The purpose of this study was to investigate factors related to Iowa dentists’ management of initial caries lesions for low, moderate and high-risk patients and their agreement with the International Caries Classification and Management System (ICCMS) Guidelines. A survey with three patient scenarios (low, moderate and high-risk) was electronically sent to 916 University of Iowa alumni dentists who were in active practice. Information on dentists’ demographics and practice characteristics were also collected in the survey. Descriptive statistics were conducted to profile the variables of interest. Bivariate analyses were performed to assess the factors associated with the management of initial caries lesions for each scenario. 138 (response rate=15%; male=83 and female=55) practicing dentists in Iowa completed the survey. Of these (mean age= 48.3±12.3 years, mean years of clinical practice= 21.4±12.5), 30.4% completed a formal post-graduate training program, and 35.5% were solo practitioners. Agreement with ICCMS guidelines regarding the management of initial caries lesions for low, moderate and high-risk scenarios was approximately 73%, 59%, and 51% respectively. Odds of having agreement with ICCMS in the low risk scenario for those who frequently dry the tooth was 3.56 times that of those who don’t dry the tooth for caries detection (p=0.0468). Odds of having agreement with ICCMS in the moderate risk for those who graduated < 20 years ago was 6 times that of those who graduated >20 years ago (p=0.0024). Odds of having agreement with ICCMS in the moderate risk scenario for those who practiced in public health setting was 14 times that of those who practiced in solo or group practices (p=0.0089) and for those who frequently used magnification was 2.9 times that of those who don’t use magnification (p=0.0225). Odds of having agreement with ICCMS in the high risk scenario for those who frequently performed CRA was 2 times that of those who don’t perform CRA (p=0.0262). The majority of Iowa dentists agreed with ICCMS guidelines in the non-surgical management of initial caries lesions regardless of patient risk level. Iowa dentists had the highest agreement with the ICCMS guidelines for low-risk scenario and agreement was associated with routinely drying teeth for caries detection. Evidence based decisions individualized for a patients’ risk status are essential for determining the best management of dental caries lesions.