Caries Management By Risk Assessment Research Articles

Unmasking caries risk: a multi-regional study in Saudi Arabia

BackgroundDental caries are common and troublesome and may affect individuals’ health conditions. It is crucial to comprehend the caries experience for prevention, management, and enhancing oral health. Techniques such as CAMBRA can help assess an individual’s risk factors for caries lesions. This study aims to assess the caries risk in five distinct regions of Saudi Arabia, utilizing the CAMBRA methodology.MethodsThis multiregional cross-sectional study was conducted at university dental clinics across the five regions of Saudi Arabia, using a Caries Management by Risk Assessment (CAMBRA) tool. This study used binary logistic regression analysis, the Pearson Chi-square test, and descriptive analysis as statistical methods.ResultsA total of 551 respondents participated in the study, with 59.7% being male and 40.3% being female. The age group with the highest proportion was 20–29, making up 31.6% of the participants. All participants exhibited at least one caries lesion (100%), with white spots (66.4%) and enamel lesions (56.1%) being the most prevalent. The moderate-risk category encompassed the largest proportion of participants, accounting for 60% of the total. High caries risk had a significant association with age group (P < 0.001), education (P < 0.001), profession (P < 0.001), and socio-economic status (P < 0.001). Furthermore, only age and socio-economic status showed a significant relationship with high caries risk in the multiple logistic regression.ConclusionThe CAMBRA tool indicates a high prevalence of moderate risk across the five regions of Saudi Arabia, identifying age and socio-economic status as significant predictors of caries risk.

Caries risk assessment and caries management by risk assessment after graduation: university dental school alumni use, attitudes, and beliefs

Aims: This project examined the acceptance and use of Caries Management by Risk Assessment (CAMBRA) by the university dental school alumni after graduation. Methods: In 2011, a university dental school implemented a CAMBRA Competency Examination (CE) for assessing students’ ability to conduct a caries risk assessment and preventive plan. A survey was distributed in 2020 to 5,000 university dental school alumni who graduated between 1975 and 2019 which assessed their use and beliefs regarding Caries Risk Assessment (CRA). Alumni were placed into two groups for purposes of analysis: Group 1(G1): those who graduated prior to 2013 (n= 373) and Group 2 (G2) : those who graduated in or after 2013 (n=213). Results: There was an overall response rate of 12% as 586 alumni responded to the survey. Overall, most (82.59%) of the survey respondents routinely assessed for caries risk, with 31.82% using a standardized tool. 42.83% of the respondents strongly agreed that CRA could predict the risk of future caries. There were significant differences between groups in terms of routine use of CRA (39.68% in G1 vs 48.36% in G2); very strong belief that a dentist’s use of CRA can predict the future risk of caries (39.68% vs 48.36%); extreme importance of active caries when determining a preventive plan (38.16% vs 53.43%); and always treating children with incipient lesions with in-office fluoride (61.56% vs 76.02%) (all p&lt;.05). Conclusion: The alumni who graduated after the implementation of the competency examination used CAMBRA to a greater extent than those who graduated before its implementation, suggesting a possible paradigm shift.

Caries risk assessment by Caries Management by Risk Assessment (CAMBRA) Protocol among the general population of Pakistan-a multicenter analytical study.

