Modeling Caries Experience: Advantages of the Use of the Hurdle Model

In dental epidemiology, the decayed (D), missing (M), and filled (F) teeth or surfaces index (DFM index) is a frequently used measure. The DMF index is characterized by a strongly positive skewed distribution with a large stack of zero counts for those individuals without caries experience. Therefore, standard generalized linear models often lead to a poor fit. The hurdle regression model is a highly suitable class to model a DMF index, but its use is subordinated. We aim to overcome the gap between the suitability of the hurdle model to fit DMF indices and the frequency of its use in caries research. A theoretical introduction to the hurdle model is provided, and an extensive comparison with the zero-inflated model is given. Using an illustrative data example, both types of models are compared, with a special focus on interpretation of their parameters. Accompanying R code and example data are provided as online supplementary material.