title: Validity of caries risk assessment programmes in preschool children.
abstract: OBJECTIVE
  Various programmes have been developed for caries risk assessment (CRA). Nevertheless, scientific evidence on their validity is lacking. This study aimed to compare the validity of 4 CRA programmes (CAT, CAMBRA, Cariogram, and NUS-CRA) in predicting early childhood caries.
  
  
  METHODS
  A total of 544 children aged 3 years underwent oral examination and biological tests (saliva flow rate, salivary buffering capacity and abundance of cariogenic bacteria mutans Streptococci and Lactobacilli). Their parents completed a questionnaire. Children's caries risk was predicted using the 4 study programmes without biological tests (screening mode) and with biological tests (comprehensive mode). After 12 months, caries increment in 485 (89%) children was recorded and compared with the baseline risk predictions.
  
  
  RESULTS
  Reasoning-based programmes (CAT and CAMBRA screening) had high sensitivity (≥ 93.8%) but low specificity (≤ 43.6%) in predicting caries in children. CAMBRA comprehensive assessment reached a better balance (sensitivity/specificity of 83.7%/62.9%). Algorithm-based programmes (Cariogram and NUS-CRA) generated better predictions. The sensitivity/specificity of NUS-CRA screening and comprehensive models were 73.6%/84.7% and 78.1%/85.3%, respectively, higher than those of the Cariogram screening (62.9%/77.9%) and comprehensive assessment (64.6%/78.5%). NUS-CRA comprehensive model met the criteria for a useful CRA tool (sensitivity+specificity ≥ 160%), while its screening model approached that target.
  
  
  CONCLUSIONS
  Our results supported algorithm-based approach of caries risk modelling and the usefulness of NUS-CRA in identifying children susceptible to caries.
  
  
  CONCLUSIONS
  This prospective study provided evidence for practitioners to select tools for assessing children's caries risk, so that prevention measures can be tailored and treatment plan can be optimised.
authors.affiliation: Dental Public Health, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong. gaoxl@hkucc.hku.hk
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Gao
authors.forename: Ivy
authors.initials: I
authors.lastname: Di Wu
authors.forename: Edward Chin Man
authors.initials: EC
authors.lastname: Lo
authors.forename: Chun Hung
authors.initials: CH
authors.lastname: Chu
authors.forename: Chin-Ying Stephen
authors.initials: CY
authors.lastname: Hsu
authors.forename: May Chun Mei
authors.initials: MC
authors.lastname: Wong
mesh_terms: D000465:Algorithms; D001294:Attitude to Health; D002021:Buffers; D002675:Child, Preschool; D004245:DMF Index; D003731:Dental Caries / Q000209:etiology* / Q000382:microbiology; D003733:Dental Caries Susceptibility / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D008297:Male; D009910:Oral Hygiene; D010290:Parents / Q000193:education / Q000523:psychology; D015397:Program Evaluation; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012463:Saliva / Q000378:metabolism / Q000502:physiology; D012636:Secretory Rate; D012680:Sensitivity and Specificity; D012923:Social Class; D013295:Streptococcus mutans / Q000302:isolation & purification; D011795:Surveys and Questionnaires
chemical_list: D002021:Buffers
keywords: Caries risk assessment; Early childhood caries; Multifactorial modelling; Prospective study; Sensitivity; Specificity