Healthy Teeth

Cavity Risk Assessment

Please answer the following questions to help us assess your child’s risk for cavities:

1. Do you live in a community without fluoridated water?	Yes	No
2. Do you feel that your child needs more help with their oral hygiene (brushing/flossing)?	Yes	No
3. Has your child ever had a cavity?	Yes	No
4. Have any siblings had cavities?	Yes	No
5. Does your child snack frequently?	Yes	No
6. Does your child have any special healthcare needs?	Yes	No

To determine your child’s risk for cavities, add up the number of yes’s
1	Low Risk
2 - 3	Moderate Risk
4 or more	High Risk