Baseline caries risk assessment as a predictor of caries incidence

Chaffee, Benjamin W.; Cheng, Jing; Featherstone, J.D.B.

doi:10.1016/j.jdent.2015.02.013

Cited by 61 publications

(76 citation statements)

References 23 publications

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“…8 Those researchers suggested that the CRA was a useful tool for risk stratiication, which is similar to our indings in which patients experienced a signiicantly higher percentage of new caries-related treatments based on increasing categories of risk. This inding was similar in the study conducted at UCSF, where nearly half of the low-risk patients were found to have a carious lesion at follow-up exams.…”

Section: Discussionsupporting

confidence: 88%

“…[7][8][9] The accuracy of the CAMBRA form in children compared to other CRA forms in a population in Hong Kong found limited accuracy. These data will help the school assess changes over time to our risk-based caries management and educational model.…”

Section: Discussionmentioning

confidence: 99%

“…8 Regarding defining the time frame for the follow-up exams, these were considered as the next documented Periodic, Update Plan, or Limited Oral Exams visit, as long as it was completed at least 180 days following the initial CRA. A similar limitation was noted in a study conducted at UCSF, where investigators analyzed decayed and illed teeth but noted that the increase in illed teeth may have been due to reasons other than carious lesions.…”

Section: Discussionmentioning

confidence: 99%

“…However, caries experience is still considered one of the greatest indicators of future risk. [7][8][9] Yet, risk assessment is an essential component of cariology education in dental curricula, 10 and thus dental schools must include CRA models in their clinics that have not been validated in their own populations. Numerous strategies and tools are available for CRA in daily practice, including an informal assessment, use of structured paper forms, and use of computerbased programs; but the majority are expert-based tools with limited validation.…”

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confidence: 99%

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Predictive Validity of a Caries Risk Assessment Model at a Dental School

Brons-Piche

Eckert

Fontana

2019

Journal of Dental Education

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Caries risk assessment (CRA) is an essential component informing clinical decision making for personalized caries management. The aim of this study was to assess the predictive validity of the CRA model used at the University of Michigan School of Dentistry. Data from patients treated in the school's adult integrated clinics between 2011 and 2014 who had a CRA documented were accessed from the electronic health record. Data extracted included caries risk category, date of reassessments, presence of caries risk indicators/factors, and treatments completed. Out of 2,449 patients who had a CRA completed in 2011, 447 had one or more reassessments at least 180 days after the initial CRA. Caries risk status was significantly associated (p<0.0001) with the number of new caries‐related treatments during follow‐up, with significant increases (p<0.01) in these needs for each caries risk level. For the 11,152 patients with a completed CRA in 2011‐14, the prediction model (area under the curve=0.82) included the following risk factors significantly (p<0.001) associated with increased caries experience/needs over time: stagnant plaque (OR 2.6, 95% CI 2.4, 2.9), presence of salivary risk factors (OR 2.6, 95% CI 2.2, 2.9), presence of dietary risk factors (OR 3.2, 95% CI 2.9, 3.6), lack of adequate protective factors (OR 2.1, 95% CI 1.8, 2.4), presence of conditions that affect compliance (OR 2.4, 95% CI 1.9, 3.1), and past/current caries experience (OR 23.7, 95% CI 21.1, 26.7). High risk patients were significantly more likely (p<0.0001) to have restorative, extraction, or endodontic treatments completed due to caries and less likely (p<0.0001) to have diagnostic procedures than low or moderate risk patients. These results suggest that the CRA model used at the dental school can help predict adult patients' future caries experience/needs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictive Validity of a Caries Risk Assessment Model at a Dental School

Brons-Piche

Eckert

Fontana

2019

Journal of Dental Education

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“…The objective of risk assessment on a population level is to allocate limited resources to those with the greatest need and on individual level to assist clinical decision‐making and to establish appropriate recall intervals . There are several risk assessment tools available for the general practitioner, most of them relying on reasoning‐based manual checklists such as CAT and CAMBRA . Cariogram is an algorithm‐based programme, using nine different caries‐related risk factors that along with the clinical judgement of the examiner, calculates the “chance to avoid caries” .…”

Section: Introductionmentioning

confidence: 99%

Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk

Birpou

Agouropoulos

Twetman

et al. 2019

Int J Paed Dentistry

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Background Caries risk assessment in preschool children has been limited validated. Aim To validate caries predictive ability of Cariogram using different combinations of factors and settings in preschool children from areas with high caries risk. Design Two to five years old children (N = 175) were examined for caries (cavitated and non‐cavitated lesions), at baseline and after 1 and 2 years. Mutans streptococci counts (MS) and saliva buffer capacity (SBC) were measured with chair side tests. Diet and oral health attitude were assessed through a parental questionnaire. Baseline caries risk was calculated using standard and high‐risk group variables in Cariogram either with nine factors or excluding MS and SBC. Poisson regression models, ROC analysis and information criteria (AIC and BIC), P < 0.05, were used to investigate the predictive ability of Cariograms and to quantify the associations. Results Accuracy of Cariogram was found limited. Cariograms with MS showed higher sensitivity but lower specificity than those without bacterial counts. Standard set Cariograms with MS counts performed slightly better than the other models, but the difference was not statistically significant. Caries prediction with standard and high set Cariograms was also found limited. Conclusions Cariogram with various factors and settings displayed suboptimal ability to predict caries in this population.

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Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Nelson,

Albert,

Selvaraj

et al. 2024

JAMA Netw Open

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ImportanceUntreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive.ObjectiveTo test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs).Design, Setting, and ParticipantsThe Pediatric Providers Against Cavities in Children’s Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3).InterventionsClinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory–based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone.Main Outcomes and MeasuresDental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data.ResultsEighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = −0.27; 95% CI, −0.56 to 0.02).Conclusions and RelevanceIn this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs.Trial RegistrationClinicalTrials.gov Identifier: NCT03385629

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Baseline caries risk assessment as a predictor of caries incidence

Cited by 61 publications

References 23 publications

Predictive Validity of a Caries Risk Assessment Model at a Dental School

Predictive Validity of a Caries Risk Assessment Model at a Dental School

Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

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