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Kalhan TA, Un Lam C, Karunakaran B, Chay PL, Chng CK, Nair R, Lee YS, Fong MCF, Chong YS, Kwek K, Saw SM, Shek L, Yap F, Tan KH, Godfrey KM, Huang J, Hsu CYS. Caries Risk Prediction Models in a Medical Health Care Setting. J Dent Res 2020; 99:787-796. [PMID: 32311276 DOI: 10.1177/0022034520913476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite development of new technologies for caries control, tooth decay in primary teeth remains a major global health problem. Caries risk assessment (CRA) models for toddlers and preschoolers are rare. Among them, almost all models use dental factors (e.g., past caries experience) to predict future caries risk, with limited clinical/community applicability owing to relatively uncommon dental visits compared to frequent medical visits during the first year of life. The objective of this study was to construct and evaluate risk prediction models using information easily accessible to medical practitioners to forecast caries at 2 and 3 y of age. Data were obtained from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring cohort. Caries was diagnosed using modified International Caries Detection and Assessment System criteria. Risk prediction models were constructed using multivariable logistic regression coupled with receiver operating characteristic analyses. Imputation was performed using multiple imputation by chained equations to assess effect of missing data. Caries rates at ages 2 y (n = 535) and 3 y (n = 721) were 17.8% and 42.9%, respectively. Risk prediction models predicting overall caries risk at 2 and 3 y demonstrated area under the curve (AUC) (95% confidence interval) of 0.81 (0.75-0.87) and 0.79 (0.74-0.84), respectively, while those predicting moderate to extensive lesions showed 0.91 (0.85-0.97) and 0.79 (0.73-0.85), respectively. Postimputation results showed reduced AUC of 0.75 (0.74-0.81) and 0.71 (0.67-0.75) at years 2 and 3, respectively, for overall caries risk, while AUC was 0.84 (0.76-0.92) and 0.75 (0.70-0.80), respectively, for moderate to extensive caries. Addition of anterior caries significantly increased AUC in all year 3 models with or without imputation (all P < 0.05). Significant predictors/protectors were identified, including ethnicity, prenatal tobacco smoke exposure, history of allergies before 12 mo, history of chronic maternal illness, maternal brushing frequency, childbearing age, and so on. Integrating oral-general health care using medical CRA models may be promising in screening caries-susceptible infants/toddlers, especially when medical professionals are trained to "lift the lip" to identify anterior caries lesions.
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Affiliation(s)
- T A Kalhan
- Faculty of Dentistry, National University of Singapore, Singapore
| | - C Un Lam
- Chief Dental Officer's Office, Ministry of Health, College of Medicine Building, Singapore
| | - B Karunakaran
- Faculty of Dentistry, National University of Singapore, Singapore
| | - P L Chay
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - C K Chng
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - R Nair
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Dentistry-Quality and Safety of Oral Healthcare, Nijmegen, the Netherlands.,Dr. D. Y. Patil Dental College & Hospital, Pune, Maharashtra, India
| | - Y S Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - M C F Fong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Y S Chong
- Chief Dental Officer's Office, Ministry of Health, College of Medicine Building, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - K Kwek
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - S M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - L Shek
- Division of Paediatric Allergy, Immunology & Rheumatology, National University Hospital, Singapore
| | - F Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Department of Paediatrics, Duke-National University of Singapore Graduate Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - K H Tan
- Dental Service, KK Women's and Children's Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - C-Y S Hsu
- Faculty of Dentistry, National University of Singapore, Singapore
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Un Lam C, Khin L, Kalhan A, Yee R, Lee Y, Chong MF, Kwek K, Saw S, Godfrey K, Chong Y, Hsu CY. Identification of Caries Risk Determinants in Toddlers: Results of the GUSTO Birth Cohort Study. Caries Res 2017; 51:271-282. [PMID: 28538220 PMCID: PMC5716459 DOI: 10.1159/000471811] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/16/2017] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to identify risk determinants leading to early childhood caries (ECC) and visible plaque (VP) in toddlers. Data for mother-child pairs participating in the Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort were collected from pregnancy to toddlerhood. Oral examinations were performed in 543 children during their clinic visit at 24 months to detect ECC and VP. Following logistic regression, ECC and VP were jointly regressed as primary and secondary outcomes, respectively, using the bivariate probit model. The ECC prevalence was 17.8% at 2 years of age, with 7.3% of children having a VP score >1. ECC was associated with nighttime breastfeeding (3 weeks) and biological factors, including Indian ethnicity (lower ECC rate), higher maternal childbearing age and existing health conditions, maternal plasma folate <6 ng/mL, child BMI, and the plaque index, while VP was associated with psychobehavioral factors, including the frequency of dental visits, brushing frequency, lower parental perceived importance of baby teeth, and weaning onto solids. Interestingly, although a higher frequency of dental visits and toothbrushing were associated with lower plaque accumulation, they were associated with increased ECC risk, suggesting that these established caries-risk factors may be a consequence rather than the cause of ECC. In conclusion, Indian toddlers may be less susceptible to ECC, compared to Chinese and Malay toddlers. The study also highlights a problem-driven utilization pattern of dental services (care sought for treatment) in Singapore, in contrast to the prevention-driven approach (care sought to prevent disease) in Western countries.
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Affiliation(s)
- C. Un Lam
- Faculty of Dentistry, National University of Singapore,
Singapore
| | - L.W. Khin
- Singapore Institute for Clinical Sciences, A-STAR, Singapore
| | - A.C. Kalhan
- Faculty of Dentistry, National University of Singapore,
Singapore
| | - R. Yee
- Faculty of Dentistry, National University of Singapore,
Singapore
| | - Y.S. Lee
- Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
| | - M.F-F. Chong
- Saw Swee Hock School of Public Health, National University of
Singapore, Singapore
| | - K. Kwek
- KK Women’s and Children’s Hospital, Singapore
| | - S.M. Saw
- Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
| | - K. Godfrey
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Southampton,
UK
- Medical Research Council Lifecourse Epidemiology Unit, Southampton,
UK
| | - Y.S. Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of
Medicine
| | - C-Y. Hsu
- Faculty of Dentistry, National University of Singapore,
Singapore
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