Step 3: Conduct a Clinical Assessment of the Oral Cavity

In addition to identifying current and past carious lesions, a thorough clinical assessment should consider anatomical and restorative factors that may contribute to increased caries risk. Tooth morphology and alignment can affect plaque retention and make effective cleaning more difficult—particularly in areas that are crowded, rotated, pitted, or rough. These surfaces create retentive niches for plaque biofilm and are often missed during routine oral hygiene, allowing for prolonged acid exposure and increased risk of demineralization. Moreover, restorations with faulty margins, such as overhangs, open contacts, or marginal gaps, can harbor cariogenic bacteria, facilitating biofilm retention and promoting secondary caries. These sites are particularly concerning in patients with inadequate oral hygiene or reduced salivary flow.^1,21 A clinical exam should systematically document such conditions to inform personalized preventive and restorative care planning.