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A Comparison of Early Childhood Caries Risk Assessment Techniques in a Pediatric Medical Clinic

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.

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A Comparison of Early Childhood Caries Risk Assessment Techniques in a Pediatric Medical Clinic

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

  2. 2-5 year olds Beltrán-Aguilar et al, MMWR 2005; NHANES

  3. 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

  4. 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

  5. Specific Aims • Compare the sensitivity & specificity of 3 ECC risk assessments • Determine the feasibility of each risk assessment technique • Identify the most effective technique for medical providersin a busy pediatric medical clinic

  6. Risk Assessment Techniques • CAMBRA oral health interview • time: 3 minutes • materials cost: $0.50 • Ivoclar CRT bacterial test • time: 1 minute • cost: $8.00 • Cariostat plaque acid test • time: 30 seconds • cost: <$8.00

  7. Study Design • Cross-sectional study • 120 subjects, ages 3 years & younger • Harborview Medical Center Children’s Clinic in Seattle, WA

  8. 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

  9. HMC Children’s Clinic

  10. Results

  11. Results • Each risk assessment was associated with the clinical dental examination • Each technique varied in: • Cost • Time • Incubation period • Needed training skills • Ease of use • Child acceptability

  12. 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)

  13. Limitations • Cross-sectional design • Bacterial techniques analyze only one factor of a multifactorial etiology

  14. Recommendations • Inform physicians: • Of predictive ECC risk assessment techniques • Choice of technique needs to be tailored to each individual clinic

  15. Acknowledgments • Thesis Committee: • Colleen Huebner PhD, MPH • Rebecca Slayton DDS, PhD • Joel Berg DDS, MS • Penelope Leggott DDS, MS • Maternal & Child Health Bureau(#T76MC00011-21-00) • OMNIIPostdoctoral Research Fellowship • HMC Children’s Clinic (Elinor Graham MD, MPH) • Patients, Parents & Staff • Lloyd Mancl PhD for his biostatistical expertise

  16. Questions?

  17. 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 • Salivary flow • pH • Anti-microbial peptides • Anatomy of teeth • Enamel defects • More prevalent in premature, LBW, low SES children (Seow 1991) • Fluoride

  18. 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

  19. 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

  20. 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

  21. Flow Diagram:From Screening to Outcome

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