title: Early childhood caries screening tools: a comparison of four approaches.
abstract: BACKGROUND
  Early childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness.
  
  
  METHODS
  The authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness.
  
  
  RESULTS
  The results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved.
  
  
  CONCLUSIONS
  Salivary culture of MS alone in a population of young, low-income Hispanic children outperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values).
  
  
  CONCLUSIONS
  Screening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.
authors: Division of Pediatric Dentistry, Columbia University College of Dental Medicine, New York City, NY 10032, USA.
authors: Richard K
authors: RK
authors: Yoon
authors: Arlene M
authors: AM
authors: Smaldone
authors: Burton L
authors: BL
authors: Edelstein
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000175:diagnosis*; D003773:Dental Plaque / Q000175:diagnosis; D005260:Female; D005891:Gingivitis / Q000175:diagnosis; D006301:Health Services Needs and Demand; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009519:New York City; D015588:Observer Variation; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012463:Saliva / Q000382:microbiology*; D012680:Sensitivity and Specificity; D012923:Social Class; D013295:Streptococcus mutans / Q000302:isolation & purification*