A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers

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

BACKGROUND

For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC).

AIM

This updated systematic review aimed to identify current evidence on caries risk in young children.

DESIGN

A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus.

RESULTS

Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome.

CONCLUSION

This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Prevalence and risk indicators of early childhood caries among toddlers in Caloocan City, Philippines: a cross-sectional study

BACKGROUND

Limited published data exist on early childhood caries (ECC) among children 2 years old and below. The study aimed to determine ECC prevalence and its association with socio-demographic indicators, feeding practices and oral health behaviours among children aged 2 years and below in the Philippines.

METHODS

A cross-sectional study observed young children aged 4-24 months in primary health centers. Each child's caregiver was interviewed and dental examinations were done on every child by one calibrated dentist using the ICDAS. Poisson regression using robust variance estimator analysis identified significant variables associated with ECC.

RESULTS

Seven hundred three healthy children were observed at a mean age of 13.3 ± 2.4 months. ECC prevalence was 29.2% (95% confidence interval: 26.0-32.7) among toddlers who showed a mean number of 6.7 ± 3.1 erupted teeth. Multiple regression revealed that child's age (prevalence ratio, PR = 1.07), caregiver's educational level (PR = 1.43), continued breastfeeding (PR = 1.36), frequent eating (PR = 1.24), visible plaque observed by the caregiver (PR = 1.34) and in the oral examination (PR = 2.90) were significant to ECC prevalence.

CONCLUSIONS

ECC is alarmingly prevalent in toddlers, marked by early onset and untreated decay. Prioritizing preventive measures in the first two years of life is crucial for understanding dietary impacts and promoting oral hygiene.

An Observation Study of Caries Experience and Potential Risk Assessments among Disabled Individuals Living in an Institutional Rehabilitation Centre

The aim of this study was to conduct salivary, microbiological, and caries risk assessments in relation to caries experience among individuals with intellectual disability in an institutional center in the Al-Baha region, Saudi Arabia. A cross-sectional study was conducted among 89 patients residing in special care homes in the Al-Baha region, Saudi Arabia, from October 2023 to February 2024. The demographic details of all participants were recorded. Clinical oral examinations were performed for the decayed, missing, or filled teeth (DMFT) and plaque indices. Salivary and microbiological assessments were also carried out. The mean age of the study sample was 30.11 ± 4.39 years, and the mean duration of years spent residing in the facility was 26.49 ± 4.66. There was no significant difference observed across plaque scores, S. mutans colony count, salivary rate, pH, DFMT, and caries experience when they were compared across the levels of severity of intellectual disability. Statistically significant differences were observed across diet score, circumstance score, and chances to avoid caries and were found to be correlated with the severity of intellectual disability (p = 0.001, p = 0.001, and p = 0.002), respectively. The cariogram revealed that participants in this study had poor oral health status, with participants with severe intellectual disability having higher diet scores, frequency scores, and susceptibility scores; hence lesser chances to avoid dental caries. Regular dental check-ups, including cleanings and other treatments if necessary, seem to be fundamental to prevent dental issues and maintain healthy teeth and gums for this group of people. Developing interventions that focus on improving oral health status among intellectually disabled individuals may be recommended to ensure the optimum level of support and reduce the burden of dental decay among those individuals.

Comparison of two different caries risk assessment tools for infants and toddlers - A cross-sectional study

CONTEXT

One of the essential components for successful caries management is caries risk assessment (CRA). Among CRA tools (CRATs) published in the literature: Caries management by risk assessment (CAMBRA) 123 and American Academy of Pediatric Dentistry (AAPD) CRATs are specifically designed for infants and toddlers.

AIMS

The aim of this study is to compare readily available internationally accepted CRAT for infants and toddlers and check the usability of these tools in assigning caries risk among the Indian population.

SETTINGS AND DESIGN

The study was conducted at Baby Oral Health Promotion Clinic, Department of Pediatrics, Tertiary Care Hospital using a cross-sectional study design.

