The University of North Carolina Caries Risk Assessment study: further developments in caries risk prediction^*

Abstract

Over 4000 first and fifth grade children from the areas surrounding Aiken, South Carolina, and Portland, Maine, participated in a 4-yr study to develop caries risk assessment models. The predictors used at baseline included detailed clinical examinations, salivary microbiological tests, and sociodemographic and dental behavior data. Mean 3-yr caries increments in South Carolina were twice those in Maine. For the four risk assessment models (two grade cohorts at two sites) specificity values averaged 0.83 and sensitivity values averaged 0.60. Clinical predictors such as prior DMFS, pit and fissure morphology, and predicted caries risk status were the major contributors to the models.

Risk Factors of Caries Progression in a Hispanic School-aged Population

“…A recent study in Singapore showed that caries prediction based on a questionnaire reached a sensitivity/specificity of 0.82/0.81 in 3-to 6-year-olds (Gao et al, 2010). However, additional risk factors (e.g., plaque, bacterial tests, salivary factors, exposure to fluoride) do not seem to markedly improve the prediction in older schoolchildren, adolescents, and adults (Disney et al, 1992;Vanobbergen et al, 2001; Stenlund et al, 2002;Twetman and Fontana, 2009). This may be explained in part by the fact that caries experience reflects relatively well both past and current interplay between and among the various etiologic factors.…”

“…For a clinician, the concepts of risk assessment and prognosis are an essential part of clinical decision-making. In fact, the dentist's overall subjective impression of the patient might have good caries-predictive power (Disney et al, 1992), but it is unclear how this information is incorporated into everyday practice. A recent survey of US practices suggests that a significant proportion of dentists had yet to adopt treatments based on assessment of caries risk (Riley et al, 2010), even when multiple expert-opinion tools are available for children [e.g., Caries Assessment Tool-CAT of the American Academy of Pediatric Dentistry, developed for use in multiple settings (2007); the American Dental Association's Caries Risk Tool (2008); the Caries Management by Risk Assessment tool (Ramos-Gomez et al, 2007)].…”

Contemporary fluid intake and dental caries in Australian children

“…107 Since CRA identifies an individual's potential for developing caries at a given time, the assessment should be made regularly throughout life and risk management instituted accordingly. 104,108,109 As a multifactorial disease, no single risk factor or combination of factors has been identified to predict future caries with both high positive predictive values and high negative predictive values. In addition to the presence of cariogenic bacteria in the dental biofilm, environmental risk factors such as diet, past caries experience, saliva, medical conditions and suboptimal fluoride exposure are implicated.…”

“…In addition to the presence of cariogenic bacteria in the dental biofilm, environmental risk factors such as diet, past caries experience, saliva, medical conditions and suboptimal fluoride exposure are implicated. 32,105,106,[108][109][110][111][112][113] Control of these risk factors can alter the ecology of the biofilm and the subsequent likelihood of caries. Dietary risk factors include the amount of sugars consumed, manner of consumption, frequency of exposure and retentiveness.…”

“…31,114,115,117 Although caries cannot be predicted with perfect sensitivity and specificity, sufficient is known of risk factors for CRA to be valuable in clinical practice and past caries experience remains the best predictor of future caries. 32,104,[107][108][109][110] Caries risk assessment is now the standard of care in paediatric dentistry, supporting individualized preventive programmes and restorative care specific to the child's current needs and perceived risk, and advising parents of their child's caries risk status. [105][106][107]118,119 Caries risk assessment can assist in determining optimal management for each child including dietary guidance, remineralization approaches, placement of sealants and restorations, the frequency of diagnostic radiographs and recall appointments, and in identifying those for whom parental support in reducing risk factors is indicated.…”