26 July 2023

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Predicting dental caries in young children in primary health care settings

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Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need.

The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities.

A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention).

Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items.

At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities.

The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios):

• child participating in public assistance programs such as Medicaid (1.74)
• being non-White (1.80–1.96)
• born premature (1.48)
• not born by caesarean section (1.28)
• snacking on sugary snacks (3 or more/d, 2.22; 1–2/d or weekly, 1.55)
• PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17)
• PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32)
• PCG brushing their teeth less than daily (2.72), PCG’s gums bleeding daily when brushing or PCG having no teeth (1.83–2.00)
• and PCG having cavities/fillings/extractions in past 2 y (1.55).

A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.

Fontana M, Eckert GJ, Katz BP, et al. "Predicting Dental Caries in Young Children in Primary Health Care Settings." Journal of Dental Research. 2023;0(0). doi:10.1177/00220345231173585.