Dental caries risk assessment and prevention.

Although dental caries in preschool children has declined in the past 20 years, the decrease is not observed equally across all populations. Considerable benefit could be achieved if the children at high risk could be identified before lesions develop. The best predictors of dental caries in preschool children are previous caries history, especially nursing bottle caries, and the salivary mutans streptococci levels. Other caries risk factors include inadequate oral hygiene practices, deficient fluoride exposure, low socioeconomic status, and familial caries patterns. Children at high caries risk should be considered for more intensive home fluoride programs, such as brushing the child's teeth with a pea-size amount of either 0.4% SnF2 or 1.1% NaF gels. Frequent professional fluoride treatments can be substituted if there is poor compliance with home programs. There is little documentation that dietary modification and plaque control and sealant programs are cost-effective measures for preventing caries in preschool children.