A dental examiner should evaluate the dentition for caries and for restorations or missing teeth due to caries. The best tool to predict future caries is past caries experience, and existence of caries or restorations suggest elevates caries risk. The teeth should be examined for smooth surface white spot lesions, pit and fissure anatomy of the biting surfaces of posterior teeth, and enamel defects. Children with white spot lesions should be considered at high risk for caries since these are pre-cavitated lesions indicative of caries activity. Stained pits and fissures and developmental enamel defects can be risk indicators.
Defective restorations and intraoral appliances that harbor cariogenic bacteria increase a child’s risk for developing caries.
Plaque accumulation also is strongly associated with caries development in young children. As a corollary to the presence of plaque, a child’s *mutans streptococci* levels may be valuable in assessing risk, especially in preschool children, but cost and temporal delay in receiving results may inhibit its adoption into routine clinical practice.