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Cavity Free at Three Caries Risk Assessment for a Dental Office

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Cavity Free at Three Caries Risk Assessment For a Dental Office

Risk Factors – Children 0-6 Years

Mother/caregiver of child has had active decay in the past 12 months
Child sleeps with a bottle containing juice, formula, or anything other than water
Frequent use (between meals) of bottle/non-spill cup containing beverages other than plain water (nothing added)
Child has special healthcare needs (developmental, physical, medical, or mental that limit performance of adequate oral health by themselves/caregivers)
Frequent snacking (greater than 3x day/total) candy, carbohydrates, soda, sugared beverages, fruit juice
Child takes saliva-reducing meds (asthma, seizure, hyperactivity), hx of anemia/iron therapy, or daily liquid medications

Risk Factors – Oral Exam/Clinical Findings

Obvious decay present on the child’s teeth
Dental fillings present
Dental plaque present
White spots present
Inadequate salivary flow
Teeth missing due to caries

Protective Factors

Child lives in a fluoridated community and drinks tap water
Teeth cleaned with fluoridated toothpaste twice daily
Child has a dental home (i.e. establish patient of record in a dental office)

Plan/Assessment

Clinical caries risk? (At least one risk factor indicated, regardless of protective factors)

Patient-Driven Self Management Goals

How to Use This Form

  • This Caries Risk Assessment is designed for dental providers to evaluate young children (0 – 6 years old). Dental providers should use a more comprehensive risk assessment (such as ADA >6) to evaluate children over age 6.
  • The questions on this assessment determine clinical risk. See section below for billing guidance.
  • This form defines clinical caries risk as one or more risk factors, regardless of protective factors, but is ultimately based on the clinical judgment of the dental provider.
  • A caries risk assessment is recommended every time you see a pediatric patient and apply fluoride varnish.
  • This form is for required documentation, it is not meant to be patient-facing.

Engaging in a Conversation With Your Patient Around Oral Health

Like any patient-centered visit, ideally an oral health screening begins with a conversation that organically elicits information on oral health risk, provides affirmations about what they are doing right, includes open-ended questions, and helps your patient formulate oral health goals. For example:

  • Tell me how you keep your child’s teeth healthy?
  • Is there one thing you want to work on between now and the next time I see you? This should be a goal that is important to you and also feels like something you can actually get done. (Prompt from self-management goal list if needed)

Fluoride

If you’re deciding whether or not to prescribe fluoride for your patient, find out if their community water supply is fluoridated. Search your browser for “my water’s fluoride” to find county-level information published by the Centers for Disease Control (CDC).

Community water fluoridation has been proven safe and effective. Go to www.colorado.gov/cdphe/community-water-fluoridation or ilikemyteeth.org for more information.

Billing Guidance

The DentaQuest Office Reference manual provides definitions of high risk for billing purposes. Exact language must be used in documentation to qualify a child ages 0 – 4 as eligible for reimbursement of screening/fluoride varnish 4 times/year. Otherwise, the standard is 2 times/year. Child members ages 5 through 20 years may receive fluoride varnish 3 times/year regardless of risk. Refer to Medicaid guidelines for most recent information.

High Risk of Caries is indicated if a member has one or more of the following four criteria:

  1. Presents with demonstrable caries, has a history of restorative treatment, or has a history of dental plaque AND has a history of enamel demineralization, OR
  2. Is a child member (age 0 through 20 years old) of mothers with a high caries rate, especially with untreated caries, OR
  3. Is a child member (age 0 through 20 years old) who sleeps with a bottle containing anything other than water, or who is breastfeed throughout the night (at-will nursing), OR
  4. Is a child member (age 0 through 20 years old) who has special health needs.