Caries development is determined by a balance of protective and pathological factors, so the clinician should be able to identify and document those factors, understand their relative weight in disease development or reversal, and make recommendations to patients that will lead to risk reduction. The caries management by risk assessment (CAMBRA) protocol frames these factors into an easy-to-follow template that also guides the clinician in making recommendations. The purposes of this study were to examine implementation of the CAMBRA-based risk assessment program in a predoctoral clinic at one dental school, assess the accuracy of caries risk evaluation by the students, and evaluate the utilization of professionally applied fluoride varnish in a moderate- and high-risk patient cohort. After dental clinic patients were screened for previous caries risk status, sixty-eight moderate- or high-risk patients were invited to participate in the study. At the study visit that included four bite-wing radiographs, a new caries risk assessment (CRA) form was completed. Our results showed that students underestimated the risk in 25 percent of the cases; the underestimation occurred especially when visible cavitation or caries into dentin by radiograph was the only risk factor or when caries were not identified at the initial visit when the CRA form was completed for the first time despite the presence of other high-risk factors. Students also underestimated both risk and protective factors at the initial evaluation visit compared with the study visit. The results show that students were not rigorous enough in documenting these factors and determining the patient's risk. In order to increase the sensitivity of risk assessment, training and recalibration for students and faculty members should be an ongoing process.