Evaluation of a Caregiver-Completed Questionnaire for Assessing Early Childhood Caries Risk: A Cross-Sectional Study

Introduction  Early childhood caries (ECC) is one of the most prevalent chronic diseases affecting preschool children worldwide and can adversely affect oral health, nutrition, growth, and quality of life. Early identification of children at risk is essential for implementing timely preventive interventions. Caregiver-completed screening tools may offer a simple and cost-effective approach to identifying children who require further dental evaluation. Therefore, the present study aimed to evaluate the diagnostic performance of a self-developed, caregiver-completed questionnaire for identifying ECC among preschool children, using clinical examination as the reference standard. Materials and methods  A cross-sectional study was conducted among 150 caregiver-child dyads, including children aged 3-6 years. Caregivers completed a self-developed, 15-item questionnaire covering feeding practices, dietary habits, oral hygiene practices, dental history, and caregiver-related factors. Content validation was performed by an expert panel, followed by pilot testing and reliability assessment. All children subsequently underwent a clinical examination for the diagnosis of ECC. Internal consistency was evaluated using Cronbach's alpha. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal questionnaire cutoff score. Sensitivity, specificity, predictive values, likelihood ratios, area under the curve (AUC), and Cohen's kappa were calculated. Results  Clinical examination identified ECC in 90 (60.0%) children, while 60 (40.0%) children did not have ECC. Questionnaire scores were significantly higher among children with ECC (19.4 ± 4.6) than among those without ECC (10.2 ± 3.8; p < 0.001). The questionnaire demonstrated good internal consistency, with an overall Cronbach's alpha of 0.86. ROC curve analysis revealed an AUC of 0.884 (95% CI: 0.830-0.938). The optimal cutoff score was ≥15, yielding a sensitivity of 82.2%, specificity of 86.7%, positive predictive value of 90.2%, and negative predictive value of 76.5%. The positive and negative likelihood ratios were 6.17 and 0.205, respectively. Agreement analysis demonstrated an observed agreement of 84.0% and a Cohen's kappa coefficient of 0.672, indicating substantial agreement with the clinical diagnosis. Conclusion  The caregiver-completed ECC questionnaire demonstrated good reliability, substantial agreement with clinical examination findings, and good diagnostic performance as a screening tool. The questionnaire may serve as a simple, non-invasive, and cost-effective tool for the early identification of children with or at risk of ECC and may facilitate timely preventive interventions in community and clinical settings.