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This resource was developed by: 

​The Brightening Oral Health Expert Group
Suzanne Boulter, MD, FAAP
Yasmi Crystal, DDS
Paula Duncan, MD, FAAP
Martha Ann Keels, DDS, PhD
Francisco Ramos-Gomez, DDS, MS​

Photos were provided for this resource by:
Rebecca Slayton, DDS, PhD
Joanna Douglass, BDS, DDS

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Risk Assessment Tool


Developed by the American Academy of Pediatrics (AAP) and endorsed by the National Interprofessional Initiative on Oral Health, the Oral Health Risk Assessment (OHRA) Tool is easy to incorporate into your practice. The tool will help you to understand the risk factors, protective factors, and clinical findings that demonstrate risk of dental caries in young children.

Download the tool below:

- OHRA Tool and Guidance​ (English)

- OHRA Tool and Guidance​ (Spanish)

Instructions for Use
This tool is intended for documenting caries risk of the child, however, two risk factors are based on the mother or primary caregiver's oral health. All other factors and findings should be documented based on the child.

The child is at an absolute high risk for caries if any risk factors or clinical findings, marked with a ⚠ ​sign, are documented yes. In the absence of a ⚠ ​risk factors or clinical findings, the clinician may determine the child is at high risk of caries based on one or more positive responses to other risk factors or clinical findings. Answering yes to protective factors should be taken into account with risk factors/clinical findings in determining low versus high risk.

Treatment of High Risk Children
If appropriate, high-risk children should receive professionally applied fluoride varnish and have their teeth brushed daily with an age-appropriate amount of fluoridated toothpaste. Referral to a pediatric dentist or a dentist comfortable caring for children should be made with follow-up to ensure that the child is being cared for in the dental home.

Self Management Goal Sheet
To accompany the OHRA Tool is a Self Management Goal Sheet for Parents and Caregivers. This helps families to decide on simple lifestyle and diet changes that will improve their family's oral health.

- Self Management Tool​ (English)

- Self-Management Tool​ (Spanish)

 Duplication of the tool for use in practice or as an educational tool is encouraged.