SUBJECTS AND METHODS

Data were collected using CAMBRA 123 and AAPD CRATs from 379 children aged 0-6 years. The caries risk of the children was recorded with each CRAT and a comparison was made between the two tools used.

STATISTICAL ANALYSIS USED

The percentage of agreement and Cohen's kappa coefficient were used to know the agreement between the CAMBRA 123 and AAPD CRATs using the SPSS statistical tool. The significance level was set at 5% (α = 0.05).

RESULTS

For children aged <2 years, the study showed slight agreement between the CAMBRA 123 and AAPD, whereas, for children more than 2 years, there was a fair agreement between the two methods which was statistically significant. This indicates that the agreement between the two methods is still not perfectly established, and AAPD CRA assigns a higher risk category than CAMBRA 123.

CONCLUSIONS

CAMBRA 123 is a promising user-friendly quantitative method for CRA in clinical practice. Since there is ambiguity in assessing the caries risk in children <2 years, there is a need to establish a CRAT that can be used exclusively for children below 2 years.

A mixed methods approach to obtaining health care provider feedback for the development of a Canadian pediatric dental caries risk assessment tool for children <6 years

Introduction

Early childhood caries (ECC) is a chronic but preventable disease affecting young children worldwide. Many young children face access to care barriers to early preventive dental visits for a variety of reasons, which can increase their risk for ECC. Non-dental primary health care providers are well positioned to assist in assessing a child's risk for ECC by performing caries risk assessment (CRA). The purpose of this project was to report on primary health care provider and stakeholder feedback in order to refine a drafted CRA tool for Canadian children &lt;6 years of age intended for use by non-dental primary health care providers.

Methods

In this mixed methods project, we conducted six focus groups with primarily non-dental primary health care providers followed by a short paper-based survey to quantify preferences and feedback. Data were thematically and descriptively analyzed.

Results

Participants’ feedback on the drafted CRA tool included the need for it to be relatively quick to complete, easy and practical to score, easy to implement into practitioners’ clinic schedules, and to include anticipatory guidance information to share with parents and caregivers. All participants (100%) welcomed a CRA tool. Many (85.4%) liked a layout that could be added to tools they already utilize. Most (73.2%) wanted the tool to be in colour, and many (90.2%) wanted the tool to include pictures.

Conclusion

Non-dental primary health care providers informed the final development and layout of the newly released Canadian CRA tool. Their feedback resulted in a user-friendly CRA tool with provider-patient dynamics and preferences.

A Comparison of Four Caries Risk Assessment Methods

Introduction: Caries risk assessment (CRA) is essential as the basis for successful management of dental caries. Of the many published CRA tools, four well-known ones are CAMBRA, Cariogram, American Dental Association (ADA), and American Academy of Pediatric Dentistry (AAPD) CRAs. The predictive accuracy of CAMBRA and Cariogram CRA tools have been examined in clinical outcomes studies in thousands of patients and the tools are widely used all over the world. The purpose of the present paper is three-fold, namely (1) to briefly review, compare and contrast these four CRA methods, (2) to provide a concise method for CRA introducing a quantitative component to the CAMBRA forms (CAMBRA 123), and (3) to guide the choice of CRA methods that will support caries management decisions. Comparison of Caries Risk Assessment Methods: In the present evaluation, the above-mentioned four CRA methods for ages 0-6 years and 6 years-adult were compared using 26 hypothetical patients (13 per age group). Comparison results show that Cariogram and CAMBRA categorized patients into identical risk categories. Each of the ADA and AAPD tools gave different results than CAMBRA and Cariogram in several comparison examples. CAMBRA 123 gave the same caries risk level results as the Cariogram and the CAMBRA methods for all hypothetical patients for both age groups. Conclusions: Both the Cariogram and the CAMBRA CRA methods are equally useful for identifying the future risk of dental caries. CAMBRA 123 shows promise as an easy-to-use quantitative method for CRA in clinical practice. The health care providers will be the ones to decide which CRA method will allow them to establish individualized, successful caries management therapies and how to combine these for the best care of their patients.