A systematic review of risk assessment tools for early childhood caries: is there evidence?

AIM: To evaluate the accuracy of commonly advocated caries risk assessment (CRA) tools in preschool children and to search for evidence whether or not this process provides better oral care and less caries in the future. METHODS: As an update of a previous systematic review, a search of electronic databases for relevant literature published between 2008 and 2018 was performed with aid of predetermined search strings. We considered only true prospective trials validating baseline risk categories over at least a 12-month period, and extracted the predictive values and assessed the quality of the papers by the QUIPS tool for prospective studies. RESULTS: Six studies were included, reporting on three manual checklists and two software tools. The National University of Singapore model displayed a good accuracy in two studies, while the accuracy of Cariogram ranged from poor to good in various populations. The manual checklists were only validated in one study each and displayed limited to poor accuracy. No study was identified that addressed questions around the long-term benefits of CRA. CONCLUSIONS: This systematic review showed a relative paucity of prospective trials validating the existing caries risk assessment tools in preschool children and the question whether or not the CRA process results in better oral care remained unanswered. Although the accuracy was far from excellent, we still recommend the CRA tools in paediatric dentistry practice because the desirable effects most likely outweigh the undesirable effects.

Caries risk assessment in children: how accurate are we?

PURPOSE: To summarise the findings of recent systematic reviews (SR) covering caries risk assessment in children, updated with recent primary studies. METHODS: A search for relevant papers published 2012-2014 was conducted in electronic databases. The systematic reviews were quality assessed with the AMSTAR tool and the primary publications according to the Cochrane handbook. The quality was rated as low, moderate, or high risk of bias. The findings were descriptively synthesised and the quality of evidence was graded according to GRADE. For the recommendations of practice, the SIGN scores were used (recommendation levels A-D). RESULTS: Three SR, three guidelines, and five papers, not considered in previous SR, were identified and formed the base for the present summary and recommendations. One of the systematic reviews and three of the primary publications were of moderate risk of bias, while the rest displayed a high risk of bias. CONCLUSIONS: Based on the present summary of literature, it may be concluded: (1) a caries risk assessment should be carried out at the child's first dental visit and reassessments should be done during childhood (D); (2) multivariate models display a better accuracy than the use of single predictors and this is especially true for preschool children (C); (3) there is no clearly superior method to predict future caries and no evidence to support the use of one model, program, or technology before the other (C); and (4) the risk category should be linked to appropriate preventive care with recall intervals based on the individual need (C).

Preventive care delivered within Public Dental Service after caries risk assessment of young adults.

OBJECTIVES: To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period. METHODS: The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics. The baseline caries risk assessment was carried out by the patient's regular team in four classes according to a predetermined model, and the team was responsible for all treatment decisions. Based on the variables 'oral health information', 'additional fluoride' and 'professional tooth cleaning', a cumulative score was constructed and dichotomized to 'basic prevention' and 'additional prevention'. RESULTS: More additional preventive care was provided to the patients in the 'low-risk' and 'some risk' categories than to those classified as 'high' or 'very high' risk (OR = 2.0, 95% CI 1.4-3.0; P < 0.05). Professional tooth cleaning and additional fluorides were most frequently employed in the 'low-risk' and 'some risk' categories, respectively. Around 15% of the patients in the high-risk categories did not receive additional preventive measures over the 3-year period. There was an insignificant tendency that patients with additional prevention developed less caries than those that received basic prevention in all risk categories except for the 'very high-risk' group. CONCLUSION: The caries risk assessment process was not accompanied by a corresponding targeted individual preventive care in a cohort of young adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention.

Caries risk assessment. A systematic review.

OBJECTIVE: To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. STUDY DESIGN: A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. RESULTS: Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. CONCLUSIONS: Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

Caries risk assessment as a predictor of metabolic control in young Type 1 diabetics.

