How this tool works

Caries risk assessment weighs three kinds of finding. CAMBRA, the ADA forms and the AAPD forms all use them:

Disease indicators are signs that caries is already active: new lesions, white spots, recent restorations for caries, or teeth lost to caries. They don't cause caries, but they show that the factors that do are present.
Risk factors make new lesions more likely. Examples are frequent sugar, heavy plaque, low saliva, appliances and exposed roots.
Protective factors lower the risk: fluoride in water, toothpaste, varnish or rinses, a dental home, and normal saliva.

The checklist is our own wording. Each item lists which of the three published tools includes an equivalent factor. There are two lists. Ages 0–6 add family decay, bottles and sippy cups. Ages 7 and up add roots, restorations, saliva and medical factors.

The rule

We don't use point scores. The tool applies a plain rule that follows the decision logic the published tools share:

Step	Finding	Risk level
1	Any disease indicator	High
2	No disease indicator; 2 or more risk factors, and more risk factors than protective factors	High
3	No disease indicator; any other combination with a risk factor	Moderate
4	No risk factors, but no protective factors either	Moderate
5	No risk factors and at least one protective factor	Low
+	Clinical judgment ticked	One level up, to high at most
+	Ages 7+: high risk plus severe hyposalivation	Extreme

Step 1 reflects CAMBRA's guidance that a disease indicator very likely means high risk. It also matches where the ADA and AAPD forms place these findings. Steps 2 and 3 express "risk factors outweighing protective factors" by counting. Step 4 follows the ADA, which rates the absence of fluoride or a dental home as moderate, and CAMBRA's advice to choose moderate when in doubt about low. The extreme level copies CAMBRA's idea for ages 6 through adult: high risk plus measured or observed hyposalivation. CAMBRA defines hyposalivation as a stimulated flow under 0.5 mL/min, against more than 1.0 mL/min as normal.

The result shows the reasons step by step. The chart note lists every ticked item, so a colleague can check the call.

Why no point scores

CAMBRA scores protective factors −1, risk factors +2 and disease indicators +3, then reads the total against printed bands. The bands contain a known inconsistency. In the 2021 paper, the 6-through-adult extreme band runs from +18 to +30. But the 8 risk factors and 4 disease indicators listed in the paper add up to at most +28 (8 × 2 + 4 × 3). Rather than copy a scale that can't reach its own top band, the tool counts factors in the open and lets disease indicators decide.

Where the published tools differ

Single high-risk factors. On the ADA form, one high-column answer makes the risk high. Examples are a bottle with anything but water at bedtime under 6, frequent between-meal sugar over 6, or severe dry mouth. Our counting rule is gentler for a single factor. Tick "raise one level" when one factor is severe.
Number of lesions. For patients over 6, the ADA form rates 1 or 2 new lesions in 36 months as moderate and 3 or more as high. CAMBRA and the AAPD treat any new lesion as a disease indicator, and so does this tool.
Age split. CAMBRA and the ADA split at age 6, and the AAPD splits at 5/6. The checklists here split at 6/7, as the ADA does. The prevention plan for ages 0–6 follows the AAPD 0–5 pathway, and the plan for 7–17 follows the AAPD pathway for 6 and over.
Very high risk under 6. CAMBRA's 0–6 form has a "very high" level for high risk plus extensive or severe decay. This tool stops at high for that age group. Use clinical judgment and the high-risk plan.

The prevention plan

The plan changes with the risk level and age group. It shows the source of each line:

Children and teens: recall, radiograph, fluoride and sealant intervals come from the AAPD care pathways. High risk means a recall every 3 months, with professional topical fluoride at each one. Moderate risk means every 6 months.
Fluoride agents: the ADA recommends 2.26% fluoride varnish or 1.23% APF gel for people at risk. From age 6 it adds prescription 0.5% fluoride gel or paste, or a 0.09% fluoride rinse. Under 6, varnish is the only professional agent.
Sealants: the ADA/AAPD guideline finds sealants effective at preventing and arresting pit-and-fissure lesions on primary and permanent molars. The AAPD notes expert opinion favors sealing permanent molars even in low-risk children.
Adults: recall intervals and home fluoride follow CAMBRA 2021. That means every 12 months at low risk, every 6 months at moderate risk, every 4–6 months at high risk, and every 3–4 months at extreme risk. At high and extreme risk, CAMBRA adds prescription 5,000 ppm toothpaste twice a day.

