A thorough assessment comprises multiple elements including:
Gain rapport with the parent/carer and discuss how they can support and encourage the child in the surgery.
Communicate effectively with the child and parent/carer, and avoid ‘talking over’ the child.
Confirm the reason for attendance and begin to assess the oral health expectations and motivation of the child and parent/carer.
Take a thorough medical, dental and social history that includes asking about current brushing practice, dietary habits and previous experience of dental treatment.
Use the information gathered to inform your assessment of the child and/or parent/carer’s attitude towards oral health and their ability and motivation to take responsibility for it.
Provide appropriate information and support to enable the parent/carer to maintain and improve the child’s ongoing oral health and be prepared to tailor preventive care and treatment to encourage compliance.
Contact other professionals (e.g. the child’s health visitor, school nurse) if multidisciplinary support is required.
If dental neglect is a concern, act to provide additional support measures for the child and parent/carer.
Assess the child’s plaque levels and their, or the parent/carer’s, toothbrushing skills/knowledge and discuss this with the child and parent/carer.
Assess the child’s primary and permanent dentition, including visual examination for the presence of caries on clean and dry teeth using a tooth-by-tooth approach.
Consider taking bitewing radiographs to accurately diagnose the extent of any caries, including proximity to the pulp.
Assess the activity of each carious lesion clinically and use radiographs to assess progression over time.
Assume that all carious lesions are active, unless there is evidence that they are arrested.
For the primary dentition, assess the risk or any carious lesions causing pain or infection prior to exfoliation to inform a suitable management strategy.
Assess any hypomineralised molars independently to determine the extent of disease and likely prognoses.
Discuss the findings of the clinical assessment with the child and their parent/carer
Assess whether or not the child is at increased risk of developing caries (patient history, resident in an area of relative disadvantage or has decayed, missing due to caries or filled teeth) and use this caries risk assessment to inform the frequency of review radiographs, provision of preventive interventions and frequency of recall.
Reassess the child’s caries risk at each assessment.