Validity of caries risk assessment programmes in preschool children

Gao, Xiaoli; Wu, Ivy Di; Lo, Edward Chin Man; Chu, Chun Hung; Hsu, Chin‐Ying Stephen; Wong, May Chun Mei

doi:10.1016/j.jdent.2013.06.005

Cited by 62 publications

(100 citation statements)

References 20 publications

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“…Collectively, these findings suggest that opportunity losses could be reduced, thereby optimizing the cost-effectiveness of a primary molar sealant strategy by ensuring that only high-risk children receive sealants. This approach is consistent with a risk-based disease prevention strategy (Gao et al, 2013) and results of previous cost-effectiveness studies on permanent molar sealants (Weintraub, 2001;Bhuridej et al, 2007). While various caries risk assessment tools are available (Ramos-Gomez and Ng, 2011;Campus et al, 2012;AAPD, 2013), none has been used in the context of cost-effectiveness evaluations of preventive care for children.…”

Section: Discussionsupporting

confidence: 63%

Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

2014

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The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategiesalways seal (AS) and standard care (SC) -with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.

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Section: Discussionsupporting

confidence: 63%

Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

2014

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“…We were not able to find any significant association of rs9701796 with dental caries experience, which may be because of the low number of our study sample size, reducing the statistical power of our study. DMFT is considered in most caries risk assessment programs, including the Cariogram, the Caries Management by Risk Assessment (CAMBRA) program and the Caries-risk Assessment Tool (CAT), as a predictor for future caries experience [Bratthall et al, 2005;Gao et al, 2013]. Therefore, in this study we included this variable as a risk factor in the logistic regression analysis.…”

Section: Discussionmentioning

confidence: 99%

Association of Sweet Taste Receptor Gene Polymorphisms with Dental Caries Experience in School Children

et al. 2015

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Sweet taste is a powerful factor influencing food acceptance. The peripheral taste response to sugar is mediated by the TAS1R2/TAS1R3 taste receptors. The aim of the study was to determine the relationship between TAS1R2 (rs35874116 or rs9701796) and/or TAS1R3 (rs307355) single nucleotide polymorphisms with dental caries experience in schoolchildren. A total of 184 schoolchildren aged between 7 and 12 years (101 girls, 83 boys) were included in the study. Genomic DNA was extracted from saliva samples and the genotypes were identified by qPCR. The genotype frequencies were as follows: 6.6% for homozygous wild type, 41.8% for heterozygous and 51.6% for homozygous polymorphic genotype carriers of TAS1R2 gene rs35874116; 27.8% for heterozygous and 72.2% for homozygous polymorphic genotype carriers of TAS1R2 gene rs9701796, and 83.1% for homozygous wild type and 16.9% for heterozygous genotype carriers of TAS1R3 gene rs307355 polymorphism. A significant association was observed between total caries experience (dft + DMFT - decayed filled primary teeth + decayed, missing and filled permanent teeth) and TAS1R2 rs35874116 (p = 0.008) and TAS1R3 rs307355 (p = 0.04) gene polymorphisms but not for TAS1R2 gene rs9701796 polymorphism. TAS1R3 gene rs307355 polymorphism has been found to be an independent risk factor for dental caries experience by logistic regression analysis and to have increased the risk of caries. Moderate caries experience (4-7 caries) was found to be associated with TAS1R3 rs307355 heterozygous genotype, whereas high-risk caries experience (>8 caries) was found to be associated with TAS1R2 rs35874116 homozygous polymorphic genotype.

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“…Our latest survey showed that about 35% of Hong Kong children aged 3 years develop new caries in one or more teeth (△dmft >0) in a year [24]. An intervention will be considered to have a clinically significant effect if it reduces this rate to 20% in a year.…”

Section: Methodsmentioning

confidence: 99%

“…According to our latest survey in Hong Kong [24], 60% of children aged 3 years have unfavorable oral health behaviors (24% with insufficient toothbrushing only; 26% with frequent snacking only; and 10% with both). To reach the target number of 690 parent-child dyads (230 dyads in each of the three groups), 1,150 children would need to be screened (1,150 × 60% = 690).…”

Section: Methodsmentioning

confidence: 99%

“…A questionnaire (in Chinese) pre-tested in our previous study [24] will be completed by parents to gather information on (i) family socio-demographic background, (ii) parental knowledge of and attitudes toward oral health, (iii) parental efficacy in protecting the child’s oral health, (iv) child’s oral health behaviors (diet and oral hygiene), and (v) child’s history of dental treatment and use of caries-preventive agents, such as topical fluorides.…”

Section: Methodsmentioning

confidence: 99%

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Innovative interventions to promote positive dental health behaviors and prevent dental caries in preschool children: study protocol for a randomized controlled trial

Gao

McGrath

et al. 2013

Trials

Self Cite

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BackgroundDental caries (tooth decay) is highly prevalent and is largely attributable to unhealthy self-care behaviors (diet and oral hygiene). The conventional (health) education (CE), focusing on disseminating information and giving normative advice, often fails to achieve sustained behavioral changes. This study incorporates two innovative elements into CE: (i) motivational interviewing (MI), a client-centered counseling for changing behaviors, and (ii) an interactive caries risk assessment (RA) tool, which is devised to facilitate dental counseling and may enhance MI in several ways. Through a randomized, controlled, evaluator-blinded trial, three intervention schemes (CE, CE + MI, and CE + MI + RA) will be compared for their effectiveness in eliciting dentally healthy behaviors and preventing caries in preschool children.Methods/DesignThis study targets 3-year-old children who are at a critical stage for embedding health habits. Children with unfavorable dental behaviors (insufficient toothbrushing and/or frequent snacking) and their parents will be recruited from 12 participating kindergartens. Parent-child dyads (n = 690) will be randomly assigned into three groups. In the first group (CE), oral health information and advice will be delivered to parents through pamphlets. In the second group (CE + MI), in addition to the pamphlets, individual MI counseling with each parent will be performed by one of two trained dental hygienists. In the third group (CE + MI + RA), besides pamphlets and MI, interactive RA will be integrated into MI to motivate parents and facilitate their informed decision making and goal planning. At baseline and after 12 and 24 months, parents will complete a questionnaire and children will undergo a dental examination. The effectiveness of the intervention schemes will be compared over 12 and 24 months. The primary outcome will be caries increment in children and proportion of caries-free children. Secondary outcomes will be changes in parental efficacy for protecting children’s oral health and changes in children’s dental behaviors.DiscussionMotivating and empowering parents to cultivate dentally healthy habits of young children presents both promises and challenges. With careful methodological considerations, this study is expected to provide scientific evidence for public health workers, dentists, and dental auxiliaries (nurses and hygienists) to choose appropriate interventions to advance children’s oral health.Trial registrationHKCTR-1455

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Validity of caries risk assessment programmes in preschool children

Cited by 62 publications

References 20 publications

Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

Association of Sweet Taste Receptor Gene Polymorphisms with Dental Caries Experience in School Children

Innovative interventions to promote positive dental health behaviors and prevent dental caries in preschool children: study protocol for a randomized controlled trial

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