Transcript A Comparison of Early Childhood Caries Risk Assessment Techniques in a Pediatric Medical Clinic Yoo-Lee Yea, DDS University of Washington.

A Comparison of Early Childhood
Caries Risk Assessment Techniques
in a Pediatric Medical Clinic
Yoo-Lee Yea, DDS
University of Washington
2-5 year olds
Beltrán-Aguilar et al, MMWR 2005; NHANES
Risk Assessment in Medical Clinics
Collaborative efforts towards reducing
overall health consequences


Well-child care visits
Training of medical residents
Opportunities for preventive oral health care

Caries risk assessment & early identification of
high risk children
Risk Assessment in Young Children
Past caries & white spot lesions


By clinical exam
Most significant predictor of future caries
Bacterial levels


By lab technique
Most accurate prediction model
Sociodemographic variables

By interview
Demers et al 1992, Grindefjord et al 1995, Powell 1998
Specific Aims
1)
Compare the sensitivity & specificity
of 3 ECC risk assessments
2)
Determine the feasibility of each risk
assessment technique
3)
Identify the most effective technique
for medical providers in a busy
pediatric medical clinic
Risk Assessment Techniques
CAMBRA oral health interview
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time: 3 minutes
materials cost: $0.50
Ivoclar CRT bacterial test
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time: 1 minute
cost: $8.00
Cariostat plaque acid test
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time: 30 seconds
cost: <$8.00
Study Design
Cross-sectional study
120 subjects, ages 3 years & younger
Harborview Medical Center Children’s Clinic
in Seattle, WA
Inclusion criteria
Exclusion criteria
ASA I
Eruption of primary teeth
ASA II or above
No erupted primary teeth
Written consent
Non-English w/o interpreter
5-minute Encounter Sequence
Eligibility &
Informed Consent
CAMBRA Interview
(17 questions)
CRT (SM) &
CRT (Lb)
Clinical
Examination
Cariostat
Oral Hygiene
Recommendations
If dental caries evident,
Healthy Mothers Healthy Babies brochure given
HMC Children’s Clinic
Table 1. Demographic Characteristics of Sample
n = 120
Age
0 to 1 year
10
1 to 2 years
55
2 to 3 years
25
3 to 4 years
24
4 years & up
6
8.3
45.8
20.8
20.0
5.0
Race
African/African-American
Asian/Asian-American
Hispanic
Other/Mixed
63
12
28
17
52.5
10.0
23.3
14.2
Gender
Male
Female
60
60
50
50
Overall Caries Experience
35
29.2
%
Results
Caries Risk Assessments
A: CRT (SM )
B: CRT (Lb )
A + B combination
C: Cariostat
D: CAMBRA-snacking
A + D combination
C + D combination
Sensitivity (%) Specificity (%)
71.4
54.1
80.0
42.4
91.4
29.4
65.7
55.3
82.9
44.7
94.3
21.2
91.4
25.9
Results
Each risk assessment was associated with
the clinical dental examination
Each technique varied in:
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Cost
Time
Incubation period
Needed training skills
Ease of use
Child acceptability
Conclusions
Each of the three RAs were found to be
significant with the visual exams
Each of the techniques showed tradeoffs
Recommended combination:

CRT (SM) & CAMBRA (snacking question)
Limitations
Cross-sectional design
Bacterial techniques analyze only one
factor of a multifactorial etiology
Recommendations
Inform physicians:


Of predictive ECC risk assessment techniques
Choice of technique needs to be tailored to
each individual clinic
Acknowledgments
• Thesis Committee:
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Colleen Huebner PhD, MPH
Rebecca Slayton DDS, PhD
Joel Berg DDS, MS
Penelope Leggott DDS, MS
• Maternal & Child Health Bureau (#T76MC00011-21-00)
• OMNII Postdoctoral Research Fellowship
• HMC Children’s Clinic (Elinor Graham MD, MPH)
• Patients, Parents & Staff
• Lloyd Mancl PhD for his biostatistical expertise
Questions?
Caries: a multi-factorial disease
Acid producing bacteria (ie S. mutans)

Vertical transmission from caregiver to infant
Eruption of teeth (host)
Frequency of sugar consumption
Saliva

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
Salivary flow
pH
Anti-microbial peptides
Anatomy of teeth

Enamel defects
More prevalent in premature, LBW, low SES children
(Seow 1991)
Fluoride
Early Childhood Caries (ECC)
Presence of 1 or more decayed, missing, or
filled tooth surfaces in any primary tooth in a
child 71 months of age or younger
The occurrence of any sign of caries
during the first 3 yrs is indicative of
severe early childhood caries (S-ECC)
AAPD, 2005
Consequences of ECC
High risk for new caries

In both primary & permanent dentitions
Pain & infection
Hospitalizations & emergency department visits
Increased treatment costs & time
Insufficient physical development (esp. ht & wt)
Loss of school days
Diminished ability to learn
Decreased oral health-related quality of life
Public Health
Utilization of Medicaid for dental care in
children is <30%
 EPSDT: 16% of eligible children
received dental care
<5% of WA state children on Medicaid
visited a dentist by age 2 in 2003
Flow Diagram:
From Screening to Outcome
Screen Children
(<3 yrs old)
Treatment need?
Action
Outcome
Positive
for caries
yes
Treatment &
Prevention
Healthy
False
positive
yes
Prevention
Healthy
Negative
for caries
no
Prevention?
Healthy
False
negative
no
Treatment?
Prevention?
Not Healthy