Caries risk (CR) assessment tools are used to properly identify individuals with caries risk and to improve preventive procedures and programs. A tool such as CAMBRA determines the precise protective factors of caries and identifies an individual's specific therapeutic intervention. The purpose of this study was to assess the caries risk using the CAMBRA protocol among the general population of Pakistan. This multicentre analytical study was conducted in ten dental hospitals in different provinces of Pakistan and the caries risk assessment was carried out using a questionnaire that was designed using the Caries Management by Risk Assessment (CAMBRA) protocol. All 521 participants were intra-orally examined to assess oral hygiene status and the presence of disease. Multiple logistic regression test was performed for analysis. A higher number of participants (61.2%) were found to be in the moderate risk category of caries risk assessment. The males are 51% less likely to have caries compared to the females (AOR = 0.49, P = 0.081). The majority of participants (71.3%) had one or more disease indicators, with white spots and visible cavities. Those with visible, heavy plaque were 13.9 times more likely to have caries compared to those without (AOR = 13.92, P < 0.001). Those using calcium and phosphate during the last 6 months were 90% less likely to have caries compared to those not using them (AOR = 0.10, P < 0.001). There was no significant interaction between all eight risk factors retained in the final model (P > 0.05), the Hosmer and Lemeshow Test P < 0.001, classification accuracy = 87.1%, and AUC = 91.2%. The caries risk among the general population of Pakistan is moderate, with significant variation among age groups, education levels, and socioeconomic status.

Comparison of two different caries risk assessment tools for infants and toddlers - A cross-sectional study.

One of the essential components for successful caries management is caries risk assessment (CRA). Among CRA tools (CRATs) published in the literature: Caries management by risk assessment (CAMBRA) 123 and American Academy of Pediatric Dentistry (AAPD) CRATs are specifically designed for infants and toddlers. The aim of this study is to compare readily available internationally accepted CRAT for infants and toddlers and check the usability of these tools in assigning caries risk among the Indian population. The study was conducted at Baby Oral Health Promotion Clinic, Department of Pediatrics, Tertiary Care Hospital using a cross-sectional study design. Data were collected using CAMBRA 123 and AAPD CRATs from 379 children aged 0-6 years. The caries risk of the children was recorded with each CRAT and a comparison was made between the two tools used. The percentage of agreement and Cohen's kappa coefficient were used to know the agreement between the CAMBRA 123 and AAPD CRATs using the SPSS statistical tool. The significance level was set at 5% (α = 0.05). For children aged <2 years, the study showed slight agreement between the CAMBRA 123 and AAPD, whereas, for children more than 2 years, there was a fair agreement between the two methods which was statistically significant. This indicates that the agreement between the two methods is still not perfectly established, and AAPD CRA assigns a higher risk category than CAMBRA 123. CAMBRA 123 is a promising user-friendly quantitative method for CRA in clinical practice. Since there is ambiguity in assessing the caries risk in children <2 years, there is a need to establish a CRAT that can be used exclusively for children below 2 years.

Risk Factors for Caries in Elementary School Children Based on Caries Management by Risk Assessment (CAMBRA)

Background: the prevalence of dental caries in children aged 10 to 14 years is almost 41.4%. The CAMBRA method helps doctors identify the cause of dental caries by identifying risk factors in each patient. Based on research, the etiology of dental caries was found by identifying risk factors in each participant. This study aims to describe what factors influence dental caries in children based on CAMBRA. Method: This research uses observational analysis with. The respondents were students at SDN Kadipiro I, Bantul, Special Region of Yogyakarta, Indonesia. Purposive sampling was used to create the sample, which included 82 children between the ages of 10 and 12 years. The research was carried out by finding dental caries risk factors using the CAMBRA method: 1. cavity or new dentin lesion, 2. white spot, 3. restoration in the last three years, 4. saliva volume, 5. plaque index/PHPM, 6. water pH saliva, and 7. Frequency of consumption of sweet foods. Data were analyzed using the SPSS version 25.0 program which included frequency analysis. Results: The results of the analysis showed five risk factors for caries, namely the condition of the teeth, cavities or new dentin lesions were found in 58 respondents (70.7%), predisposing factors, the number of plaque was obtained in 44 respondents (53.7%), the frequency of protective factors was obtained and the frequency of caries was obtained. 63 respondents experienced dental caries. Conclusion: The risk factors for dental caries based on CAMBRA that influence children's dental caries are the criteria for lesion depth of dentin, saliva pH, and amount of plaque. Keywords: CAMBRA, risk actors, caries, children

Hubungan Faktor Risiko Karies Gigi terhadap Kualitas Hidup Lansia di Kabupaten Jember

