Transforming the caries risk assessment from the individual level to the tooth and surface level
Felemban, Osama Mahmood
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OBJECTIVE: Caries risk assessment tools operate on the subject level. The aim of the study is to create new caries risk assessment models that functions on the tooth and surface level to assess the risk of caries of single teeth and surfaces. METHODS: Secondary data from the Dental Longitudinal Study was used to evaluate caries symmetry. Teeth were grouped into posterior and anterior teeth. Surfaces were grouped into fissured, proximal, and facial and lingual surfaces. The prediction of future caries on a tooth or a surface by the current caries on a bilateral or adjacent tooth or surface was evaluated. Additional general and oral caries risk factors on teeth and surfaces were adopted from the American Dental Association caries risk assessment tool. Caries on bilateral and/or adjacent teeth or surfaces were augmented with significant oral clinical caries predictor to build the caries risk assessment tools for teeth and surfaces. The models were validated by calculating sensitivities and specificities. RESULTS: 495 subjects with baseline and three year follow up data were included in the study. Caries prevalence and incidence was symmetrical (right and left) on the population level. On the individual level, caries incidence was symmetrical (right and left) and also tends to affect adjacent teeth or surfaces. Baseline caries on bilateral and adjacent teeth and surfaces was predictive of caries at follow up in all groups of teeth and surfaces except posterior teeth. Local oral caries risk factors like visible plaque, interproximal restorations, and xerostomia significantly predicted caries on single teeth and surfaces. Tools of caries risk assessment for anterior teeth and the three groups of surfaces were built. The sensitivities of these tools ranged between 67.33% to 85.51 %, specificities ranged between 38.40 % to 66.11%, and the overall accuracies ranged between 41.95% to 66.27%. CONCLUSION: Dental caries is a symmetrical disease affecting the right and left sides of the mouth equally. Past caries experience is significant in predicting future caries. New models were built to assess caries risk for anterior teeth, fissured surfaces, proximal surfaces, and facial and lingual surfaces with acceptable accuracy.