Validation of a Subjective Caries Risk Assessment Tool
The objective of this study was to evaluate the predictive validity of the American Dental Association's caries risk assessment (CRA) tool, adapted with permission. The sample included 57,675 Veterans; 50.1% were classified as low, 33.2% as moderate, and 16.8% as high caries risk. During the twelve-month predictive period, both teeth/person and teeth with caries-related treatment rose sequentially from low to high CRA categories. However, poor sensitivity (0.34–0.58) and better specificity (0.53–0.78) values were observed. Similarly, better negative predictive values (0.72–0.79) compared to positive predictive values (0.28–0.34) were found. Adjusted logistic regression models showed that currently treated caries (caries detected at the time of the CRA exam) were more strongly associated with future caries-related treatment than the subjective CRA determination.

The subjective CRA tool evaluated in this study is better at identifying patients at low risk of requiring future caries-related treatment versus those at higher risk. This makes it difficult to target the most caries susceptible patients with preventive measures. Furthermore, we found that the amount of caries treatment required at the time of the CRA exam had the strongest association with caries-related treatment during the subsequent twelve-month predictive period. The amount of caries-related treatment required at the time of the caries risk classification is the strongest predictor of future caries.