CAMBRA Form

Question 1

What risk level if…
no fluoride exposure

Answer 1

moderate risk

Question 2

What risk level if…
fluoride exposure

Answer 2

low risk

Question 3

What risk level if…
sugary foods and drinks primarily at mealtimes

Answer 3

low risk

Question 4

What risk level if…
sugary foods and drinks frequent or prolonged b/w meal exposures/day

Answer 4

high risk

Question 5

What risk level if…
no carious lesions in the past 24 months
(caries experience of mother, caregiver, and/or siblings for patients 6-14)

Answer 5

low risk

Question 6

What risk level if…
carious lesions in the last 7-23 months
(caries experience of mother, caregiver, and/or siblings for patients 6-14)

Answer 6

moderate risk

Question 7

What risk level if…
carious lesions in the last 6 months
(caries experience of mother, caregiver, and/or siblings for patients 6-14)

Answer 7

high risk

Question 8

What risk level if…
established patient of record

Answer 8

low risk

Question 9

What risk level if…
not established patient of record

Answer 9

moderate risk

Question 10

What risk level if…
no special health care needs

Answer 10

low risk

Question 11

What risk level if…
special health care needs (over age 14)

Answer 11

moderate risk

Question 12

What risk level if…
special health care needs (age 6-14)

Answer 12

high risk

Question 13

What risk level if…
no chemo/radiation

Answer 13

low risk

Question 14

What risk level if…
chemo/radiation

Answer 14

high risk

Question 15

What risk level if…
no eating disorders

Answer 15

low risk

Question 16

What risk level if…
eating disorders

Answer 16

moderate risk

Question 17

What risk level if…
no meds that reduce salivary flow

Answer 17

low risk

Question 18

What risk level if…
meds that reduce salivary flow

Answer 18

moderate risk

Question 19

What risk level if…
no drug/alcohol abuse

Answer 19

low risk

Question 20

What risk level if…
drug/alcohol abuse

Answer 20

moderate risk

Question 21

What risk level if…
no new carious lesions or restorations in the last 36 months

Answer 21

low risk

Question 22

What risk level if…
1 or 2 new carious lesions or restorations in the last 36 months

Answer 22

moderate risk

Question 23

What risk level if…
3 or more carious lesions or restorations in the last 36 months

Answer 23

high risk

Question 24

What risk level if…
no teeth missing due to caries in the last 36 months

Answer 24

low risk

Question 25

What risk level if... teeth missing due to caries in the last 36 months

Answer 25

high risk

Question 26

What risk level if... no visible plaque

Answer 26

low risk

Question 27

What risk level if... visible plaque

Answer 27

moderate risk

Question 28

What risk level if... no unusual tooth morphology

Answer 28

low risk

Question 29

What risk level if... unusual tooth morphology

Answer 29

moderate risk

Question 30

What risk level if... no interproximal restorations (1 or more)

Answer 30

low risk

Question 31

What risk level if... interproximal restorations (1 or more)

Answer 31

moderate risk

Question 32

What risk level if... no exposed root surfaces

Answer 32

low risk

Question 33

What risk level if... exposed root surfaces

Answer 33

moderate risk

Question 34

What risk level if... no restorations with overhangs and/or open margins; open contacts with food impaction

Answer 34

low risk

Question 35

What risk level if... restorations with overhangs and/or open margins; open contacts with food impaction

Answer 35

moderate risk

Question 36

What risk level if... no dental/ortho appliances (fixed or removable)

Answer 36

low risk

Question 37

What risk level if... dental/ortho appliances (fixed or removable)

Answer 37

moderate risk

Question 38

What risk level if... no xerostomia

Answer 38

low risk

Question 39

What risk level if... xerostomia

Answer 39

high risk