Building Caries Risk Assessment Models for Children

TLDR

Caries risk assessment is important, yet practical models are lacking. The study aimed to develop biopsychosocial caries risk assessment models for diverse settings. Using questionnaires, oral exams, and salivary, microbiological, and plaque pH tests, the authors prospectively studied 1,782 children (3–6 years) and built models by training on 50 % of cases and validating on the rest. The models identified key risk and protective factors, achieving 82%/73% sensitivity/specificity without biological tests and 90%/90% with them, and a questionnaire‑only model reached 82%/81% for high‑burden children, indicating promising cost‑effective caries control tools. Abbreviations used include dmft, ROC, RR, CI, NIH, WHO, US/DHHS, and AAPD.

Abstract

Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a “one-year caries increment”, screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. Abbreviations: decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).