ความสามารถในการทำนายผลของแบบประเมินความเสี่ยงการเกิดฟันผุในเด็กไทยอายุไม่เกิน 3 ปี

Abstract

Objectives: The objectives of this study were to 1) assess the distributions of risk levels, the sensitivity, specificity, and predictive values of caries risk assessment tools including CAT, CAMBRA, THAI, PSU-CRA, and PSU-adjusted, 2) to compare the distributions of caries risk levels using the assessment tools, and 3) assess the association between risk indicators assessing the same factors collected differently and caries increment during the 6-month follow-up. Method: This study was a prospective observational study. Children aged 3 years old or younger and their primary caregivers were recruited for the study. Children oral examination: for dental caries and plaque status were performed. Primary caregivers were interviewed for demographic data and caries related factors. Oral examinations and interviews were conducted at baseline and about 6 month: thereafter. Children were classified into high and low risk groups according to each risk assessment tool criteria. The decision matrix of risk levels from each assessment and caries increment status were constructed. The sensitivity, specificity and predictive values were calculated. The associations of risk indicators and caries increment status were analyzed using the chi-square test. The McNemar test was performed for the difference among predictive outcomes of the tools. This study was approved by the Ethics Committee of the Faculty of Dentistry, Prince of Songkla University (EC6007-20-P-LR) and registered in the Thai Clinical Trials Registry (TCTR20180905001). Results: The assessment with highest predictive power was CAT with one factor criterion (using white spot lesions or enamel defects as the determinant factor). There were statistically significant associations between the assessed risk level of THAI, PSU-CRA and PSU- adjusted at baseline and caries increment at 6-months follow-up (p<0.05). The assessed risk level of CAT-preponderance factors was a statistically significant difference from the assessed risk levels of the other tools at baseline (p<0.05). The predictive power of CAT (preponderance), CAT (one factor: white spot lesions or enamel defects), CAMBRA, THAI, PSU-CRA, and PSU-adjusted were 92.8, 138.1, 106.1, 129.2, 127.2, and 116.9, respectively. For caries experience as a risk indicator, children having initial caries (OR=5.37) were more likely to have one or more caries increment at follow-up than those having dental caries on anterior teeth (OR=4.27) and those having obvious dental carie: (OR=1.34). For plaque status as a risk indicator, having plaque on teeth (OR=3.11) and having plaque on anterior teeth (OR=2.72) were significantly associated with having caries increment at follow-up. However, having plaque on posterior teeth was not significantly associated with having caries increment at follow-up. Conclusion: Caries risk assessment tools including CAT with one factor criterion (using white spot lesions or enamel defects as the determinant factor), THAI, PSU-CRA, and PSU- adjusted had acceptable predictive power for assessing caries risk in Thai Children younger than 3 years old. High caries risk children at baseline using the assessments were significantly associated with having caries increment at 6-months follow-up.