Exploring the contributions of components of caries risk assessment guidelines.
OBJECTIVE
To examine the relative contribution of current caries activity, past caries experience, and dentists' subjective assessment of caries risk classifications.


METHODS
Administrative data from two dental plans were analyzed to determine dentists' risk classification, as well as current caries activity and previous caries experience at the time of the classification. The performance of these predictors in identifying patients who would experience subsequent caries was then modeled using logistic regression.


RESULTS
In both plans, current caries activity alone had relatively low sensitivity and high specificity in identifying patients who would experience subsequent caries. Sensitivity improved, but at the cost of specificity when previous caries experience was included in the models. Further improvement in sensitivity accrued when dentists' subjective assessment was included, but performance was different in the two plans in terms of false-positives.


CONCLUSIONS
Consideration of previous caries experience tends to strengthen the predictive power of caries risk assessments. Dentists' subjective assessments also tend to improve sensitivity, but overall accuracy may suffer.
Bader
James D
JD
School of Dentistry and Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27514, USA. Jim_bader@unc.edu
Perrin
Nancy A
NA
Maupomé
Gerardo
G
Rush
William A
WA
Rindal
Brad D
BD
D003442:Crowns; D004245:DMF Index; D003731:Dental Caries / Q000145:classification / Q000209:etiology*; D003732:Dental Caries Activity Tests; D003733:Dental Caries Susceptibility; D003793:Dental Restoration, Permanent; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014081:Tooth Extraction