A dental examiner should evaluate the dentition for caries and for restorationsor missing teeth due to caries. Although the best tool to predict future cariesis past caries experience, it is not particularly useful in young children due tothe importance of determining caries risk before the disease is manifest.The teeth should be examined for smooth surface white spot lesions, pits and fissureanatomies of the biting surfaces of posterior teeth, and enamel defects. Childrenwith white spot lesions should be considered at high risk for caries since theseare pre-cavitated lesions indicative of caries activity. Stained pits andfissures and developmental enamel defects can be high risk indicators.
Defective restorations and intraoral appliances that harbor cariogenic bacteriaincrease a child’s risk for developing caries.
Plaque accumulation also is strongly associated with caries development in youngchildren. As a corollary to the presence of plaque, a child’s mutans streptococcilevels and the age at which a child becomes colonized with cariogenic flora arevaluable in assessing risk, especially in preschool children.