A dental examiner should evaluate the dentition for caries and for restorations or missing teeth due to caries. Although the best tool to predict future caries is past caries experience, it is not particularly useful in young children due to the importance of determining caries risk before the disease is manifest. The teeth should be examined for smooth surface white spot lesions, pits and fissure anatomys 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 precavitated lesions indicative of caries activity. Stained pits and fissures and developmental enamel defects can be high 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 and the age at which a child becomes colonized with cariogenic flora are valuable in assessing risk, especially in preschool children.