For caries experience as a number, use the DMFT / DMFS Calculator. For fluoride toothpaste amounts and supplements in children, see the Kids Fluoride Calculator.

Frequently asked questions

Is this the CAMBRA form or the ADA form?

No. CAMBRA forms are licensed CC BY-NC-ND and the ADA forms are "all rights reserved", so we don't reproduce either. This is our own checklist, built from the factors that CAMBRA, the ADA and the AAPD have in common. Each item shows which of them includes it. The original forms are linked under Sources.

Why does one disease indicator make the risk high?

New lesions or recent restorations show that the factors causing caries are already at work. CAMBRA says a disease indicator very likely means high risk, and the ADA and AAPD forms put these findings in their high-risk column.

Why doesn't the tool give a CAMBRA point score?

Scores add a false sense of precision, and the published bands have a known inconsistency. The CAMBRA 2021 bands for ages 6 to adult run to +30, but the items listed add up to at most +28. The tool uses a plain rule you can check: count risk factors against protective factors, and let any disease indicator decide.

How often should a high-risk child have fluoride varnish?

The AAPD care pathways suggest professional topical fluoride every 3 months at high risk and every 6 months at moderate risk. Under age 6, 2.26% fluoride varnish is the only professional agent the ADA and AAPD recommend.

What makes the risk extreme?

In CAMBRA's 6-through-adult system, extreme risk is high risk plus hyposalivation that you measure or observe. The tool uses the same idea: tick severe hyposalivation (stimulated flow under 0.5 mL/min, or obvious dry mouth) with a high result.

Sources

Featherstone JDB, Crystal YO, Alston P, Chaffee BW, Doméjean S, Rechmann P, Zhan L, Ramos-Gomez F. Frontiers in Oral Health 2:657518. Evidence-Based Caries Management for All Ages-Practical Guidelines. 2021. CAMBRA forms for ages 0–6 and 6 through adult, risk bands, the extreme-risk definition and adult recall and fluoride protocols. Forms © UC Regents, CC BY-NC-ND 4.0: cited, not reproduced. Accessed October 26, 2026.
Featherstone JDB, Alston P, Chaffee BW, Rechmann P. Journal of the California Dental Association 47:25-34. Caries Management by Risk Assessment (CAMBRA®): An Update for Use in Clinical Practice for Patients Aged 6 Through Adult. 2019. Cited from the 2021 paper's reference list.
Featherstone JD, Domejean-Orliaguet S, Jenson L, Wolff M, Young DA. Journal of the California Dental Association 35:703-7, 710-3. Caries risk assessment in practice for age 6 through adult. 2007. Cited from the 2021 paper's reference list.
American Dental Association. Caries Risk Assessment and Management (Oral Health Topics). updated July 18, 2023. Links the ADA forms and summarizes the 2013 topical fluoride, 2016 sealant and 2018 nonrestorative treatment guidelines. Accessed October 26, 2026.
American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry 2025:325-31. Caries-risk Assessment and Management for Infants, Children, and Adolescents (latest revision 2022). 2022. Risk factors for ages 0–5 and 6+, and the care pathways (recall, radiographs, fluoride, sealants) by risk level. Accessed October 26, 2026.
American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry 2025:372-8. Fluoride Therapy (latest revision 2023). 2023. Professional fluoride at least twice a year; 5% NaF varnish the only professional agent under 6; prescription 0.5% fluoride gels and pastes for high-risk patients over 6. Accessed October 26, 2026.
Weyant RJ, Tracy SL, Anselmo TT, et al. (ADA Council on Scientific Affairs Expert Panel). Journal of the American Dental Association 144(11):1279-1291. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. 2013. Linked from the ADA topic page. Accessed October 26, 2026.
Slayton RL, Urquhart O, Araujo MWB, et al. Journal of the American Dental Association 149(10):837-849.e19. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. 2018. Linked from the ADA topic page. Accessed October 26, 2026.

Last reviewed October 26, 2026 by the Dental Health Time editorial team, against the sources above. How we review.