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20-06-2013 | Paediatrics | Article

Quantitative over qualitative for preschool caries assessment


Free abstract

medwireNews: An algorithm-based quantitative approach is the best means of caries risk assessment (CRA) in preschool children, suggests research published in the Journal of Clinical Dentistry.

In a group of 485 children aged 3 years old, the algorithm-driven National University of Singapore (NSU)-CRA program was 73.6% sensitive and 84.7% specific for caries at 12 months follow-up when used as a screening program, report Xiaoli Gao (University of Hong Kong, China) and co-authors.

The values rose to 78.1% and 85.3%, respectively, when combined with saliva tests for the cariogenic mutans Streptococci and Lactobacilli bacteria to create a comprehensive test.

The NSU-CRA comprehensive program therefore met the criteria for a useful CRA tool, defined as a combined sensitivity and specificity score of at least 160%, the researchers report.

The Cariogram, a second algorithm-driven test, achieved sensitivity and specificity of just 62.9% and 77.9%, respectively.

"The incorporation of age-specific risk factors and indicators, such as infant feeding history and parental socio-economic status, and the algorithms built through large-scale prospective study among preschool children might be the main contributors to the superior performance of NUS-CRA over Cariogram," Gao et al hypothesize.

Nevertheless, the Cariogram still fared well compared with the results of the reasoning-based, qualitative Caries risk-Assessment Tool (CAT) and CAries Management by Risk Assessment (CAMBRA) screening tests, which achieved high sensitivity (≥93.8%) at the cost of poor specificity (≤43.6%).

The team explains that caries risk is overestimated by the CAT program, because children are immediately classified as at overall high risk for caries if any risk indicator falls into that category, and by the CAMBRA program, which classifies all children with a developmental problem or a poor socioeconomic background at high risk.

When combined with biologic tests, the CAMBRA screening test achieved a better balance between sensitivity and specificity, at 83.7% and 62.9%, respectively, but was still inferior to the NSU-CRA comprehensive program.

"This prospective study provided evidence for practitioners to choose tools for assessing children's caries risk, so that prevention measures can be tailored and treatment plan can be optimized," the team concludes.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lynda Williams, Senior medwireNews Reporter

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