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

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Abstract

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.

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References

  • American Academy of Pediatric Dentistry. Caries risk assessment and management for infants, children, and adolescents. Ref Man. 2015–2016;37:132–9.

  • Birpou E, Agouropoulos A, Twetman S, Kavvadia K. Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk. Int J Paediatr Dent. 2019. https://doi.org/10.1111/ipd.12476.

    Article  PubMed  Google Scholar 

  • Bratthall D, Hänsel Petersson G. Cariogram—a multifactorial risk assessment model for a multifactorial disease. Community Dent Oral Epidemiol. 2005;33:256–64.

    Article  Google Scholar 

  • Cagetti MG, Bontà G, Cocco F, Lingstrom P, Strohmenger L, Campus G. Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review. BMC Oral Health. 2018;18:123.

    Article  Google Scholar 

  • Chaffee BW, Featherstone JDB, Zhan L. Pediatric caries risk assessment as a predictor of caries outcomes. Pediatr Dent. 2017;39:219–32.

    PubMed  PubMed Central  Google Scholar 

  • Christian B, Armstrong R, Calache H, Carpenter L, Gibbs L, Gussy M. A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children. Int J Paediatr Dent. 2018. https://doi.org/10.1111/ipd.12446.

    Article  PubMed  Google Scholar 

  • Divaris K. Predicting dental caries outcomes in children: a “Risky” concept. J Dent Res. 2016;95:248–54.

    Article  Google Scholar 

  • Evans RW, Clark P, Jia N. The caries management system: are preventive effects sustained postclinical trial? Community Dent Oral Epidemiol. 2016;44:188–97.

    Article  Google Scholar 

  • Featherstone JDB, Chaffee BW. The evidence for caries management by risk assessment (CAMBRA®). Adv Dent Res. 2018;29:9–14.

    Article  Google Scholar 

  • Fontana M. The clinical, environmental, and behavioral factors that foster early childhood caries: evidence for caries risk assessment. Pediatr Dent. 2015;37:217–25.

    PubMed  Google Scholar 

  • Garg A, Madan M, Dua P, Saini S, Mangla R, Singhai P, Dupper A. Validating the usage of Cariogram in 5- and 12-year-old schoolchildren in Paonta Sahib, Himachal Pradesh, India: a 12-month prospective study. Int J Clin Pediatr Dent. 2018;11:110–5.

    Article  Google Scholar 

  • Gao X, Di Wu I, Lo EC, Chu CH, Hsu CY, Wong MC. Validity of caries risk assessment programmes in preschool children. J Dent. 2013;41:787–95.

    Article  Google Scholar 

  • Gao XL, Hsu CY, Xu Y, Hwarng HB, Loh T, Koh D. Building caries risk assessment models for children. J Dent Res. 2010;89:637–43.

    Article  Google Scholar 

  • Gauba K, Goyal A, Mittal N. A CAMBRA model for high caries risk Indian children: a pragmatic comprehensive tailored intervention. J Clin Pediatr Dent. 2016;40:36–43.

    Article  Google Scholar 

  • Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, GRADE Working Group. Going from evidence to recommendations. BMJ. 2008;336:1049–51.

    Article  Google Scholar 

  • Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health. 2004;21(1 Suppl):71–85.

    PubMed  Google Scholar 

  • Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158:280–6.

    Article  Google Scholar 

  • Holgerson PL, Twetman S, Stecksén-Blicks C. Validation of an age-modified caries risk assessment program (Cariogram) in preschool children. Acta Odontol Scand. 2009;67:106–12.

    Article  Google Scholar 

  • Leong PM, Gussy MG, Barrow SY, de Silva-Sanigorski A, Waters E. A systematic review of risk factors during first year of life for early childhood caries. Int J Paediatr Dent. 2013;23:235–50.

    Article  Google Scholar 

  • MacRitchie HM, Longbottom C, Robertson M, Nugent Z, Chan K, Radford JR, Pitts NB. Development of the Dundee Caries Risk Assessment Model (DCRAM)—risk model development using a novel application of CHAID analysis. Community Dent Oral Epidemiol. 2012;40:37–45.

    Article  Google Scholar 

  • Mejàre I, Axelsson S, Dahlén G, Espelid I, Norlund A, Tranæus S, Twetman S. Caries risk assessment. A systematic review. Acta Odontol Scand. 2014;72:81–91.

    Article  Google Scholar 

  • Mejàre IA, Klingberg G, Mowafi FK, Stecksén-Blicks C, Twetman SH, Tranæus SH. A systematic map of systematic reviews in pediatric dentistry—what do we really know? PLOS One. 2015;10:e0117537.

    Article  Google Scholar 

  • Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nat Rev Dis Primers. 2017;3:17030.

    Article  Google Scholar 

  • Ramos-Gomez FJ, Crall J, Gansky SA, Slayton RL, Featherstone JD. Caries risk assessment appropriate for the age 1 visit (infants and toddlers). J Calif Dent Assoc. 2007;35:687–702.

    PubMed  Google Scholar 

  • Senneby A, Mejàre I, Sahlin NE, Svensäter G, Rohlin M. Diagnostic accuracy of different caries risk assessment methods. A systematic review. J Dent. 2015;43:1385–93.

    PubMed  Google Scholar 

  • Tinanoff N, Baez R, Diaz-Guillory C, Donly K, Feldens C, MacGrath C, Phantumvanit P, Pitts MB, Seow K, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education and policy: global perspective. Int J Paediatr Dent. 2019;29:238–48.

    Article  Google Scholar 

  • Twetman S. Caries risk assessment in children: how accurate are we? Eur Arch Paediatr Dent. 2016;17:27–32.

    Article  Google Scholar 

  • Twetman S, Fontana M, Featherstone JD. Risk assessment—can we achieve consensus? Community Dent Oral Epidemiol. 2013;41:e64–70.

    Article  Google Scholar 

  • WHO. WHO expert consultation on public health intervention against early childhood caries: report of a meeting, Bangkok, Thailand, 26–29 January 2016. Geneva: World Health Organization; 2017.

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Acknowledgements

This paper was prepared for the IAPD Global Summit on Early Childhood Caries in Bangkok, Thailand, November 2–4, 2018. The author’s institution entirely funded the work.

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Authors and Affiliations

  1. Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200, Copenhagen N, Denmark

    M. R. Jørgensen & S. Twetman

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  1. M. R. Jørgensen
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  2. S. Twetman
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Correspondence to S. Twetman.

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Jørgensen, M.R., Twetman, S. A systematic review of risk assessment tools for early childhood caries: is there evidence?. Eur Arch Paediatr Dent 21, 179–184 (2020). https://doi.org/10.1007/s40368-019-00480-2

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