Validity of Caries Risk Assessment Programs in Preschool Children
Available online 19 June 2013
Abstract
Objectives
Various
programs have been developed for caries risk assessment (CRA).
Nevertheless, scientific evidence on their validity is lacking. This
study aimed to compare the validity of 4 CRA programs (CAT, CAMBRA,
Cariogram, and NUS-CRA) in predicting early childhood caries.
Methods
A
total of 544 children aged 3 years underwent oral examination and
biological tests (saliva flow rate, salivary buffering capacity and
abundance of cariogenic bacteria mutans Streptococci and Lactobacilli).
Their parents completed a questionnaire. Children's caries risk was
predicted using the 4 study programs without biological tests (screening
mode) and with biological tests (comprehensive mode). After 12 months,
caries increment in 485 (89%) children was recorded and compared with
the baseline risk predictions.
Results
Reasoning-based
programs (CAT and CAMBRA screening) had high sensitivity (≥93.8%) but
low specificity (≦43.6%) in predicting caries in children. CAMBRA
comprehensive assessment reached a better balance
(sensitivity/specificity of 83.7%/62.9%). Algorithm-based programs
(Cariogram and NUS-CRA) generated better predictions. The
sensitivity/specificity of NUS-CRA screening and comprehensive models
were 73.6%/84.7% and 78.1%/85.3%, respectively, higher than those of the
Cariogram screening (62.9%/77.9%) and comprehensive assessment
(64.6%/78.5%). NUS-CRA comprehensive model met the criteria for a useful
CRA tool (sensitivity + specificity≥160%), while its screening model
approached that target.
Conclusions
Our
results supported algorithm-based approach of caries risk modelling and
the usefulness of NUS-CRA in identifying children susceptible to
caries.
Clinical significance
This
prospective study provided evidence for practitioners to choose tools
for assessing children's caries risk, so that prevention measures can be
tailored and treatment plan can be optimized.
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