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Comparing CRA Forms: A Hygienist’s Perspective

Comparing CRA Forms: A Hygienist’s Perspective
Janelle Blondin

Like many hygienists, I was first introduced to the concept of risk assessment in hygiene school.  It wasn’t until some time later that I really learned to appreciate the value of performing caries risk assessment, or CAMBRA.  It’s not only hugely beneficial in terms of patient education, but it really helps me as a hygienist pinpoint why my patient is experiencing decay.


So with so many different options, which CRA form is the best?  There are four main versions; one is by the American Dental Association (ADA), one is by the California Dental Association (CDA), another is by the American Academy of Pediatric Dentistry (AAPD) and the last is by CariFree.  All four of these forms have different versions for ages 0-5 and >6.  Here are some pros and cons to consider regarding the different adult CRA forms:


ADA Endorsed by the ADA Some questions don’t apply to adults·   Only filled out by dental professional·   0, 1, 10 point system yet to be validated by clinical trial
CDA Balance visual aids in patient education·    Validated by Dr. John Featherstone·    Incorporates biometrics Recommends bacteria culture and saliva flow test, can be expensive and time consuming·   Only filled out by dental professional
AAPD Most simplified form Most effective for pediatric patients and young adults·   Some profiling could be considered offensive


Psychological questions help determine patient motivation·   Incorporates ATP testing·   Patients self-report risk factors·   Risk categories are more specific than low, moderate or high Not as beneficial if used without biometric (i.e. CariScreen)


For me as a hygienist, the most important reason for performing CRA is the educational component.  Being able to show a patient the factors contributing to their disease is huge in helping them understand (and comply with) the preventive side.  For this reason, my preferred CRA Form is the CariFree form.  I like how it puts the patient in the driver’s seat and has them self-identify their risk factors.

Regardless of which CRA Form you use, performing a caries risk assessment in some capacity is better than none at all.

Do you offer CRA to your patients?  Which CRA form do you prefer?

Disclaimer: Janelle is an employee of Oral BioTech, manufacturers of CariFree


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