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CLINICAL FINDINGS a White spots or visible decalcifications in the past 12 months n Yes n No a Obvious decay n Yes n No a Restorations (fillings) present n Yes n No • Visible plaque accumulation n Yes n No • Gingivitis (swollen/bleeding gums) n Yes n No • Teeth present n Yes n No • Healthy teeth n Yes n No Caries Risk: n Low n High Completed: n Anticipatory Guidance n Fluoride Varnish n Dental Referral Self Management Goals: n Regular dental visits n Wean off bottle n Healthy snacks n Dental treatment for parents n Less/No juice n Less/No junk food or candy n Brush twice daily n Only water in sippy cup n No soda n Use fluoride toothpaste n Drink tap water n Xylitol RISK FACTORS a Mother or primary caregiver had active decay in the past 12 months n Yes n No • Mother or primary caregiver does not have a dentist n Yes n No • Continual bottle/sippy cup use with fluid other than water n Yes n No • Frequent snacking n Yes n No • Special health care needs n Yes n No • Medicaid eligible n Yes n No ASSESSMENT/PLAN PROTECTIVE FACTORS • Existing dental home n Yes n No • Drinks fluoridated water or takes fluoride supplements n Yes n No • Fluoride varnish in the last 6 months n Yes n No • Has teeth brushed twice daily n Yes n No Adapted from Ramos-Gomez FJ, Crystal YO, Ng MW, Crall JJ, Featherstone JD. Pediatric dental care: prevention and management protocols based on caries risk assessment. J Calif Dent Assoc. 2010;38(10):746–761; American Academy of Pediatrics Section on Pediatric Dentistry and Oral Health. Preventive oral health intervention for pediatricians. Pediatrics. 2003; 122(6):1387–1394; and American Academy of Pediatrics Section of Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics. 2003;111(5):1113–1116. The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Copyright © 2011 American Academy of Pediatrics. All Rights Reserved. The American Academy of Pediatrics does not review or endorse any modifications made to this document and in no event shall the AAP be liable for any such changes. Treatment of High Risk Children If appropriate, high-risk children should receive professionally applied fluoride varnish and have their teeth brushed twice daily with an age-appropriate amount of fluoridated toothpaste. Referral to a pediatric dentist or a dentist comfortable caring for children should be made with follow-up to ensure that the child is being cared for in the dental home. Oral Health Risk Assessment Tool The American Academy of Pediatrics (AAP) has developed this tool to aid in the implementation of oral health risk assessment during health supervision visits. This tool has been subsequently reviewed and endorsed by the National Interprofessional Initiative on Oral Health. Instructions for Use This tool is intended for documenting caries risk of the child, however, two risk factors are based on the mother or primary caregiver’s oral health. All other factors and findings should be documented based on the child. The child is at an absolute high risk for caries if any risk factors or clinical findings, marked with a a sign, are documented yes. In the absence of a risk factors or clinical findings, the clinician may determine the child is at high risk of caries based on one or more positive responses to other risk factors or clinical findings. Answering yes to protective factors should be taken into account with risk factors/clinical findings in determining low versus high risk. Patient Name:____________________________________ Date of Birth:___________________ Date:___________________ Visit: n 6 month n 9 month n 12 month n 15 month n 18 month n 24 month n 30 month n 3 years n 4 years n 5 years n 6 years n Other___________________

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Page 1: Oral Health Risk Assessment Tool · experience enamel hypoplasia. Protective Factors Dental Home According to the American Academy of Pediatric Dentistry (AAPD), the dental home is

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___________________

Page 2: Oral Health Risk Assessment Tool · experience enamel hypoplasia. Protective Factors Dental Home According to the American Academy of Pediatric Dentistry (AAPD), the dental home is

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.

http://brightfutures.aap.org/clinical_practice.html
http://brightfutures.aap.org/clinical_practice.html
http://aap.org/oralhealth/PracticeTools.html
www.smilesforlifeoralhealth.org
http://www.aap.org/oralhealth//pact/ppt/Fluoride.ppt
http://www.aap.org/oralhealth//pact/ppt/Fluoride.ppt
Page 3: Oral Health Risk Assessment Tool · experience enamel hypoplasia. Protective Factors Dental Home According to the American Academy of Pediatric Dentistry (AAPD), the dental home is

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.

mailto:oralhealth%40aap.org?subject=
www.aap.org/oralhealth

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