Oliveros-Villarico Maritess, Pungchanchaikul Patimaporn, Watthanasaen Supatra, Pitiphat Waranuch
Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen Thailand; Subsection of Pediatric Dentistry, Department of Clinical Dental Health Sciences, College of Dentistry, University of the Philippines Manila, Manila, Philippines.
Division of Pediatric Dentistry, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
Int Dent J. 2025 Apr;75(2):586-595. doi: 10.1016/j.identj.2024.07.1217. Epub 2024 Aug 24.
Caries risk assessment is an essential part of the diagnostic process. Many studies have assessed these tools, proving their effectiveness in reducing future caries risk in developed countries with low caries prevalence. However, Filipino children have consistently registered high caries prevalence rates in successive official surveys. This prospective study aimed to compare the validity of available caries risk assessment tools in predicting future caries among a high-caries-prevalent population in the Philippines.
From the vaccination registry of community health centres in Caloocan City, Philippines, children aged 4-24 months underwent oral examinations according to modified International Caries Detection and Assessment System (ICDAS) criteria, and their primary caregivers were interviewed using a structured questionnaire. Baseline caries risk categories were evaluated using 3 available tools, without biological tests. Caries incidence was recorded during the follow-up visit after 2 years.
Baseline oral examinations in 703 toddlers (mean age: 13.3 months, standard deviation (SD) 2.4) revealed a high caries prevalence of 29.2%. Of the 654 eligible children without cavitated caries at baseline, 323 (mean age: 35.6 months, SD 5.1) attended the 2-year follow-up visit, with a caries incidence (cavitated and non-cavitated) of 76.5%. Caries-risk Assessment Form (CrAF) demonstrated high sensitivity but low specificity scores (93.1% and 3.9%), while Caries Management by Risk Assessment (CAMBRA) showed similar patterns (71.7% and 34.2%). Conversely, Cariogram exhibited low sensitivity but high specificity (23.5% and 80.3%).
Among CrAF, CAMBRA or Cariogram, no assessment tool came close (sensitivity + specificity < 160) to effectively identify toddlers highly at risk of caries development.
Current CRA tools lack sufficient accuracy in predicting caries development in high-risk populations like Filipino children. Refinement or development of more valid tools is crucial for implementing effective caries prevention strategies at both individual and population levels.
龋病风险评估是诊断过程的重要组成部分。许多研究对这些工具进行了评估，证明它们在龋病患病率较低的发达国家降低未来龋病风险方面是有效的。然而，在连续的官方调查中，菲律宾儿童的龋病患病率一直居高不下。这项前瞻性研究旨在比较现有龋病风险评估工具在预测菲律宾高龋病患病率人群未来龋病方面的有效性。
从菲律宾卡洛奥坎市社区卫生中心的疫苗接种登记册中，对4至24个月大的儿童按照改良的国际龋病检测与评估系统（ICDAS）标准进行口腔检查，并使用结构化问卷对其主要照顾者进行访谈。在不进行生物学检测的情况下，使用3种现有工具评估基线龋病风险类别。在2年后的随访中记录龋病发病率。
对703名幼儿（平均年龄：13.3个月，标准差（SD）2.4）进行的基线口腔检查显示，龋病患病率高达29.2%。在基线时无龋洞龋病的654名符合条件的儿童中，323名（平均年龄：35.6个月，SD 5.1）参加了2年的随访，龋病发病率（有龋洞和无龋洞）为76.5%。龋病风险评估表（CrAF）显示出高敏感性但低特异性评分（93.1%和3.9%），而基于风险评估的龋病管理（CAMBRA）表现出类似模式（71.7%和34.2%）。相反，龋病预测模型表现出低敏感性但高特异性（23.5%和80.3%）。
在CrAF、CAMBRA或龋病预测模型中，没有一种评估工具接近（敏感性+特异性<160）有效识别有高度龋病发展风险的幼儿。
目前的龋病风险评估工具在预测像菲律宾儿童这样的高风险人群的龋病发展方面缺乏足够的准确性。改进或开发更有效的工具对于在个体和人群层面实施有效的龋病预防策略至关重要。