When aging, elderly people are expected to have a good quality of life. However, the elderly are vulnerable to various dental and oral health problems such as dental caries. The impact of tooth decay affects the quality of life of the elderly regarding oral health (Oral Health Related Quality of Life). The aim of this research is to determine the relationship between risk factors for dental caries and the quality of life of the elderly in Jember district. This research was conducted from January to March 2022 in three sub-districts in Jember Regency. The total number of respondents required is 168, who are classified into the pre-elderly group (45-59 years) and the elderly group (≥60 years). The instrument used in this research was a questionnaire. Risk of dental caries using a questionnaire based on CAMBRA (Caries Management by Risk Assessment) and Quality of life related to dental health using the OHIP-14 questionnaire. The data analysis method used was statistical analysis using the Spearmen non-parametric correlation test; with a significance level of 0.01. Spearman correlation analysis shows a high correlation indicated by a figure of -0.580(**), which means it falls into the range 0.51–0.75 which is defined as having a strong relationship in the negative direction. The higher the risk factors for caries in the elderly in Jember district, the lower their quality of life.

Is there evidence that e-cigarettes promote an increased risk of dental caries?

This study was conducted on a sample of patients who attended the dental clinic at Tufts University School of Dental Medicine, between January 1, 2019 and January 1, 2022. Ethical approval was obtained before commencing the research. This cross-sectional study was carried out through an electronic search of electronic records. It includes patients aged over 16 years, both electronic cigarette (e-cigarettes) users and non-users, with recorded caries risk assessments. Patients with a history of recreational drug use or lacking a caries diagnosis were excluded. The Caries Management by Risk Assessment (CAMBRA) was utilized to indicate and classify caries risk. Descriptive statistics, multivariate and bivariate analyzes were used to assess the relationship between use of e-cigarettes and caries risk level. SPSS software, Version 26 (IBM) was used in the analysis with significance level set at α = 0.05. Out of a total of 13,216 patients included in the research, 13,080 (99.3%) self-declared as non-users of e-cigarettes, and 136 (0.69%) were e-cigarette users. There was a statistically significant difference (P < 0.001) in caries risk levels between e-cigarette users (6.6% low, 14.3% moderate, and 79.1% high caries risk level) and control group (14.5% low, 25.9% moderate, and 59.6% high caries risk level). The study provides evidence supporting the notion that e-cigarette users exhibit a high level of caries risk.

Indonesian version of caries management by risk assessment mobile application “SKOR GIGI” in highly educated parents

Background: The Indonesian version of caries management by risk assessment (CAMBRA) is a common caries risk assessment for children aged 0–5 years. During the coronavirus disease 2019 (COVID-19) pandemic, the frequency of dental visits have decreased, making it difficult to assess the caries risk in children. Smartphones and operating systems such as Android are expected to be useful for parents to assess the caries risk of their children. The education level of parents has an impact of its use. The research about the Indonesian version of CAMBRA Android–based application in children aged 0–5 years with highly educated parents has never been done in Indonesia. Purpose: To analyze the accuracy of Android–based application “SKOR GIGI” in assessing the caries risk of children aged 0–5 years by highly educated parents. Methods: This study was conducted in kindergarten, pre-primary school, and Dental Hospital of Faculty of Dentistry Universitas Indonesia with 37 highly educated parents as participants. Participants filled out the informed consent and SKOR GIGI application. Six days later, dentists filled out the Indonesian version of CAMBRA. The results of this study were statistically tested to see the sensitivity, specificity, and the comparison between the variables. Results: The sensitivity test of SKOR GIGI application showed 96.3%, specificity 100%, positive predictive value 100%, and negative predictive value 90.9%. The comparative test with McNemar showed a p-value of 1.000, which means there is no significant difference between the caries risk assessment of children aged 0–5 years using SKOR GIGI application and the Indonesian version of CAMBRA. Conclusion: SKOR GIGI application can be used to assess the caries risk of children aged 0–5 years by highly educated parents.

