentedbasedonthechild.
Thechildisatanabsolutehighriskforcariesifanyriskfactorsorclinicalfindings,markedwithaasign,aredocumentedyes.Intheabsenceofariskfactorsorclinicalfindings,theclinicianmaydeterminethechildisathighriskofcariesbasedononeormorepositiveresponsestootherriskfactorsorclinicalfindings.Answeringyestoprotectivefactorsshouldbetakenintoaccountwithriskfactors/clinicalfindingsindetermininglowversushighrisk.
PatientName:____________________________________DateofBirth:___________________Date:___________________Visit:n 6monthn 9monthn 12monthn 15monthn 18monthn 24monthn 30monthn 3yearsn 4yearsn 5yearsn 6yearsn Other___________________
Oral Health Risk Assessment Tool GuidanceTiming of Risk AssessmentTheBrightFutures/AAP“RecommendationsforPreventivePediatricHealthCare,”(ie,PeriodicitySchedule)recommendsallchildrenreceiveariskassessmentatthe6-and9-monthvisits.Forthe12-,18-,24-,30-month,andthe3-and6-yearvisits,riskassessmentshouldcontinueifadentalhomehasnotbeenestablished.ViewtheBrightFutures/AAPPeriodicitySchedule—http://brightfutures.aap.org/clinical_practice.html.
Risk Factorsa Maternal Oral Health Studieshaveshownthatchildrenwithmothersorprimarycaregiverswhohavehadactivedecayinthepast12monthsareat greaterrisktodevelopcaries.This child is high risk.
Maternal Access to Dental CareStudieshaveshownthatchildrenwithmothersorprimarycaregiverswhodonothavearegularsourceofdentalcareareatagreaterrisktodevelopcaries.Afollow-upquestionmaybeifthechildhasadentist.
Continual Bottle/Sippy Cup UseChildrenwhodrinkjuice,soda,andotherliquidsthatarenotwater,fromabottleorsippycupcontinuallythroughoutthedayoratnightareatanincreasedriskofcaries.Thefrequentintakeofsugardoesnotallowfortheaciditproducestobeneutralizedorwashedawaybysaliva.Parentsofchildrenwiththisriskfactorneedtobecounseledonhowtoreducethefrequencyofsugar-containingbeveragesinthechild’sdiet.
Frequent SnackingChildrenwhosnackfrequentlyareatanincreasedriskofcaries.Thefrequentintakeofsugar/refinedcarbohydratesdoesnotallowfortheaciditproducestobeneutralizedorwashedawaybysaliva.Parentsofchildrenwiththisriskfactorneedtobecounseledonhowtoreducefrequentsnackingandchoosehealthysnackssuchascheese,vegetables,andfruit.
Special Health Care NeedsChildrenwithspecialhealthcareneedsareatanincreasedriskforcariesduetotheirdiet,xerostomia(drynessofthemouth,sometimesduetoasthmaorallergymedicationuse),difficultyperformingoralhygiene,seizures,gastroesophagealrefluxdiseaseandvomiting,attentiondeficithyperactivitydisorder,andgingivalhyperplasiaorovercrowdingofteeth.Prematurebabiesalsomayexperienceenamelhypoplasia.
Protective FactorsDental HomeAccordingtotheAmericanAcademyofPediatricDentistry(AAPD),thedentalhomeisoralhealthcareforthechildthatisdeliveredinacomprehensive,continuouslyaccessible,coordinatedandfamily-centeredwaybyalicenseddentist.TheAAPandtheAAPDrecommendthatadentalhomebeestablishedbyage1.Communicationbetweenthedentalandmedicalhomesshouldbeongoingtoappropriatelycoordinatecareforthechild.Ifadentalhomeisnotavailable,theprimarycareclinicianshouldcontinuetodooralhealthriskassessmentateverywell-childvisit.
Fluoridated Water/SupplementsDrinkingfluoridatedwaterprovidesachildwithsystemicandtopicalfluorideexposure,aprovencariesreductionintervention.Fluoridesupplementsmaybeprescribedbytheprimarycareclinicianordentistifneeded.ViewfluorideresourcesontheOralHealthPracticeToolsWebPagehttp://aap.org/oralhealth/PracticeTools.html.
Fluoride Varnish in the Last 6 MonthsApplyingfluoridevarnishprovidesachildwithhighlyconcentratedfluoridetoprotectagainstcaries.Fluoridevarnishmaybeprofessionallyapplied.Foronlinefluoridevarnishtraining,accesstheChildOralHealthandFluorideVarnishModulesintheSmilesforLifeNationalOralHealthCurriculum,www.smilesforlifeoralhealth.org.
Tooth Brushing and Oral HygienePrimarycareclinicianscanreinforcegoodoralhygienebyteachingparentsandchildrensimplepractices.Infantsshouldhavetheirmouthscleanedafterfeedingswithawetsoftwashcloth.Onceteetheruptitisrecommendedthatchildrenhavetheirteethbrushedtwiceaday.Forchildrenundertheageof2determinedtobeatmoderateorhighriskforcaries,itisappropriatetorecommendasmearoffluoridatedtoothpasttwiceperday.Childrenolderthan2yearsoldshoulduseapea-sizedamountoffluoridatedtoothpastetwiceaday.ViewfluorideresourcesintheAAPProtectingAllChildren’sTeethCurriculumFluorideModulehttp://www.aap.org/oralhealth//pact/ppt/Fluoride.ppt.
Therecommendationsinthispublicationdonotindicateanexclusivecourseoftreatmentorserveasastandardofmedicalcare.Variations,takingintoaccountindividualcircumstances,maybeappropriate.Copyright©2011AmericanAcademyofPediatrics.AllRightsReserved.TheAmericanAcademyofPediatricsdoesnotrevieworendorseanymodificationsmadetothisdocumentandinnoeventshalltheAAPbeliableforanysuchchanges.
Clinical Findings
aWhite Spots/Decalcifications This child is high risk. Whitespotdecalcificationspresent—immediatelyplacethechildinthehigh-risk category.
aObvious Decay This child is high risk. Obviousdecaypresent—immediatelyplacethechildinthehigh-riskcategory.
aRestorations (Fillings) Present This child is high risk. Restorations(Fillings)present—immediatelyplacethechildinthehigh-risk category.
Visible Plaque AccumulationPlaqueisthesoftandstickysubstancethataccumulatesontheteethfromfooddebrisandbacteria.Primarycareclinicianscanteachparentshowtoremoveplaquefromthechild’steethbybrushingandflossing.
GingivitisGingivitisistheinflamationofthegums.Primarycareclinicianscanteachparentsgoodoralhygieneskillstoreducetheinflammation.
Healthy TeethChildrenwithhealthyteethhavenosignsofearlychildhoodcariesandnootherclinicalfindings.Theyarealsoexperiencingnormaltoothandmouthdevelopmentandspacing.
FormoreinformationabouttheAAP’[email protected]/oralhealth.
