A systematic review of risk assessment tools for early childhood caries: is there evidence?

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.

Effectiveness of risk-based caries management among Chinese preschool children: a randomized controlled single-blind trial

BACKGROUND

Early childhood caries (ECC) remain a serious oral health problem on a global scale. Risk-based caries management (RBCM) implemented in some parts of the world has been effective in preventing ECC. However, there is a lack of prospective research on the application of RBCM among Chinese children, and little is known about its effectiveness. The purpose of this study was to evaluate the effectiveness of RBCM in preventing caries among children aged 3-5 years in Wanzhou District, Chongqing Municipality, China.

METHODS

Three- to five-year-old children from four kindergartens in Wanzhou were randomly selected for baseline dental examination and caries risk assessment (CRA) and randomly assigned to the experimental group (EG) or the control group (CG) according to the kindergarten. The EG received caries prevention measures of different intensities based on the child's caries risk level. The CG received full-mouth fluoride twice a year according to standard prevention, regardless of their caries risk. One year later, another dental examination and CRA were conducted, to observe changes in the decayed, missing, and filled teeth (dmft) index and caries risk, and to analyze potential factors that may affect the incidence of new caries.

RESULTS

Complete data were collected from 291 children (EG, N = 140, 84.8%; CG, N = 181, 83.4%). A total of 25.7% of the EG and 50.3% of the CG children developed new caries, with newly added dmft scores of 0.54 ± 1.12 and 1.32 ± 1.72, respectively (P < 0.05). Multivariate logistic regression indicated that children living in rural areas, assigned to the CG, and rated as high-risk at baseline were more likely to develop new caries (P < 0.05). The proportion of children with an increased caries risk in the EG was significantly lower than that in the CG (P < 0.05).

CONCLUSIONS

RBCM effectively prevented new caries in 3- to 5-year-old Wanzhou children and reduced the proportion of children at increased risk of caries. It is an effective approach for preventing ECC.

CLINICAL TRIAL REGISTRATION

This trial was registered in the Chinese Clinical Trials Register. The registration number was ChiCTR230067551 (11/01/2023).

More than clean teeth! Identifying factors that contribute to the development of early childhood caries

The updated systematic review by Khan et al. reviews the evidence surrounding the possible factors that could contribute to the development of early childhood caries (ECC) in children of a particular age group. This follows a previously published systematic review across 1997-2017. These factors can then be used for the development of a Caries Risk Assessment (CRA) tool.

DATA SOURCES

This review aimed to identify established and updated evidence-based factors that could contribute to a child's development of Early Childhood Caries (ECC). Four online databases were used to source evidence including the Cochrane Library, EMBASE, MEDLINE, and Scopus.

STUDY SELECTION

The data search selected studies published between 2017 and 2021. Three specific terms were used to search: Dental Caries, Children, and Risk Assessment. There were three teams involved in data collection, two teams then reviewed selected articles. Exclusion criteria included any duplicate studies, commentaries, and editorials. Inclusion criteria included only randomised control trials and cohort studies. Selected studies must include children younger than 72 months, define the demographics, their clinical characteristics, and have clear follow-up of the patients involved. Commonly identified factors that were mentioned in multiple studies were then collected and assigned strength depending on the evidence measured using ratios. These could then be utilised to form a draft Caries Risk Assessment tool.

DATA EXTRACTION AND SYNTHESIS

512 abstracts and 52 articles were screened, having matched the criteria set. Extraction of the data was completed under four headings: the child's age at the time of study (in years/months), risk predictors, the outcome, and the quality of the evidence presented. The GRADE system was then employed to separate the studies into high, moderate, low, and very low categorisation. Eventually, 22 new studies were included that would build on the original 25 articles that were identified in the previous systematic review.

RESULTS

The most defining factors across the most recent systematic reviews in 2021 highlighted behavioural factors such as toothbrushing quality - parental supervision, frequency, and fluoride exposure. Specifically, the presence of plaque was used as a marker for oral hygiene evaluation. Dietary history included snacking frequency and, controversially, baby-toddler breastfeeding patterns. However, this does not take into consideration the dental impact - mainly the frequency or timing of breastfeeding (e.g. overnight). The review emphasises the importance of consideration of socio-economic factors though this may be a difficult topic of discussion if families are struggling i.e. household income and education level of parents or guardians. There is also mention of factors that do not have a significant evidence base such as the child's gender, ethnicity, and parental smoking status.