Validity comparison of CAT (caries risk assessment tool) and CAMBRA (caries management by risk assessment) on children: a rapid review

Caries Risk Assessment (CRA) focuses on caries prevention than restorative approaches. CariesManagement by Risk Assessment (CAMBRA) and Caries Risk Assessment Tool (CAT) are examples of manualcharting CRA methods that were made to make it easier for clinicians and non-clinicians. This study aims tocompare the validity of CAMBRA and CAT as CRA for children. This study is a rapid review and uses articles asresearch samples. Systematic searching was carried out using the PRISMA diagram. This study uses PubMed andScience Direct databases. This study includes randomized controlled, cohort, and methodological studies reportingthe validity of CAT and CAMBRA methods on children published from 2011-2021. Searching strategy for this studyis (children) AND (dental caries) AND (risk assessment) AND ((CAT) OR (CAMBRA) OR (AAPD)) AND (validity).Articles that meet the inclusion criteria will be extracted and discussed. One hundred three articles were identified,and only five articles met the inclusion criteria. Modified CAT by adding the patient's Streptococcus mutansexamination without asking the patient's social-economic status has the highest validity value. The method with thelowest validity value in this study is the unmodified CAT method. Both CAMBRA and CAT validity are stilllimited. The evidence is still low. CAT has high sensitivity score but a low specificity value, while the CAMBRAmethod has a different validity value for each reported article.KEYWORDS: Caries risk assessment, children, Caries Management by Risk Assessment (CAMBRA), Caries RiskAssessment Tool (CAT), validity

CAMBRA Protocol Efficacy: A Systematic Review and Critical Appraisal.

The Caries Management by Risk Assessment (CAMBRA) protocol consists of analyzing the patient’s profile by assessing the risk and protective factors and assigning a risk level to the patient to allow an individualized treatment plan, which combines restorative treatments with a preventive chemical therapy. This systematic review and critical appraisal aim to evaluate the effectiveness of the CAMBRA protocol in reducing the incidence of caries lesions and oral bacterial load. An electronic search was carried out in the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases. Clinical studies evaluating the incidence of dental caries lesions and/or the reduction of cariogenic bacterial load (Streptococcus mutans and/or Lactobacilli spp.), with at least an intervention group that follows the CAMBRA protocol and a control group published up until January 2022, were included. The methodological quality assessment of the included clinical studies was assessed through the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The quality of the case-control study was evaluated according to the Methodological Index for Non-Randomized Studies (ROBINS-I). There is currently no scientific evidence to recommend the integration of the CAMBRA protocol into clinical practice. The results reported by the studies included in the systematic review do not suggest a decrease in the incidence of dental caries lesions and/or bacterial load. There is a clear need for the development of new clinical studies with an adequate methodology and follow-up, both for the CAMBRA protocol and for its components individually.

Caries Risk Assessment Using the Caries Management by Risk Assessment (CAMBRA) Protocol among the General Population of Sakaka, Saudi Arabia-A Cross-Sectional Study.

Background: Caries risk assessment is a useful tool in caries prevention and management. Using a tool such as CAMBRA, every individual can be assessed according to his or her disease indicators, risk factors, and protective factors for the current and future caries. Aim: This study aimed to assess caries risk among the general population of Sakaka, Saudi Arabia using the CAMBRA protocol. Methods: This cross-sectional study was conducted at university dental clinics using a questionnaire that was formulated using the CAMBRA caries risk assessment tool; afterwards, all 160 participants were intra-orally examined to assess oral hygiene status and presence of disease. Independent t-tests, ANOVAs, and chi-square tests were performed for analysis. Results: The majority of participants had one or more disease indicators, with white spots and visible cavities (71.3%), and the most commonly present risk factor was visible heavy plaque on teeth (82.5%). The use of fluoridated toothpaste (92.5%) was the most common protective factor. The majority of participants (85%) were in the ‘High’ category of Caries risk assessment. The prevalence of high caries risk was significantly higher among the rural participants compared to the urban (p <0.05), and significantly fewer of those with a primary school education level or lower were in the high dental caries risk group compared to the other educational categories (p <0.001). Conclusion: The caries risk among the general population of Sakaka, Saudi Arabia, is high, with significant variation among age groups, education levels, and geographical locations.

