| 1. |
- Hänsel Petersson, Gunnel, et al.
(författare)
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Caries risk assessment in schoolchildren using a reduced Cariogram model
- 2010
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren. METHODS: The study group consisted of 392 school children, 10-11 years of age, who volunteered after informed consent. A caries risk assessment was made at baseline with aid of the computer-based Cariogram model and expressed as "the chance of avoiding caries" and the children were divided into five risk groups. The caries increment (DeltaDMFS) was extracted from the dental records and bitewing radiographs after 2 years. The reduced Cariogram was processed by omitting the variables "salivary mutans streptococci", "secretion rate" and "buffer capacity" one by one and finally all three. Differences between the total and reduced models were expressed as area under the ROC-curve. RESULTS: The baseline caries prevalence in the study population was 40% (mean DMFS 0.87 +/- 1.35) and the mean 2-year caries increment was 0.51 +/- 1.06. Both Cariogram models displayed a statistically relationship with caries development (p < 0.05); more caries was found among those assessed with high risk compared to those with low risk. The combined sensitivity and specificity decreased after exclusion of the salivary tests and a statistically significant reduction of the area under the ROC-curve was displayed compared with the total Cariogram (p < 0.05). Among the salivary variables, omission of the mutans streptococci enumeration impaired the predictive ability the most. CONCLUSIONS: The accuracy of caries prediction in school children was significantly impaired when the Cariogram model was applied without enumeration of salivary tests.
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| 2. |
- Hänsel Petersson, Gunnel, et al.
(författare)
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Caries risk assessment in young adults : a 3 year validation of the Cariogram model
- 2015
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Ingår i: BMC Oral Health. - : BioMed Central. - 1472-6831. ; 15:17
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Tidskriftsartikel (refereegranskat)abstract
- Background: To validate baseline caries risk classifications according to the Cariogram model with the actual caries development over a 3-year period in a group of young adults living in Sweden. Methods: The study group consisted of 1,295 19-year-old patients that completed a comprehensive clinical baseline examination, including radiographs and salivary tests. An individual caries risk profile was computed and the patient was placed in one of five risk categories. After 3 years, 982 patients (75.8%) were re-examined and caries increment for each patient was calculated. The outcome was expressed as sensitivity, specificity and predictive values and compared with a risk assessment scheme used in Public Dental Service. Results: The drop-outs displayed more risk factors and a significantly higher caries burden at baseline compared with those that remained in the project (p < 0.05). There was a strong association between the Cariogram risk categories and the 3-year caries increment on cavity level but the predictive values were modest. The high or very high caries risk categories yielded high specificities (>90%) but poor sensitivities. The low risk groups displayed higher sensitivities on expense of impaired specificities. No combinations proved clinically useful values according to Yuoden's index. Conclusions: Within the limitations of the present study, the computer-based Cariogram did not perform better than a caries risk assessment scheme based on past caries experience and caries progression, over a 3-year period in young adults.
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| 3. |
- Hänsel Petersson, Gunnel, et al.
(författare)
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Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need
- 2016
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or "gut feeling" or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient's own perception of future oral treatment need correspond with the sum of examiners risk score. Methods: Clinical examinations were performed on randomly selected individuals 20-89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram. Results: For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients' perception of future oral treatment need correlated to some extent with the sum of examiners risk score. Conclusions: The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.
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| 4. |
- Hänsel Petersson, Gunnel, et al.
(författare)
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Relationship between risk assessment and payment models in Swedish Public Dental Service : a prospective study
- 2017
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Ingår i: BMC Oral Health. - : BioMed Central. - 1472-6831. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: To a) compare risk categories in patients selecting a capitation payment (CP) model with those in fee-for-service (FFS), b) determine the 3-year caries increment in the two groups, and c) compare the amount of delivered preventive care in the two groups. Methods: A comprehensive risk assessment was carried out in 1295 young adults attending eight Public Dental Clinics in the Scania region and 75% could be re-examined after 3 years; 615 had selected the CP model and 310 the traditional FFS. Caries was scored according to WHO and data concerning preventive care was extracted from the dental records. Results: More patients in the low risk category preferred the CP model (74% vs. 26%) while > 80% with high risk selected FFS. The baseline caries level was significantly higher in the FFS group as well as the 3-year caries increment (1.6 vs. 0.8 DFS: p < 0.05). The amount of additional preventive care delivered to each patient was generally lower in the FFS model; it was most frequent among patients with "some" risk in the CP model (83.8%) while the lowest delivery rates were found among low risk patients in the FFS system (32.4%). Conclusions: Young adults in public dental care with low risk preferred the prepaid model while those in the higher risk categories selected fee-for-service. As more additional preventive care was delivered to patients in the subscribed care, oral health planners and decision makers should be aware of the fact that capitation payment models may enhance inequalities in dental health over time.
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