title: The distribution of burden of dental caries in schoolchildren: a critique of the high-risk caries prevention strategy for populations.
abstract: BACKGROUND
  The 'high-risk approach' is a commonly adopted strategy recommended for the prevention of dental caries in populations. The scientific basis for the strategy has been questioned. The objective of this study is to assess the contribution that children identified at 'high-risk' made towards the total of new caries lesions over a 4-year period, by analysing the distribution of new lesions per 100 children.
  
  
  METHODS
  Data are from the National Preventive Dentistry Demonstration Programme (NPDDP) in the United States. The analyses identified the distribution of new carious lesions over a 4-year period in four groups of 7 year-old children who received differing preventive regimes.
  
  
  RESULTS
  The majority of new lesions occurred in those children classified at lowest caries risk at baseline. Irrespective of the preventive regime adopted and the initial caries levels, children classified as 'highest risk' contributed less than 6% of the total number of new lesions developing over 4 years.
  
  
  CONCLUSIONS
  These findings challenge the basis for the adoption of a high-risk strategy.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 8BT, UK. paulb@public-health.ucl.ac.uk
authors.forename: Paul A
authors.initials: PA
authors.lastname: Batchelor
authors.forename: Aubrey
authors.initials: A
authors.lastname: Sheiham
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003731:Dental Caries / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D011313:Preventive Dentistry / Q000191:economics / Q000379:methods*; D015397:Program Evaluation; D018570:Risk Assessment / Q000379:methods*; D012571:School Dentistry / Q000191:economics / Q000379:methods*; D014481:United States / Q000453:epidemiology