Evaluation of the Canadian CRA tool in caries-free children <6yrs

Abstract

Introduction: The Canadian Caries Risk Assessment (CRA) Tool is a six-item screening tool used to identify risk level for future caries development in children <6 years. The purpose of this study was to determine whether baseline CRA tool scores in caries-free children <6 years of age can predict future caries development. Methods: Baseline and follow-up CRA tool scores were obtained as part of routine care from preschool children attending three publicly funded dental clinics in Winnipeg. Data for this study were restricted to children who were caries-free at baseline. Charts of children who had returned for follow-up one year later were then reviewed to determine the proportion developing caries, as evidenced by new carious lesions (including white spot lesions). Statistical analyses included descriptive statistics along with bivariate analyses. A p value ≤ 0.05 was significant. Results: A total of 145 children were caries-free at baseline, of which, 96 returned and had completed follow-up data. The mean total CRA score significantly increased from baseline to follow-up (1.9 ± 1.0 vs. 2.4 ± 1.9, p = 0.005). While not statistically significant, not brushing teeth twice daily (OR = 1.89, 95% CI = 0.72-4.90, p = 0.19) and low family income (OR = 1.73, 95% CI = 0.65-4.57, p = 0.27) were the strongest indicators of caries development by follow-up. The CRA tool was found to have a sensitivity and specificity for baseline CRA rating and the development of new caries at follow-up of 30.4% and 75.3%, respectively, indicating a low sensitivity but high specificity. Conclusions: The CRA tool has a high potential of identifying low risk children who truly do not develop future caries. This research emphasizes the use of CRA tools in preventive pediatric dentistry to improve children’s oral health and maintain a caries-free state.