CONCLUSION

In conclusion, the factors found to be relevant in the development of ECC were the child's age, toothbrushing quality/plaque control, parental involvement in toothbrushing, fluoride exposure, pattern of dental attendance, dietary sugar exposure, and habits, clinically carious active lesion presence, the oral bacterial composition (Streptococcus mutans presence) and the socio-economic status of the child and their family. Though the review encourages identification of the caries risk factors in the mentioned groups, separated by both dental and non-dental professionals, ideally the aim would be to create a holistic care approach for management and signposting.

Multivariable prediction models of caries increment: a systematic review and critical appraisal

BACKGROUND

Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.

METHODS

Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.

RESULTS

Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.

CONCLUSIONS

The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.

TRIAL REGISTRATION

PROSPERO CRD#152,467 April 28, 2020.

Predicting Dental Caries in Young Children in Primary Health Care Settings

Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80-1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1-2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83-2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.

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.

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study

BACKGROUND

Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life.

AIM

To evaluate the ECC prevalence and its impact on OHRQoL in 3-5 years-old Mexican children according to disease severity.

DESIGN

Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression.

RESULTS

A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p < .05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR = 1.39, 95%CI = 1.11-1.72; p < .01), two main meals/day (OR = 2.75, 95%CI = 1.26-6.03; p = .01) and unsupervised toothbrushing (OR = 3.20, 95%CI = 1.96-5.24; p < .01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ² ₍₄₎  = 175.85, p < .01; trend across groups z = 12.63 Prob > |z| < 0.01).

CONCLUSIONS

M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

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

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) Caries Management 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 to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers

BACKGROUND

Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries.

AIM

To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings.

DESIGN

Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE.

RESULTS

Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance.

CONCLUSIONS

This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.

Risk factors for dental caries in Latin American and Caribbean countries

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

OBJECTIVES

To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses.

DATA/SOURCES

We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

STUDY SELECTION

A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00.

CONCLUSION

The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies.

CLINICAL SIGNIFICANCE

Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Caries Prevalence and Severity for 12-Year-Old Children in Latvia

Objectives

To study caries prevalence/severity in 12-year-old children in Latvia and potential risk indicators.

Methods

A cross-sectional oral-health national survey of 12-year-old children was conducted in 2016. A nationally representative stratified-cluster probabilistic sample of 2,138 pupils in 92 schools was selected. Children were examined by seven calibrated examiners (kappa inter-examiner, intra-examiner scores of 0.71–0.77, 0.81–0.97, respectively) at school. Enamel-non-cavitated decay (D₁), enamel cavitation (D₃), dentine cavitation (D₅), missing (M) or filled (F) status at the tooth (T)/surface (S) levels were evaluated, and decayed, missing, and filled (DMF) index scores for severity, along with the Significant Caries Index (SiC), were calculated. An associated caries factor questionnaire was completed by participants.

Results

The prevalence of caries was 98.5% for D₁MFT, 79.7% for D₃MFT, and 71.9% for D₅MFT. The means (standard deviations) for severity were 9.2 (5.3) for D₁MFT, 3.3 (3.0) for D₃MFT, and 2.4 (2.4) for D₅MFT, and 5.6 (2.1) for the SiC. Indicators associated with a lower risk of caries (D5MFT) were irregular dental visits (prevalence odds ratio POR = 0.45, 95% confidence interval (CI): 0.36, 0.56) and irregular use of mouthwashes (POR = 0.73, 95% CI: 0.60, 0.89).

Conclusions

We found a high caries prevalence and severity in 12 year-old children in Latvia. Although the WHO target for 2010 (D₅MFT ≤ 3) is met, the values for caries prevalence (D₅MFT > 0 = 71.9%) and severity (D₅MFT = 2.5) in 12-year-old Latvian children are higher than the European averages (D₅MFT > 0 = 52%, D₅MFT = 1.1).

Conceptualization of dental caries by dental students is related to their preventive oral care routine

OBJECTIVE

Whether the understanding of dental caries influences how future dentists manage the disease themselves has not been previously studied. Thus, this study evaluated whether the conceptualization (understanding) of dental caries by dental students is related to their own preventive oral care routine.

METHODS

Dental students at a U.S. dental school (n = 517) were invited to voluntarily respond to an anonymous electronic survey in spring 2018. Demographic characteristics, caries conceptualization (CC), dental care habits, and self-caries risk determination were asked. Discursive responses to CC were analyzed by content analysis technique, and categories [c] were created. Chi-square and Fisher's exact tests were used for analysis.

