Two Protocols for Assessing the Risk of Dental Caries in Adolescents: A Comparative Study

Gonçalves, Cláudia Silva; Moimaz, Suzely Adas Saliba; Saliba, Tânia Adas; Chiba, Fernando Yamamoto

doi:10.1590/pboci.2026.018

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 26 • 2026 • https://doi.org/10.1590/pboci.2026.018 linkcopy

Two Protocols for Assessing the Risk of Dental Caries in Adolescents: A Comparative Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To evaluate the caries risk in adolescents, according to different protocols.

Material and Methods: This is an observational, cross-sectional, quantitative, and analytical study, performed in 2024, in Araçatuba city, São Paulo, Brazil, with 15-year-old adolescents enrolled in an educational foundation that helps them find work. Sample size calculation was performed considering the prevalence of high risk of dental caries as the main outcome. Caries risk was evaluated according two protocols: 1) Technical Area of Oral Health of the State Department of Health of São Paulo, Brazil (TAOH); 2) American Dental Association (ADA). Data were collected by a single researcher through clinical examinations and interviews. Data were analyzed using descriptive statistics techniques and the binomial test was used to compare the proportions according to the caries risk.

Results: 103 adolescents participated in the study. The proportion of low caries risk was higher (p=0.0113) in TAOH protocol compared to ADA protocol. Dental caries index (DMFT) was 3.56+3.39. The classification according to TAOH protocol was: 59.23% high risk; 25.24% moderate risk; and 15.53% low risk. The classification according to ADA protocol was: 62.14% high risk; 33.01% moderate risk; and 4.85% low risk.

Conclusion: In both protocols, the caries risk of most adolescents was classified as high. The proportion of low caries risk was higher according to the TAOH protocol compared to ADA protocol.

Keywords:
Dental Caries; Dental Caries Susceptibility; Risk Factors; Adolescent

Variables	N	%
Sex
Male	59	57.28
Female	44	42.72
Skin color
Brown	56	54.37
White	38	36.89
Black	8	7.77
Yellow	1	0.97

Caries Risk	Protocols				p-value
	TAOH		ADA
	N	%	N	%
Low	16	15.53	5	4.85	0.0113
Moderate	26	25.24	34	33.01	0.2199
High	61	59.23	64	62.14	0.6687
Total	103	100.00	103	100.00

Dental Caries Factor	Dental Biofilm Factor	Caries Risk	N	%
Without history of dental caries	Absence	Low	16	15.53
	Presence	High	4	3.88
Presence of restored teeth	Absence	Moderate	26	25.24
	Presence	High	7	6.80
Demineralization of the enamel that appears as a white spot on the surfaces of the tooth	Presence	High	2	1.94
Caries lesion in grooves, pits, and scars without evident pulp involvement	Absence	High	22	21.37
	Presence	High	12	11.65
Caries lesion on the proximal surface, angles of the incisal edge, and cervical third without evident pulp involvement	Absence	High	4	3.88
Tooth with suspected pulpal or periapical involvement with clinical condition in the form of pulpitis, fistula, exposed pulp, abscess, or pain	Absence	High	3	2.91
	Presence	High	7	6.80
Total			103	100.00

Variables	Low Risk		Moderate Risk		High Risk
	Yes		No		No
	N	%	N	%	N	%
Contributing Conditions
Exposure to fluoride (through drinking water, supplements, professional applications, toothpaste)	103	100.00	0	0.00	0	0.00
Consumption of sugary foods or drinks (including juices, carbonated or non-carbonated soft drinks, energy drinks, medicinal syrups)	Especially at mealtimes				Frequent or prolonged between meals
	57	55.34	0	0.00	46	44.66
Patient receives regular dental care at a dental office	38	36.89	65	63.11	0	0.00
General Health Conditions
Special health care needs (developmental, physical, medical, or mental disabilities that prevent or limit the performance of adequate oral health care by you or your caregivers)	103	100.00	0	0.00	0	0.00
Chemotherapy/Radiotherapy	103	100.00	0	0.00	0	0.00
Eating disorders	100	97.09	3	2.91	0	0.00
Medications that reduce salivary flow	100	97.09	3	2.91	0	0.00
Drug/alcohol abuse	100	97.09	3	2.91	0	0.00
Clinical Conditions
Cavitated or non-cavitated (incipient) carious lesions or restorations	No new carious lesions or restorations in the last 36 months		1 or 2 new carious lesions or restorations in the last 36 months		3 or more carious lesions or restorations in the last 36 months
	41	39.81	29	28.16	33	32.04
Teeth lost due to decay in the last 36 months	102	99.03	0	0.0	1	0.97
Visible dental biofilm	65	63.11	38	36.89	0	0.00
Unusual dental morphology that compromises oral hygiene	93	90.29	10	9.71	0	0.00
Interproximal restorations - 1 or more	81	78.64	22	21.36	0	0.00
Exposed tooth root surfaces present	103	100.00	0	0.00	0	0.00
Restorations with excesses and/or deficient margins; open contact points with food impaction	89	86.41	14	13.59	0	0.00
Orthodontic appliances (fixed or removable)	94	91.26	9	8.74	0	0.00
Xerostomia	98	95.15	5	4.85	0	0.00

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[TFN1] TAOH: Technical Area of Oral Health of the State Department of Health of São Paulo, Brazil; ADA: American Dental Association.