Validity of caries risk assessment programmes in preschool children
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Xiaoli Gao1, Ivy Di Wu, Edward Chin Man Lo
1Dental Public Health, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong. gaoxl@hkucc.hku.hk
Insights
The NUS-CRA tool effectively predicts early childhood caries risk, outperforming other methods. This algorithm-based approach aids in tailoring preventive measures for better oral health outcomes.
Area of Science:
- Pediatric Dentistry
- Dental Public Health
- Caries Risk Assessment
Background:
- Caries risk assessment (CRA) programs lack robust scientific validation.
- Early childhood caries (ECC) poses a significant public health challenge.
Purpose of the Study:
- To compare the predictive validity of four CRA programs: CAT, CAMBRA, Cariogram, and NUS-CRA.
- To evaluate their effectiveness in identifying children at risk for early childhood caries.
Main Methods:
- A prospective study involving 544 three-year-old children.
- Oral examinations and biological tests (saliva, bacteria) were conducted.
- Caries risk was predicted using screening and comprehensive modes of each program.
Main Results:
- Algorithm-based programs (NUS-CRA, Cariogram) showed better predictive accuracy than reasoning-based programs (CAT, CAMBRA).
- The NUS-CRA comprehensive model demonstrated high sensitivity (78.1%) and specificity (85.3%), meeting criteria for a useful CRA tool.
- NUS-CRA screening also showed promising results, approaching the target for a useful tool.
Conclusions:
- Algorithm-based caries risk modeling, particularly NUS-CRA, is supported by this evidence.
- NUS-CRA is a useful tool for identifying children susceptible to caries.
- Findings guide practitioners in selecting effective CRA tools for tailored prevention and optimized treatment.
Objectives:
Various programmes have been developed for caries risk assessment (CRA). Nevertheless, scientific evidence on their validity is lacking. This study aimed to compare the validity of 4 CRA programmes (CAT, CAMBRA, Cariogram, and NUS-CRA) in predicting early childhood caries.
Methods:
A total of 544 children aged 3 years underwent oral examination and biological tests (saliva flow rate, salivary buffering capacity and abundance of cariogenic bacteria mutans Streptococci and Lactobacilli). Their parents completed a questionnaire. Children's caries risk was predicted using the 4 study programmes without biological tests (screening mode) and with biological tests (comprehensive mode). After 12 months, caries increment in 485 (89%) children was recorded and compared with the baseline risk predictions.
Results:
Reasoning-based programmes (CAT and CAMBRA screening) had high sensitivity (≥ 93.8%) but low specificity (≤ 43.6%) in predicting caries in children. CAMBRA comprehensive assessment reached a better balance (sensitivity/specificity of 83.7%/62.9%). Algorithm-based programmes (Cariogram and NUS-CRA) generated better predictions. The sensitivity/specificity of NUS-CRA screening and comprehensive models were 73.6%/84.7% and 78.1%/85.3%, respectively, higher than those of the Cariogram screening (62.9%/77.9%) and comprehensive assessment (64.6%/78.5%). NUS-CRA comprehensive model met the criteria for a useful CRA tool (sensitivity+specificity ≥ 160%), while its screening model approached that target.
Conclusions:
Our results supported algorithm-based approach of caries risk modelling and the usefulness of NUS-CRA in identifying children susceptible to caries.
Clinical Significance:
This prospective study provided evidence for practitioners to select tools for assessing children's caries risk, so that prevention measures can be tailored and treatment plan can be optimised.
