Items on Left side of screen:

Note that not all the items below will appear on every screen; the page contents will depend on the patient's age and Target Tooth, as well as other selections you make.

Target Tooth:

The first section asks about the condition of the specific kind of Target Tooth you indicated, the type of tooth that has been exposed to saliva in the mouth for at least 12 months. Select the one condition that describes the least healthy target tooth, from the list displayed. The choices may include:

• Sound or sealed
• Pits, fissures, or other defects: Any irregularities on the chewing surfaces of the teeth not yet showing signs of caries.
• Carious or early decalcification
• Restored
• 1-2 interproximal restorations
• >2 interproximal restorations

The list above is in increasing order of disease progression. The correct response is the most “advanced” stage of disease.

Root surfaces:

• Not visible
• Visible and sound
• Carious
• Restored

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Months patient has been caries free:

This question only appears on the screen if you indicate that there is at least one target tooth that has a restoration. Select one choice to indicate the time period in which the patient has not been diagnosed with active caries. (36 or more, 24-35, 12-23, Less than 12).

Erosion, abrasion, or abfraction on root surfaces:

This question only appears on the screen if you select any description of the root surfaces except "Not visible" in the question above. These are root surface lesions, and look like grooves or notches in the root surface. Generally they only appear on the lip and cheek side.

A tooth has been fractured (non-traumatic):

This is when any tooth or restoration has fractured, except for traumatic accidents including sports injuries.

A tooth that is present has root canal fillings and is not restored with a crown:

Check the box if this is true for this patient.

Oral Hygiene (Excellent/Acceptable/Unacceptable):

This is subjective, and is not used to calculate the Caries risk or health score. It is valuable for your documentation purposes, and appears in reports for patient education and motivation.

• Excellent indicates no visible plaque is present
• Acceptable signifies some plaque is present but no disease
• Unacceptable means there is a substantial amount of plaque. Unacceptable oral hygiene implies that there is enough plaque to cause disease.
  

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Items on Right side of screen:

Note that not all the items below will appear on every screen; the page contents will depend on the patient's age and Target Tooth, as well as other selections you make.

Fluoride products are used:

This includes fluoridated water, supplements, toothpaste, oral rinses, or gels. Check if this is true.

Liquids other than water are given in the crib or bed:

Check the box if this is true for this patient.

Mother has active decay or history of >8 (more than 8) proximal or root fillings:

Check the box if this is true for this patient.

Older siblings have active caries or restorations:

Check the box if this is true for this patient.

Has a fixed orthodontic appliance:

Fixed orthodontic appliances excludes plastic retainers. Any appliance that the patient can remove is excluded. Only appliances that the patient cannot remove are included. These are the traditional “braces” with bands and brackets attached to the teeth and wires attached to the brackets. Check if this is true.

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Experiences dry mouth:

At this time this is a subjective judgement of the dentist or patient. Simple clinical tests to diagnose "dry mouth" are generally not done in the United States. Check if this is true.

Bruxes, grinds, or clenches – OR – Symptoms of habits like occlusal or incisal wear, tooth facets, or cervical wear exist:

This is identified by observing the wear patterns on the teeth. Flat spots on the biting surfaces and possibly root surface defects are indicative of bruxing, grinding, or clenching. The patient might be aware of these habits, with the dentist becoming aware when the patient’s history is reviewed. Check if this is true.

Has a pierced tongue, or oral habits like eating ice, playing a musical instrument with a mouthpiece, or opening a bottle with the teeth:

This includes any oral habit that places excessive stress on the teeth, such as nail biting or chewing on a pencil. It refers to habits that can actually break teeth. (An example of a habit not included here is thumbsucking, which can move teeth. This is undesirable, but not within the scope of decay and gum disease.) Check if this is true.

Has had a major change in health (heart attack, stroke, etc.) during the past 12 months:

Check the box if this is true for this patient. This includes any change in health which has a major impact on the patient's life, including a heart attack, stroke, diagnosis of a major kind of cancer or some other disease or condition with similar impact on the patient's health.

Number of times per day snacks or beverages containing sugar are consumed between meals:

You are asked to select either “5 or more” or “4 or less.” As you know, you may need to clarify for your patient what is included here (e.g. an apple, a glass of milk, and pretzels all contain sugar), as a parent may assume the only kind of “snacks containing sugar” you are asking about are candies or desserts.