The condition of children’s teeth and the associated
tissues are critical to their well-being. A child with poor dentition
may be suffering with chronic pain and thus may have difficulties
achieving proper nutrition. He or she may also be at risk of malocclusion
and life-threatening infection. Further, dental problems such as
early childhood caries can affect the secondary dentition if not
addressed, with consequences extending through the life span. Caries
are the most common dental problem encountered; the National Health
and Nutrition Examination Survey of 1999–2004 showed that 42% of
children from ages 2 to 11 have some evidence of decay in their
primary teeth, and 21% of children from ages 6 to 11 have
evidence of decay in their secondary dentition.2 Unfortunately,
a large proportion of these children have untreated caries.1 At
higher risk of caries are children living in low-income and moderate-income
households, children of color, and children with special health
care needs.2,3 However, decay can and does occur in
children of all backgrounds. As the health professional most likely
to encounter new mothers and their infants at a young age, the pediatric
clinician has a unique opportunity to provide anticipatory guidance
that may help to prevent or slow the development of caries. Therefore,
it behooves the provider to evaluate a child’s current
dental status from an early age, to advise the child and the primary
caregiver about positive and negative practices that may bear on
future dentition, and to assist the family in establishing a dental
The evaluation of a child’s current dental status begins
with age-appropriate history gathering regarding the child’s
current practices. Data should be accumulated to assess risk for caries
(see Table 13-1).4 Fixed
events such as known decay, special health care needs, low socioeconomic
status, and familial history of caries raise the child’s
overall assessed risk for developing decay and should be noted in
early life. However, mutable practices such as the use of a dental
home, exposure to fluoride, exposure to simple sugars, and frequency
of brushing are potentially modifiable by behavioral intervention
and are critical to assess with every health supervision visit.
In addition, sucking habits, including bottle, pacifier, and thumb,
should be addressed to evaluate for the risk of malocclusion.
Table 13-1. AAPD Caries-Risk Assessment Tool (CAT) |Favorite Table|Download (.pdf)
Table 13-1. AAPD Caries-Risk Assessment Tool (CAT)
|Risk Factors to Consider||Risk Indicators|
|(For each item below,
circle the most accurate response found to the right under “Risk
|Part 1. History
(determined by interviewing the parent/primary caregiver)|
|Child has special health care needs, especially any that impact
motor coordination or cooperation*||Yes||No|
|Child has condition that impairs saliva (dry mouth)†||Yes||No|
|Child’s use of dental home (frequency of routine
dental visits) ||None||Irregular||Regular|
|Child has decay ||Yes||No|
|Time lapsed since child’s last cavity||< 12 months||12–24 months||> 24 ...|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.