A mother reports having had active carious lesions within the past 12 months. Her young child is being assessed. How does the mother's history affect the CHILD's caries risk classification?

Correct answer: B. It places the child in the HIGH caries risk category

• A. Caregiver caries status is an explicit BIOLOGICAL RISK FACTOR in every major paediatric risk assessment instrument — it cannot be disregarded.
• B. CORRECT. Maternal caries activity within the preceding 12 months is one of the strongest single predictors of caries in a young child and places the child at HIGH RISK in both the AAPD Caries-risk Assessment Tool and the ADA framework. The mechanism is VERTICAL TRANSMISSION: cariogenic bacteria, principally Streptococcus mutans, are transferred from caregiver to infant through saliva-sharing behaviours such as tasting food, sharing utensils and cleaning a dropped pacifier by mouth. Earlier colonisation means higher and earlier caries experience.
• C. The absence of cavities in the child does not override the risk factor. Risk assessment is predictive: it estimates FUTURE disease, so a caries-free child with a high-risk caregiver is still high risk.
• D. A history of caries within the last year counts, whether or not the lesions have since been restored — the microbial reservoir and the behaviours that transmit it persist.

Note: The clinical consequence is that treating the MOTHER is part of treating the CHILD. Effective interventions include restoring the mother's active lesions, xylitol gum for the caregiver, counselling against saliva-sharing behaviours, establishing a dental home by age one, fluoride varnish every 3–6 months, and diet counselling directed at the whole family.