Pediatric Caries Risk Assessment (CAMBRA) Utilization In A Community Clinic

Methods: Patient records from a public dental clinic in SF of all children ages 0.8-5.9 years with a baseline (BE) visit between July 2004 to April 2007 (N=346) were selected for CRA analysis. Eighty-eight (304) percent had completed CRAs and 215 had 1+ follow-up visits. Logistic regression and chi-squared tests analyzed CRA factors related to high caries risk. Recorded recommendations and improvements were compared to risk status.

Results: High caries risk was associated with items in the CRA including “obvious decay” (OR=20.8, 95%CI=11.8-34.7), “obvious plaque” (OR=6.6, 95%CI=3.9-11.0), “use of saliva-reducing medications” (OR=3.1, 95%CI=1.2-8.0), “recent dental restorations in the past 2 years” (OR=3.1, 95%CI=1.2-7.8), and “low socio-economic status” (OR=2.0, CI=1.1-3.4). High caries risk was significantly associated with caries at BE (p<0.001) and at 3+ month follow-up (p=0.018; 36% to 18%; OR=2.7, 95%CI=1.2-6.1). Items including “Establishment of a Dental Home” and “Mother Has Not Had Active Caries” both were infrequently recorded (<75%) at BE; mother's active caries was improperly recorded in >48% of records. Mothers most frequently reported improving the following: wean from breastfeeding and the bottle, brushing twice a day, and diluting juice with tap water.

Conclusion: The results indicate that some CRA items were validated, a few CRA indicators including “Mother Has Not Had Active Caries” and “Continual Bottle Use-Contains Fluid Other Than Water” should be rephrased or omitted to prevent confusion when assessing risk status. Although caries management recommendations should be customized to meet the needs of each mother/caregiver and child, study results show counseling to wean from the breast or bottle and brushing twice a day can prove valuable. Continued study is needed to uniformly validate all components of the CRA for children aged 0-6 years.