Caries risk assessment in young adults: A 3-year validation of clinical guidelines used in Public Dental Service

Abstract

Objectives. To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values. Materials and methods. All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated. Results. At baseline, 11.9% were assessed as being at ‘high' or ‘very high' risk. The dropouts had significantly more caries than the remaining patients (p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk (p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for ‘low' risk vs any risk. By combining the ‘low' and ‘some' risk categories, the PDS model generated an improved specificity (94%). Conclusions. The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65–70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk.

Key Words::

• risk classification
• guidelines
• risk model

Acknowledgment

The authors would like thank the staff at all participating Public Dental Clinics for their collaboration. The dental assistants Anette Hansson and Birgitta Wallin are acknowledged for their engagement and skilful clinical work, and Anna Karlbrink Sjöberg for her assistance with input of data. The study was supported by grants from the Skåne Region and from the Swedish Patent Revenue Research Fund for Preventive Odontology.

Declaration of interest: The authors report no conflicts of interests. The authors alone are responsible for the content and writing of the paper.