RESULTS

Overall response rate was 54.5% (n = 282, 48.2% female). Three researchers independently analyzed discursive answers and classified them into 1 of 6 caries concept categories [c]: [c1] only signs of the disease (10.3%), [c2] bacterial disease-not specifying bacterial metabolism (38.3%), [c3] bacterial byproducts-not specifying substrate (13.8%), [c4] biological or multifactorial concept (24.8%), [c5] comprehensive multifactorial disease (8.2%), or [c6] other (4.6%). Only 33% completely defined dental caries according to the modern understanding of the disease (c4-c5). Statistical differences were found between: CC and diet modification, CC and rinsing after brushing, year of school (YS) and self-determined caries-risk, YS and brushing at school, and YS and rinsing after brushing (P < 0.05).

CONCLUSION

Our data suggest that the students' understanding of the disease can influence how they will manage the disease in terms of diet modification and behavior after brushing. Moreover, self-caries risk determination influenced students' brushing behavior.

Improving Caries Risk Prediction Modeling: A Call for Action

Dentistry has entered an era of personalized/precision care in which targeting care to groups, individuals, or even tooth surfaces based on their caries risk has become a reality to address the skewed distribution of the disease. The best approach to determine a patient's prognosis relies on the development of caries risk prediction models (CRPMs). A desirable model should be derived and validated to appropriately discriminate between patients who will develop disease from those who will not, and it should provide an accurate estimation of the patient's absolute risk (i.e., calibration). However, evidence suggests there is a need to improve the methodological standards and increase consistency in the way CRPMs are developed and evaluated. In fact, although numerous caries risk assessment tools are available, most are not routinely used in practice or used to influence treatment decisions, and choice is not commonly based on high-quality evidence. Research will propose models that will become more complex, incorporating new factors with high prognostic value (e.g., human genetic markers, microbial biomarkers). Big data and predictive analytic methods will be part of the new approaches for the identification of promising predictors with the ability to monitor patients' risk in real time. Eventually, the implementation of validated, accurate CRPMs will have to follow a user-centered design respecting the patient-clinician dynamic, with no disruption to the clinical workflow, and needs to operate at low cost. The resulting predictive risk estimate needs to be presented to the patient in an understandable way so that it triggers behavior change and effectively informs health care decision making, to ultimately improve caries outcomes. However, research on these later aspects is largely missing and increasingly needed in dentistry.

In vivo correlation of near-infrared transillumination and visual inspection with bitewing radiography for the detection of interproximal caries in permanent and primary teeth

PURPOSE

To evaluate near-infrared light transillumination (NILT) for interproximal caries detection in children by comparing the correlation between both NILT and visual inspection (ICDAS) with bitewing (BW) radiography and by investigating possible differences in caries detection with NILT between primary and permanent teeth.

METHODS

From 35 patients, 121 and 63 interproximal surfaces in, respectively, primary and permanent teeth were included. NILT images were obtained using DIAGNOcam™ (KaVo) and scored by two calibrated raters. A consensus diagnosis was reached for BW radiography; whereas, the ICDAS scores were obtained by one calibrated rater. Weighted Kappa (wκ) was used to evaluate inter- and intra-rater reliability of NILT and to evaluate the correlation between NILT, ICDAS and BW radiography.

RESULTS

The correlation between NILT and BW radiography was moderate to substantial for primary teeth [Rater 1: wκ = 0.61 (95% CI = 0.49-0.75), Rater 2: wκ = 0.55 (95% CI = 0.41-0.69)] and fair for permanent teeth [Rater 1: wκ = 0.34 (95% CI = 0.15-0.53), Rater 2: wκ = 0.33 (95% CI = 0.08-0.58)]. The correlation between ICDAS and BW radiography was moderate for primary teeth [wκ = 0.49 (95% CI = 0.35-0.63)] and substantial for permanent teeth [wκ = 0.62 (95% CI = 0.32-0.92)]. No significant differences were found between primary and permanent teeth.

CONCLUSION

NILT cannot be recommended as a single diagnostic tool for interproximal caries detection in primary teeth. The number of false negatives for dentine caries, especially in first primary molars, was too high. For the use in permanent teeth, NILT could be more accurate than BW radiography.