Validation of Cariogram in Caries Prediction in Women and Their Children 4 Years After Pregnancy – Longitudinal Study

Abstract

Background

Cariogram^®, an algorithm-based software model, for predicting caries risk has been used to assess the caries risk profile of many different groups. The aims of the study were to evaluate Cariogram caries risk assessment during pregnancy with DMFT/dmft incidence in mothers and their children 4 years after pregnancy and to check if there is an association between children’s caries risk profiles using Cariogram and caries risk profiles (by Cariogram) of their mothers during pregnancy.

Methods

The study population consisted of 96 pregnant women (average age 27.4±7.2 years at baseline) who completed clinical baseline examination and salivary tests. The follow-up study was initiated 4 years later and the 80 pairs of mother and children (from that pregnancy) were re-examined using the same procedure at baseline. An individual caries risk profile and DMFT/dmft incidence were made for each woman and child. The prediction of the Cariogram was compared to the actual dental experience in 4 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for two cut-offs were calculated to express the outcome.

Results

The results showed a strong association between the risk categories of pregnant women and their offspring as well as between caries development in offspring and the Cariogram risk categories of pregnant women. Sensitivity and PPV for new DMFT (ΔDMFT>0) 4 years after for women were  high (>80%) for those participants assessed with 0–60% “chance to avoid caries”, as well as diagnostic accuracy (74.00%). High specificity (91.00%), very high PPV (95.00%) and clinically useful values according to Youden’s index (0.53) were obtained for moderate-risk and two lowest-risk groups for dmft in children.

Conclusion

Cariogram was valid in the authors’ sample only and highly predictive in caries risk assessment in investigated children based on caries risk assessment of their mothers in pregnancy.

Keywords:

• specificity
• early childhood caries
• Cariogram
• pregnant women
• sensitivity
• longitudinal study

Acknowledgments

We are grateful to Bojan Stanković for statistical analysis.

Abbreviations

EEC, early childhood caries; WHO-CPI probe, World Health Organization Community Periodontal Index; DMFT, decayed-missed-filled-teeth; Se, sensitivity; Sp, specificity; PPV, positive predictive value; NPV, negative predictive value.

Data Sharing Statement

This study is a part of the Ph.D. thesis and all data and materials (ethical approval, consent to participate and publish) can be found in official documents at the University of Banja Luka archive on the native language.

Ethics Approval and Consent to Participate

The research has been conducted in full accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and approval for the study was obtained from the Research Committee of Faculty of Medicine, University of Banja Luka (code 0602-350/07). All participants gave their written consent to participate in research. The guardians were responsible for the child’s written consent to participate in research.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests. The authors alone are responsible for the content and writing of the paper. The authors do not hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript. The authors as well do not hold or currently applying for any patents relating to the content of the manuscript, and never had received fundings from an organization that holds or has applied for patents relating to the content of the manuscript. There are no nonfinancial competing interests (political, personal, religious, academic, ideological, intellectual, commercial or any other).