Over the past decade, dentists have been urged to perform caries risk assessments (CRAs) to boost the chance that patients will receive appropriate treatment to prevent future dental cavities. Adding the dentist's personal assessment to classification determined strictly by a patient's previous caries experience and current caries improves the sensitivity of identifying patients at risk for subsequent cavities. However, overall accuracy may suffer, according to a new study. Nancy A. Perrin, Ph.D., of Oregon Health & Science University, and colleagues determined the impact of these three approaches to determining caries risk by examining administrative data from two dental plans.
At Plan A, current caries activity alone explained about 2.5 percent of the variance in future caries activity, while previous and current caries activity explained 5.5 percent of the variance. The results for Plan B were similar. Current caries activity alone explained 4.9 percent of the variance, but previous and current caries activity explained 6.9 percent of the variance. When the dentists' CRAs were added to past and current caries activity, the model explained 8.2 percent of the variance in Plan A, but only 4.1 percent of the variance in Plan B.
In Plan B, more of the additional patients identified by the dentists' CRAs as caries-active were false-positives, thereby weakening the overall effectiveness of the additional information. At both plans, dentists were more likely to assign an elevated caries risk to those patients who were older, received prior preventive treatment, and had larger numbers of caries-related procedures in the prior 1-year period and current period.
The authors call for more studies to improve dentists' accuracy in caries risk assessments. The study was supported by the Agency for Healthcare Research and Quality (HS13339).
See "Exploring the contributions of components of caries risk assessment guidelines," by James D. Bader, D.D.S., M.P.H., Dr. Perrin, Gerardo Maupome, D.D.P.H., Ph.D., and others, in Community Dentistry and Oral Epidemiology 36, pp. 357-362, 2008.