Caries prevalence using ICDAS visual criteria and risk assessment in children and adolescents with cerebral palsy: A comparative study.

To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs). Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 ± 16.8/7.5 ± 4.3 and 10.7 ± 17.6/5.3 ± 5.8, respectively, and for NA were 17.2 ± 16.9 /6.9 ± 4.8 and 11.1 ± 11.7/5.5 ± 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1± 16.7/3.0 ± 4.1 and 4.9 ± 15.6/0.2 ± 0.4, respectively, while for NA the mean values were 9.8 ± 13.0/3.5 ± 3.8 and 2.1 ± 5.7/0.9 ± 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p>0.05). Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

Caries risk assessment with the 'Bangkok checklist' in preschool children: A prospective cohort study.

Caries risk assessment in preschool children is poorly validated in prospective studies. To validate the Bangkok checklist (BCL) in predicting caries development in a cohort of preschool children from low and moderate socioeconomic areas and compare it with two established risk assessment tools. We followed 146 preschool children, aged 2-5years for 2years. At baseline, the caries risk category (low, moderate, high) was determined with three checklists: (a) BCL, (b) American Academy of Pediatric Dentistry form (CRAF), and (c) Caries Management By Risk Assessment (CAMBRA). Data were collected from questionnaires and clinical examinations. Caries increment was recorded by counting the number of surfaces that changed from sound to decayed. We used Kendall's tau, Poisson regression models and ROC analysis to assess the predictive ability of the different checklists. Over 50% of the children developed new caries on a yearly basis. The BCL assigned the majority of the children (87%) into the high-risk category. Sensitivity was 88% but specificity was low (16%). Accuracy of BCL was similar to CRAF but inferior to CAMBRA. Bangkok checklist had a very limited performance in accurately predicting future early childhood caries in this population.

Evidence-Based Caries Management for All Ages-Practical Guidelines.

Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0–6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level.Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0–6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals.Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.

Validation of caries risk assessment methods in orthodontic patients

Dental caries is an undesirable side effect of orthodontic treatment with fixed appliances. Caries lesions can result in long-term esthetic disturbance, costly interventions, and even interrupted treatment. Therefore, it is crucial to assess accurately both a patient's caries risk before treatment and their suitability for orthodontic treatment. This study aimed to evaluate the validity of 5 caries risk assessment methods for predicting caries outcome during orthodontic treatment: Cariogram, Caries Management by Risk Assessment (CAMBRA), R2, decayed filled teeth (DFT), and decayed initial filled surfaces (DiFS). A prospective longitudinal clinical study of 270 adolescents who were referred to the Specialist Clinic for Orthodontics, Mölndal Hospital, Sweden for treatment with fixed orthodontic appliances. The following data were collected before treatment: plaque index, radiographs to determine caries prevalence (DFT, DiFS), photographs to determine white-spot lesions, saliva samples (Streptococcus mutans and Lactobacilli), and responses to a questionnaire (regarding diet and oral hygiene). The variables were compiled to assess caries risk according to Cariogram, CAMBRA, and R2. Radiographs were also taken posttreatment to assess caries incidence. The caries outcomes after treatment were analyzed and compared with the caries risk, assessed by the caries risk assessment methods at baseline. DiFS proved to be the most reliable method for predicting caries during orthodontic treatment, presenting the highest area under the receiver operating characteristic curve for both manifest caries (0.77) and initial caries (0.71). The DiFS prevalence index was demonstrated to be useful in identifying patients who are at risk for developing manifest and initial caries during orthodontic treatment.

