Quality Resource Guide l Caries Risk Assessment and Management for Adults 2nd Edition 3 www.metdental.com consultations or in-person visits. Tele dentistry has proved to be beneficial for remote dental screening and can serve as a method to save valuable chair time. 22 Practitioners should consider incorporating a formal caries risk assessment in their practice. Several electronic record systems have available CRA modules. There are also several CRA instruments applicable to adults that are available online, either at no-cost or for a fee. Some examples of no-cost sources include: • The ADA CRA (for those older than 6) <https://www.ada.org/-/media/project/ada- organization/ada/ada-org/files/resources/ public-programs/give-kids-a-smile/gkas_ caries_risk_assessment_forms.pdf > • The AAPD (for those 6 years and older) <https://www.aapd.org/media/Policies_ Guidelines/BP_CariesRiskAssessment.pdf > • The Cariogram - Caries Risk Assessment Apps for iOS: <https://apps.apple.com/us/app/cariogram- dental-caries-risk/id1378035435> Caries Risk Assessment for Android: <https://play.google.com/store/apps/ details?id=com.appbites.cariogram&hl=en_ US&gl=US> • CAMBRA <https://www.frontiersin.org/articles/10.3389/ froh.2021.657518/full> Caries Detection and Assessment: Evidence indicates that previous caries experience is the only consistently reliable caries indicator. 23,24 Indicators are the signs of the disease. White spot lesions or initial lesions, cavitated lesions or recent restorations are all considered risk indicators for dental caries. Early caries detection is essential to properly assess the patient’s current and future risk before there is frank evidence of disease. Visual examination of a clean dry surface is necessary to optimize detection. 5 Surfaces that are covered in biofilm or saliva may appear to be sound and early signs of the disease may be missed (see Figure 2). Because not all dental caries lesions progress to cavitation, 25,26 determining caries lesion activity is of utmost importance and closely tied to caries risk. Determining which lesion will progress to cavitation has been a challenge confirmed only by longitudinal monitoring. However, monitoring of these lesions must go beyond placing non- Figures 2 a & b First molar covered in saliva and after drying. Note the widening of the fissure and the white opacity at the entrance of the fissure on the distal portion visible once the surface is dried. Figure 3 ICDAS and ADA Caries Criteria cavitated lesions on “watch”. Using visual criteria that categorize lesions beyond “watch” and “cavitated” allows the clinician to detect early changes and adjust management accordingly. 27-29 Some recent reports suggest that visual examination using a more granular assessment such as with the International Caries Detection and