Caries risk assessment with the ‘Bangkok checklist’ in preschool children: A prospective cohort study

Abstract

Background: Caries risk assessment in preschool children is poorly validated in prospective studies. Aim: To validate the Bangkok checklist (BCL) in predicting caries development in a cohort of preschool children from low and moderate socioeconomic areas and compare it with two established risk assessment tools. Design: We followed 146 preschool children, aged 2-5 years for 2 years. At baseline, the caries risk category (low, moderate, high) was determined with three checklists: (a) BCL, (b) American Academy of Pediatric Dentistry form (CRAF), and (c) CariesManagement By Risk Assessment (CAMBRA). Data were collected from questionnaires and clinical examinations. Caries increment was recorded by counting the number of surfaces that changed from sound to decayed. We used Kendall's tau, Poisson regression models and ROC analysis to assess the predictive ability of the different checklists. Results: Over 50% of the children developed new caries on a yearly basis. The BCL assigned the majority of the children (87%) into the high-risk category. Sensitivity was 88% but specificity was low (16%). Accuracy of BCL was similar to CRAF but inferior to CAMBRA. Conclusions: Bangkok checklist had a very limited performance in accurately predicting future early childhood caries in this population.

A systematic review of caries risk in children <6 years of age

“…10 Five studies reported the sensitivity and specificity of specific CRA tools with different populations or made comparisons between existing CRA tools (Table 2). [14][15][16][17][18] Key findings from multivariate analyses of the combined 47 publications appear in Table 3. This new search allowed the evaluation of the association between caries and 36 sociodemographic and family risk factors, 13 behavioral factors, seven clinical factors, and five salivary and bacterial factors (Table 3).…”

“…Despite their significance, CRA tools have limitations, including a lack of validation for some combined factor questions. 15,59,60 Many tools are formed by expert panels and are not based on systematic literature reviews. Fortunately, evaluations and validation of CRA tools are gaining acceptance.…”

“…Caries risk assessment tools are crucial in providing a comprehensive understanding of the picture, which enables tailored anticipatory guidance for reducing the caries disease burden. Despite their significance, CRA tools have limitations, including a lack of validation for some combined factor questions 15,59,60 . Many tools are formed by expert panels and are not based on systematic literature reviews.…”

Subtypes of early childhood caries predict future caries experience

“…6 In the clinical setting, it would be useful to understand which children are at highest risk of caries. Past caries experience is a recognized predictor for new caries experience, 7 and caries experience in primary teeth can predict caries experience in the permanent dentition. 8 This may be because children who develop caries at a young age have a high burden of genetic, environmental, or behavioural risk factors, and these same risk factors are important for both primary and permanent teeth.…”

Subtypes of early childhood caries predict future caries experience

“…6 In the clinical setting, it would be useful to understand which children are at highest risk of caries. Past caries experience is a recognised predictor for new caries experience 7 , and caries experience in primary teeth can predict caries experience in the permanent dentition. 8 This may be because children who develop caries at a young age have a high burden of genetic, environmental, or behavioural risk factors, and these same risk factors are important for both primary and permanent teeth.…”