Objective To evaluate the impact of a continuous improvement project to improve completion of a caries risk assessment (CRA) and to assess its impact on delivery of dental caries prevention. Design Single centre clinical improvement project. Setting A paediatric dental department within a UK dental hospital over the course of 2008-2009. Subjects (materials) and methods Continuous monitoring of documentation of a CRA was instigated and results fed back to clinicians. Tools were developed to structure the process of CRA. After six months of intervention, a comparison of preventive care to a pre-intervention sample was undertaken. Main outcome measures The main outcome measure was completion of a CRA. Comparison was also made with pre-intervention data on levels of preventive care received. Results Over the 12 month project the mean rate of CRA completion improved from 30% over the first 6 months to 73% in the second 6 months. Compared to the pre-intervention sample, all items of the caries prevention package had improved, with delivery of toothpaste strength advice (16% vs 60%, p = 0.001) and diet advice (32% vs 70%, p = 0.004) improving significantly. Conclusion By targeting and improving CRA completion the quality of preventive care delivered has also significantly improved.