Limited evidence for existing caries assessment systems

DATA SOURCES: Data were sourced from the Cochrane Oral Health Groups Specialised Register, Cochrane Central Register of Controlled Trails, Medline, bibliographic references of identified systematic reviews, prospective cohort studies and clinical trials, textbooks and review articles.

STUDY SELECTION: The studies included presented validating criteria for caries incidence/ increment and were limited to those with human subjects and natural carious lesions. Only studies published in peer reviewed journals were included. Excluded were studies which gave an incomplete description of sample selection, or of outcome, or had a small sample size. Studies which did not meet the Oxford Centre for Evidence Based Medicine prognosis category criteria for best evidence were also excluded.

DATA EXTRACTION AND SYNTHESIS: Data were extracted by the first review author and were independently checked by a second author. The criteria reported in the ADA Clinical Recommendations Handbook(1) were used to assess the quality of the studies. Adjustments made for potential confounders were considered as a means to evaluate the internal validity of each study.

RESULTS: One hundred and thirty-seven study reports remained for review following systematic strategic search and title review. Of these, six studies of existing caries risk assessment models were selected for inclusion. Of the six studies reviewed four were deemed 'fair' by the ADA criteria and two 'poor'. The authors found variation in the parameters used for caries risk assessment and the population groups studied. No study found the risk assessment systems to have reliable prediction utility in children. One prospective study found Cariogram to give good to moderate caries prediction in elderly adults and one retrospective study found the CAMBRA assessment to provide prediction for cavitated lesions, but only between low risk and extreme risk individuals over the age of six.

CONCLUSIONS: This systematic review suggests that evidence available on the validity of a number of existing systems for caries risk assessment is limited and weak.