Hänsel Petersson Gunnel, Åkerman Sigvard, Isberg Per-Erik, Ericson Dan
Department of Cariology, Faculty of Odontology, Malmö University, SE-205 06, Malmö, Sweden.
Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden.
BMC Oral Health. 2016 Jul 7;17(1):13. doi: 10.1186/s12903-016-0238-4.
Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or "gut feeling" or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient's own perception of future oral treatment need correspond with the sum of examiners risk score.
Clinical examinations were performed on randomly selected individuals 20-89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram.
For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients' perception of future oral treatment need correlated to some extent with the sum of examiners risk score.
The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.
预测口腔疾病的未来风险、治疗需求和预后是临床实践中每天都要进行的工作。已经报道了各种各样的方法，从临床判断或“直觉”甚至患者访谈，到对已知风险因素组合的复杂评估。在临床实践中，人们一直在不断寻找更简单、更有效的风险评估工具。此外，对于不同的常见方法之间如何相互关联也缺乏了解。本研究的目的是调查基于临床判断的龋病风险评估（CRA）和龋病预测模型是否给出相似的结果。此外，评估临床状况和病史中的哪些因素与基于临床判断的CRA最相符，以及患者自身对未来口腔治疗需求的认知与检查者风险评分总和的对应情况。
对居住在瑞典斯科讷地区、年龄在20 - 89岁之间的随机选择个体进行临床检查。总共检查了451人，其中51%为女性。临床检查包括龋齿检测、唾液样本、影像学检查以及病史和问卷调查。检查者进行了风险分类，作者根据龋病预测模型进行了第二次风险计算。
使用龋病预测模型评估为低风险的人群中，69%基于临床判断也被评估为低风险。对于其他风险组，一致性较低。与基于临床判断的CRA显著相关的临床变量有DS（龋坏面）、DS与早期病变的组合、DMFT（龋坏、缺失和充填牙）、菌斑量、病史和软饮料摄入量。患者对未来口腔治疗需求的认知在一定程度上与检查者风险评分总和相关。
主要发现是，对于预测未来疾病水平较低的组，基于临床判断的CRA和龋病预测模型给出了相似的结果，但对其他组则不太理想。基于临床判断的CRA与DS加早期病变的数量最为相符。