Retrospective Review of Oral Probiotic Therapy.

Purpose: There have been many in vitro studies reporting on the efficacy of probiotic bacteria in inhibiting pathogens, and there have been published studies reporting on the inhibitor effects of probiotic bacteria on the salivary levels of bacterial pathogens. However, there have not been but a few studies on the clinical benefits of oral probiotic therapy. Study design: Dental records of 60 patients that were enrolled in an Institutional Review Board approved study were reviewed as to current caries activity status with measurement of the Decayed Missing Filled Teeth index and by Caries Management By Risk Assessment (CAMBRA) determination. The current oral health status was compared to the prior-to-study enrollment status and then analyzed in respect to published national norms. The data (without any identifiers) had a statistical analysis by a blinded biostatistician. The data was subjected to statistical analysis (Statsgraphic) before and after the probiotic therapy. Results: Of the 53 subjects available for follow up, only 4 had remained caries active with a grand total of 27 carious lesions being detected and subsequently restored in this group. Of the original total of 60 patients with 292 initial carious lesions, after probiotic therapy and dental restoration, 78 total restorations were placed in the subject group over the following three years. Approximately half of these restorations were required in teeth that had initially presented with smaller lesions and had been placed in a "watch" category. Two of the patients that developed further carious lesions had been randomly assigned to the probiotic PerioBalance, while the other two caries active patients were assigned EvoraKids probiotic. Of the original group of caries active patients, 24 did not present with any further carious involvement. Another 25 could be categorized as caries static, as the restorations required were substantially less than before probiotic therapy had been begun. The F-ratio, which in this case equals 51.3313, is a ratio of the between-group estimate to the within-group estimate. Since the P-value of the F-test is less than 0.05, there is a statistically significant difference between the means of the 4 variables at the 95.0% confidence level. Conclusion: The tested probiotic supplements had a statistically significant effect on the caries experience of the enrolled subjects.

Overweight/obese children are associated with lower caries experience than normal-weight children/adolescents.

To compare (a) enamel carious (EC) and dentin carious (DC) lesions and (b) caries risk, between normal-weight (NW) and overweight/obese (OW) children/adolescents. In this cross-sectional study, 91 participants aged 6-12years were classified according to the body mass index (BMI): NW (n=50) and OW (n=41). Caries experience was evaluated using the International Caries Detection and Assessment System (ICDAS) with two thresholds: "EC/DC" (ICDAS 1-3/4-6) and "DC" (ICDAS 4-6). Caries risk was determined by the Caries Management by Risk Assessment (CAMBRA) system. A logistic regression analysis was performed to determine the association among OW, caries thresholds, and caries risk. Caries experience was similar for both groups at the "EC/DC" threshold (P=.477) and higher for the NW group at the "DC" threshold (P=.009). For CAMBRA, caries risk classification was similar for both groups (P=.082). The logistic regression showed the OW group was less likely to exhibit radiographically visible proximal carious lesions (odds ratio [OR] of 0.330, P=.019), thick biofilm visible on the tooth surface (OR=0.360, P=.019), high caries risk (OR=0.367, P=.039), and moderate-to-high caries levels (OR=0.190, P=.022). OW children/adolescents had lower caries experience, at both ICDAS thresholds, and lower caries risk, compared to NW children/adolescents.

Caries Management by Risk Assessment (CAMBRA): An Update for Use in Clinical Practice for Patients Aged 6 Through Adult

Caries Management by Risk Assessment (CAMBRA): An Update for Use in Clinical Practice for Patients Aged 6 Through Adult

Heuristics evaluation and development of the Caries Management by Risk Assessment (CAMBRA)-kids application for caries management of preschoolers

Heuristics evaluation and development of the Caries Management by Risk Assessment (CAMBRA)-kids application for caries management of preschoolers

A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children.

At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear. This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment. The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is protected by copyright. All rights reserved.