title: Caries Risk Assessment Item Importance: Risk Designation and Caries Status in Children under Age 6.
abstract: BACKGROUND
  Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children under age 6-years.
  
  
  OBJECTIVE
  Assess the relative importance of pediatric CRA items in dental providers' decision-making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally.
  
  
  METHODS
  CRA information was abstracted retrospectively from electronic patient records of children initially ages 6-72 months at a university pediatric dentistry clinic (N=3810 baseline; N=1315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay.
  
  
  RESULTS
  Thirteen individual CRA items, including all clinical indicators and all but one risk indicator, were independently and statistically significantly associated with student/resident providers' caries-risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%), moderate (30.6%), to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and one risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor.
  
  
  CONCLUSIONS
  In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers' risk determination than with future caries status. These university dental providers considered many items in decision-making regarding patient risk, suggesting that in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management.
authors.affiliation: University of California San Francisco, Department of Preventive and Restorative Dental Sciences, 3333 California St. Suite 495 Box 1361, San Francisco, CA 94143, benjamin.chaffee@ucsf.edu.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Chaffee
authors.affiliation: University of California San Francisco, john.featherstone@ucsf.edu.
authors.forename: John D B
authors.initials: JD
authors.lastname: Featherstone
authors.affiliation: University of California San Francisco, stuart.gansky@ucsf.edu.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Gansky
authors.affiliation: University of California San Francisco, jing.cheng@ucsf.edu.
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.affiliation: University of California San Francisco, ling.zhan@ucsf.edu.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhan
keywords: child dentistry; decision-making; dental caries; epidemiology; preschool child; risk factors