Large language models for early childhood caries risk triage: A validation study using standardized pediatric dental...

To compare the diagnostic accuracy and public health utility of Gemini 2.5 Flash and GPT-4 for early childhood caries (ECC) risk triage in classifying presentations as high risk (warranting immediate referral) or low risk (amenable to preventive counseling).

A standardized dataset of 50 clinical vignettes (25 high risk and 25 low risk) was evaluated against both large language models via official application programming interfaces using a blinded, prospective comparative design (CONSORT-AI; TRIPOD+AI). This constitutes a vignette-based internal validation study and does not represent a clinical diagnostic accuracy study. Ground truth was established by two consultant pediatric dentists (intraclass correlation coefficient = 0.92). Performance was quantified using sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate (FNR). Readability, actionability, and multilingual competence in Hindi and Tamil were additionally assessed.

Both models exceeded the 80% accuracy threshold. GPT-4 achieved significantly higher sensitivity (92.0% vs. 80.0%; P = 0.032) and a lower FNR (8.0% vs. 20.0%), with superior readability (Flesch-Kincaid Grade Level 5.9 vs. 8.1), actionability (4.8 vs. 4.2), and cross-lingual consistency. Both models achieved 100% safety disclaimer compliance in English.

GPT-4 demonstrates a statistically superior safety profile for ECC risk triage. As a Level 1 adjunct, it can assist pediatric dentists by prescreening caregiver-reported presentations, reducing diagnosis lag, and directing specialist capacity toward confirmed high-risk pathology without replacing clinical judgment.

This study establishes that GPT-4 is a safer and more accessible AI triage tool than Gemini 2.5 Flash for pediatric dental screening, particularly in linguistically diverse, resource-constrained settings where specialist access is limited.