Diagnostic accuracy of different caries risk assessment methods. A systematic review.
OBJECTIVE
To evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries.


METHODS
Studies on following methods were included: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, oral hygiene, dietary habits and sociodemographic variables. QUADAS-2 was used to assess risk of bias. Sensitivity, specificity, predictive values, and likelihood ratios (LR) were calculated. Quality of evidence based on ≥3 studies of a method was rated according to GRADE.


METHODS
PubMed, Cochrane Library, Web of Science and reference lists of included publications were searched up to January 2015.


METHODS
From 5776 identified articles, 18 were included. Assessment of study quality identified methodological limitations concerning study design, test technology and reporting. No study presented low risk of bias in all domains. Three or more studies were found only for previous caries experience and salivary mutans streptococci and quality of evidence for these methods was low. Evidence regarding other methods was lacking. For previous caries experience, sensitivity ranged between 0.21 and 0.94 and specificity between 0.20 and 1. Tests using salivary mutans streptococci resulted in low sensitivity and high specificity. For children with primary teeth at baseline, pooled LR for a positive test was 3 for previous caries experience and 4 for salivary mutans streptococci, given a threshold ≥10(5) CFU/ml.


CONCLUSIONS
Evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design.


CONCLUSIONS
Low validity for the analysed methods may lead to patients with increased risk not being identified, whereas some are falsely identified as being at risk. As caries risk assessment guides individualized decisions on interventions and intervals for patient recall, improved performance based on best evidence is greatly needed.
Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden.
Anna
A
Senneby
The Swedish Council on Technology Assessment in Health Care, Box 3657, 103 59 Stockholm, Sweden.
Ingegerd
I
Mejàre
Department of Medical Ethics, Lund University, 221 84 Lund, Sweden.
Nils-Eric
NE
Sahlin
Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden.
Gunnel
G
Svensäter
Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden. Electronic address: madeleine.rohlin@mah.se.
Madeleine
M
Rohlin
D003731:Dental Caries / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D003733:Dental Caries Susceptibility; D006801:Humans; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
Dental caries; Likelihood ratio; Microbiota; QUADAS-2; Sensitivity; Specificity