Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses.

We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00.

The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies.

Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.