Predictive validity and cost-effectiveness analysis of two caries risk assessment tools for preschool children

Area of Science:

• Pediatric Dentistry
• Public Health
• Dental Caries Prevention

Background:

• Community-based prevention programs require effective tools for caries risk screening in preschoolers.
• Evaluating the predictive validity and cost-effectiveness of screening tools is crucial for optimizing resource allocation.

Purpose of the Study:

• To compare the predictive validity and cost-effectiveness of Cariostat and a reduced Cariogram model for caries risk screening in 3-4 year old children.
• To inform the selection of appropriate tools for community-based dental caries prevention initiatives.

Main Methods:

• A 12-month longitudinal study involving 156 preschoolers (aged 3-4 years).
• Baseline caries risk assessment using Cariostat and a reduced Cariogram model.
• Follow-up oral examinations to record caries incidence and calculate predictive performance metrics (sensitivity, specificity, AUC).
• Cost-effectiveness analysis including cost per correctly identified moderate-to-high-risk child.

Main Results:

• 50.3% of children developed new caries over 12 months.
• The reduced Cariogram demonstrated higher sensitivity (90.24%) compared to Cariostat (73.17%).
• Specificity and AUC were similar between the two models.
• The reduced Cariogram was significantly more cost-effective, with a 6-fold lower cost per correctly screened child and a negative incremental cost-effectiveness ratio.

Conclusions:

• The reduced Cariogram model is superior to Cariostat for community-based caries screening in preschoolers, particularly regarding sensitivity and cost-effectiveness.
• Its higher sensitivity and lower cost make it a valuable tool for resource-limited settings.
• The findings support the implementation of the reduced Cariogram for guiding preventive dental strategies in early childhood.