Assessing caries risk in children

With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need f or, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of li fe. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an ind ividual. In studies involving several factors, past caries experience (espe cially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the f orm of commercial kits are still expensive; no one test is an adequate pred ictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional lon gitudinal risk assessment studies in which potential risk factors are ident ified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able t o be predicted in a population with low disease prevalence. Any risk assess ment strategy must be followed by appropriate preventive interventions.