Dentists use "Caries Risk Assessments" (CRA's) to determine your risk of developing future cavities.

  • Over the past 25 years, the American Dental Association┬« and the California Dental Association developed and updated their CRA's that many Dentists use (Sources #1 & 2)
  • We know what increases your chances of developing future cavities!
  • In 2018, a large study with thousands of people finally confirmed the accuracy of these CRA's (Sources #4, 5, & 6 below)
    • For example, the research shows if you are classified as High Caries Risk, you're 4x more likely to develop a new cavity than someone who is Low Caries Risk. For every 100 people who are High Caries Risk, about 70 of them will develop a cavity within the next 3-8 years.
  • Future research will determine specific preventative treatment protocols to best reduce the risk of developing new cavities.
  • Because cannot clinically examine your mouth nor take x-rays, our risk determination is not as accurate as the assessment made by a licensed Dentist during a comprehensive exam.

The initial development of caries risk classification guidelines

With these major guidelines, Dentists can predict who will develop new cavities.

Source #1: Journal of the American Dental Association (pages 1151-1159)

  • In 2006, the American Dental Association┬« gathered an expert panel of researchers and Dentists to update their 1995 classification guidelines. This panel searched systematic reviews and clinical studies up through 2005 for the best possible evidence of what makes a person more likely to develop a cavity. Based on their findings, they classified people into three groups: Low, Moderate, and High Caries Risk which correlate with how likely they are to develop a cavity.
  • They also determined that Fluoride varnish or gels could effectively prevent cavities in adults if placed on the teeth 2x per year (if at Moderate Caries Risk) or 2x-4x per year (if at High Caries Risk).
  • The U.S. Navy has practically mirrored the ADA CRA guidelines since 1999.

Source #2: Journal of the California Dental Association (pages 703-723)

  • In 2007, the California Dental Association gathered a consensus conference, reviewed research studies from 1993 to 2006, and published their own classification guidelines in the Journal of the California Dental Association. In addition to Low, Moderate, and High Caries Risk, they also included a fourth category: Extremely High Caries Risk.
  • These guidelines took risk factors and protective factors into account to determine a patient's risk of developing a cavity.

Source #3: Journal of the California Dental Association (pages 703-723)

  • In 2019, the Journal of the California Dental Association "features a series of five papers reporting the latest CAMBRA-related research results, updates on clinical-practice CAMBRA implementation and a report from a unique model program."

The validation of caries risk classification guidelines

With these studies, Dentists know their future cavity predictions are accurate.

Source #4: Journal of Public Health Dentistry

  • This 2005 retrospective study determined that caries risk guidelines are accurate. For two years, two Dentists placed their patients into either the Low, Moderate, or High Caries Risk category (following a guideline similar to the 2006 CRA of the American Dental Association┬«). The High and Moderate Caries Risk patients were 4x and 2x more likely, respectively, to develop a cavity than the patients at Low Caries Risk.

Source #5: Advances in Dental Research (pages 1-6)

  • This 2018 article highlighted multiple studies regarding thousands of patients seen at the University of California, San Francisco (UCSF). These patients were originally classified as Low, Moderate, High, or Extremely High Risk according to the CDA CRA pilot program established in 2003. After years of classifying patients, including the use of the updated 2007 CDA CRA, the patient data was evaluated to see which patients did indeed develop cavities. It turned out that 70% of High Caries Risk and 88% of Extremely High Caries Risk patients developed a new cavity after 3-8 years.
  • This study also analyzed which patients did and did not follow preventative measures. The researchers determined the patients who followed preventative instructions ended up developing 38% fewer cavities. This demonstrates the future validation of caries risk preventative treatment protocols.
  • This review also described evidence that antibacterial therapy is needed in certain groups of people (consistent with CDA guidelines) to effectively prevent cavities.

Source #6: Journal of the California Dental Association (pages 709-715)

  • Researchers reviewed 6 years of UCSF School of Dentistry patient data (over 2,500 patients) to discover the CDA guidelines used at UCSF are easy to implement and accurately predict which patients will develop future cavities.

Future Research

We now know eliminating risk factors and adding protecting factors yields less future cavities. More research is needed to determine SPECIFIC preventative treatment protocol for each risk category.


  • Cavity already started
  • White spots (carious) on teeth
  • Filling within last 3 years
  • High titers of bacteria
  • Heavy plaque on teeth
  • Frequent snacking
  • Deep fits/grooves
  • Recreational drug use
  • Inadequate salivary flow
  • Saliva reducing factors (meds/radiation)
  • Exposed roots
  • Braces


  • Lives in fluoridated community
  • Fluoride toothpaste used daily
  • High strength toothpaste used daily (5,000 ppm F)
  • Fluoride mouthrinse used daily
  • Fluoride varnish within last 6 months
  • Xylitol gum/lozenges used daily
  • Adequate saliva flow (>1ml/min)