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Journal of dental research
08, 2023;102 (9): 988-998.

Predicting Dental Caries in Young Children in Primary Health Care Settings.

M Fontana, G J Eckert, B P Katz, M A Keels, B T Levy, S M Levy, A R Kemper, E Yanca, R Jackson, J Warren, J L Kolker, J M Daly, S Kelly, J Talbert, P McKnight
Author Information
  1. M Fontana: University of Michigan, Ann Arbor, MI, USA. ORCID
  2. G J Eckert: Indiana University, Indianapolis, IN, USA. ORCID
  3. B P Katz: Duke University, Durham, NC, USA.
  4. M A Keels: Duke University, Durham, NC, USA.
  5. B T Levy: University of Iowa, Iowa City, IA, USA.
  6. S M Levy: University of Iowa, Iowa City, IA, USA.
  7. A R Kemper: Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
  8. E Yanca: University of Michigan, Ann Arbor, MI, USA.
  9. R Jackson: Indiana University, Indianapolis, IN, USA.
  10. J Warren: University of Iowa, Iowa City, IA, USA.
  11. J L Kolker: University of Iowa, Iowa City, IA, USA.
  12. J M Daly: University of Iowa, Iowa City, IA, USA.
  13. S Kelly: Duke University, Durham, NC, USA.
  14. J Talbert: University of Iowa, Iowa City, IA, USA.
  15. P McKnight: George Mason University, Fairfax, VA, USA.
PMID: 37329133 DOI: 10.1177/00220345231173585

Abstract

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 ( < 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.

Keywords

cariology cohort study pediatric dentistry pediatrics personalized medicine risk factors

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Grants

  1. U01 DE021412/NIDCR NIH HHS
  2. UL1 TR000006/NCATS NIH HHS
  3. UL1 TR000433/NCATS NIH HHS
  4. UL1 TR000442/NCATS NIH HHS

MeSH Term

Pregnancy
Humans
Child
Female
Child, Preschool
Infant
Male
Dental Caries
Cohort Studies
Prospective Studies
Cesarean Section
Primary Health Care
DMF Index
Journal Article Research Support, N.I.H., Extramural

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