RESUMEN
Central to the development of a model for identifying children at high risk to caries is a clinical evaluation to assess dental status and other conditions potentially useful in caries prediction. Traditionally, this evaluation has been based on a relatively lengthy visual/tactile examination conducted by a dentist. Replacing the dentist examination with a dental auxiliary conducted screening evaluation could lead to reduced time and costs. The 4-yr University of North Carolina Caries Risk Assessment Study involved approximately 5000 schoolchildren initially in Grades 1 and 5 living near Aiken, South Carolina, and Portland, Maine. The effectiveness of caries prediction models using visual/tactile examination data were compared with the same models using simplified screening evaluation data. Results showed sensitivity ranged from 0.57 to 0.61 for the visual/tactile and screening models by site and grade cohort. Specificity for the models ranged from 0.80 to 0.83. None of these differences in sensitivity and specificity between visual/tactile (dentist) and screening (hygienist) models was statistically significant. Findings show that for the prediction of children at high risk to dental caries the clinical evaluation may be conducted with no reduction of precision by using dental hygienist performed screening evaluations rather than dentist conducted visual/tactile examinations. While no cost data were collected, these results imply that costs to future prediction programs could be reduced by using screening evaluations.
Asunto(s)
Caries Dental/diagnóstico , Caries Dental/epidemiología , Examen Físico , Niño , Estudios de Cohortes , Índice CPO , Caries Dental/microbiología , Susceptibilidad a Caries Dentarias , Fisuras Dentales/epidemiología , Fisuras Dentales/patología , Higienistas Dentales , Índice de Placa Dental , Odontólogos , Humanos , Lactobacillus/aislamiento & purificación , Modelos Logísticos , Maine/epidemiología , Modelos Estadísticos , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , South Carolina/epidemiología , Diente Primario , Cepillado DentalRESUMEN
Over 4000 first and fifth grade children from the areas surrounding Aiken, South Carolina, and Portland, Maine, participated in a 4-yr study to develop caries risk assessment models. The predictors used at baseline included detailed clinical examinations, salivary microbiological tests, and sociodemographic and dental behavior data. Mean 3-yr caries increments in South Carolina were twice those in Maine. For the four risk assessment models (two grade cohorts at two sites) specificity values averaged 0.83 and sensitivity values averaged 0.60. Clinical predictors such as prior DMFS, pit and fissure morphology, and predicted caries risk status were the major contributors to the models.