0.  Sound tooth surface : No evidence of caries after 5 sec air drying.
1. First visual change in enamel: Opacity or discoloration (white or brown) is visible at the entrance to the pit or fissure seen after prolonged air drying
2. Distinct visual change in enamel visible when wet, lesion must be visible when dry
3. Localized enamel breakdown (without clinical visual signs of dentinal involvement) seen when wet and after prolonged drying
4. Underlying dark shadow from dentine
5. Distinct cavity with visible dentine
6. Extensive  (more the half the surface) distinct cavity with visible dentine


E1 (outer half of enamel)

E2 (inner half of enamel)

D1 (outer third of dentin)

D2 (middle third of dentin)

D3 (inner third of dentin)


  0. None
  1. Separate flecks of plaque at cervical margin
  2. Thin band of plaque at cervical margin (<1 mm)
  3. Band of plaque at cervical margin, <1/3 of crown
  4. Plaque covering between 1/3 and 2/3 of crown
  5. Plaque covers more than 2/3 of crown


Low risk:

  • No dental lesions
  • No visible plaque PSR 0 or 1
  • Suboptimal fluoride
  • Regular dental care
  • Diet – good

Moderate risk

  • Dental lesions in last 4 years.
  • Visible plaque PSR 1,2, gingival inflammation
  • Suboptimal fluoride
  • Low-socio-economic status
  • Irregular dental care
  • Diet – frequent snacking
  • Exposed root surface
  • BMI borderline

High risk

  • One or more cavitated lesions
  • Visible plaque PSR 3 or 4, gingivitis and or periodontal disease
  • Suboptimal fluoride
  • Low socio-economic status
  • No dental care
  • Diet – Frequent snacking
  • High bacterial challenge
  • Impaired saliva
  • Systemic disease
  • medications
  • Tobacco or other substance abuse

Extreme High risk

  • SAME AS HIGH RISK + any of the following
  • No saliva, dry mouth
  • Special Needs
  • Radiation therapy (head and neck)