AIMS: To investigate the relationship between caries risk and glucosylated haemoglobin and to evaluate the use of a computerized caries risk assessment program as a predictor of metabolic control in schoolchildren with Type 1 diabetes mellitus. METHODS: The material consisted of 64 young Type 1 diabetes mellitus patients (8-16 years) attending an outpatient paediatric clinic. Within 2 weeks after the onset of diabetes, a caries risk assessment was carried out with the aid of a computer-based program (Cariogram) and data on the level of metabolic control were collected from the medical records at the 3-year check-up. Caries increment was registered at recall clinical examinations. RESULTS: A statistically significant positive relationship between caries risk and metabolic control was found (r = 0.51; P < 0.01), with a sevenfold increased risk of impaired metabolic control after 3 years in those assessed with high caries risk at onset (OR 7.3; P < 0.01). When the Cariogram was used as a predictor for the metabolic state of the disease, the sensitivity and specificity was 75% and 71%, respectively. The negative predictive value was 91%. CONCLUSIONS: Our data suggested that a caries risk assessment at the diagnosis of diabetes mellitus in children may be a good indicator of overall health care that can provide useful prognostic information on the level of metabolic control after 3 years.

Evaluation of a computer program for caries risk assessment in schoolchildren.

The 'Cariogram' is an interactive PC program for caries risk evaluation. It takes into account the interactions between caries-related factors and expresses a graphic assessment of the risk. The aim of this study was to assess the caries risk in schoolchildren using the Cariogram and to evaluate the program by comparing the caries risk assessments with the actual change in DMF. A 2-year prospective study on 446 schoolchildren, 10-11 years old, was conducted. At baseline, data on general health, diet, oral hygiene and use of fluoride were obtained. Saliva analyses included mutans streptococci and lactobacilli counts, buffer capacity and secretion rate. DMFT and DMFS were calculated from records and bitewing radiographs. Scores were entered and caries risk was assessed. Re-examination for caries was done after 2 years. The children were divided into 5 groups according to the assessed caries risk at baseline. Where the Cariogram predicted a 0-20% (high risk), 21-40%, 41-60%, 61-80% and 81-100% (low risk) chance of avoiding new lesions, 8, 35, 42, 73 and 83%, respectively, had no new lesions 2 years later. Logistic regression analyses were carried out. When the Cariogram was included, only two factors, the Cariogram (p < 0.001) and the DMFS at baseline, i.e. past caries experience (p = 0.001), turned out to be significantly associated with caries increment. The Cariogram was the most powerful explanatory variable. When the Cariogram was excluded, lactobacillus count, mutans streptococci, diet intake frequency and DMFS at baseline were significantly associated with caries increment. The Cariogram predicted caries increment more accurately than any included single-factor model. How this finding can be translated into daily practice in the best and most practical way is a matter for future research.

Use of the strip mutans test in the assessment of caries risk in a group of preschool children.

The purpose of this study was to evaluate the use of a chair-side test involving a count of salivary mutans streptococci (the Strip mutans test) in the assessment of caries risk in a group of preschool children living in an area with a low caries prevalence. A group of 528 4-year-old children were randomly allocated to a study or a control group. In the study group, the baseline microbial data, together with clinical findings of past caries experience, were used for caries risk assessment and for planning subsequent preventive treatment. All children were examined at baseline and after 2 years. Caries experience was assessed according to WHO criteria. There was no difference in caries experience between the study group and the control group at baseline. Within the study group, caries increment was positively correlated (P < 0.01) with the number of mutans streptococci in saliva at baseline, and children assessed 'at risk' at baseline (Strip mutans score > or = 2 and/or > or = 1 dmfs) developed more new lesions than those considered as 'low risk' (mean dmfs 2.6 v 0.9; P < 0.05). The sensitivity and specificity of this combined clinical and microbial caries risk selection were 67% and 75%, respectively, disease being defined as an increment of at least one carious lesion over the 2-year period. In both groups, 50% of the children remained caries inactive during the study. The mean caries increment was, however, lower in the study group than in the control group (mean dmfs 1.7 v 2.1) but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)