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Published on: February 2, 2020
Early childhood caries screening tools: a comparison of four approaches
Richard K Yoon1, Arlene M Smaldone, Burton L Edelstein
1Division of Pediatric Dentistry, Columbia University College of Dental Medicine, New York City, NY 10032, USA.
Insights
Culturing Streptococcus mutans (MS) alone is a highly accurate method for identifying early childhood caries (ECC) risk in young children. This salivary screening method outperformed the Caries-risk Assessment Tool (CAT) in clinical usefulness.
Area of Science:
- Pediatric Dentistry
- Oral Health
- Microbiology
Background:
- Early childhood caries (ECC) presents a significant public health challenge.
- Accurate risk assessment is crucial for timely, intensive interventions.
- Existing tools require evaluation for optimal clinical utility.
Purpose of the Study:
- To compare the accuracy and clinical usefulness of four risk assessment approaches for ECC.
- To identify the most effective screening method for early intervention in young children.
Main Methods:
- Screened 229 low-income Hispanic children with ECC and 242 without.
- Utilized the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT).
- Compared CAT, CAT without socioeconomic status, CAT without socioeconomic status plus Streptococcus mutans (MS) culture, and MS culture alone.
Main Results:
- The CAT showed high sensitivity (100%) and negative predictive value (100%) but low specificity (2.9%) and positive predictive value (49.4%).
- MS culture alone demonstrated superior accuracy and clinical utility (sensitivity 86.5%, specificity 93.4%, PPV 92.5%, NPV 87.9%).
- Removing socioeconomic status improved the CAT's performance.
Conclusions:
- Salivary MS culture alone is more accurate and clinically useful than the CAT for identifying ECC risk in young, low-income Hispanic children.
- Both MS cultures and variations of the CAT show promise for identifying children needing early intervention.
Background:
Early childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness.
Methods:
The authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness.
Results:
The results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved.
Conclusions:
Salivary culture of MS alone in a population of young, low-income Hispanic children outperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values).
Clinical Implications:
Screening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.
