Chapter 8: Risk Assessment: Considerations for Coronal Caries

Caries risk assessment (CRA) is essential to delivering personalized/precision care in caries management. Limited formal evaluation and validation of existing CRA tools affects the ability to accurately predict new lesions. However, this should not prevent clinicians from assessing modifiable risk factors to guide preventive measures and address individual needs to personalize care. Since caries is a multifactorial and dynamic disease process, CRA is complex and impacted by multiple variables throughout the life course, demanding periodic re-assessment. Many factors can influence caries risk at the individual, family, and community level; however, unfortunately, caries experience is still considered one of the greatest indicators of future risk for caries. CRA tools that are validated, inexpensive, and easy to use should be developed and prioritized to help support decision-making to implement evidence based, and minimally invasive caries management strategies for coronal caries lesions in children, adults, and older persons. Efforts into developing CRA tools should include evaluation and reporting of internal and external validation information. In the future, approaches using big data and artificial intelligence may drive risk predictions, and cost-effectiveness analyses may help derive the selection of appropriate risk thresholds for decision-making. Because of the importance of CRA in the treatment planning and decision-making process, challenges for implementation including how to communicate risk to drive behavior change, development of tools that are quick and easy to integrate seamlessly into the busy clinical flow, and reimbursement for the time needed to implement should be considered.