Derivation and Description of Clinical Subtypes of Early Childhood Caries

Objectives: Early childhood caries (ECC) is the most common chronic childhood disease. An internationally harmonized, consensus definition of ECC now exists; however, the diversity of clinical presentations within the ECC definition presents challenges for its precise diagnosis and optimal management. In this study, we sought to identify clinical subtypes of ECC in preschool-age children.
Methods: We used ICDAS surface-level information on dental caries experience from a community-based sample of 3-5-year-old children [N=6,404 of which 54% (n=3,465) had ECC] participating in an epidemiologic study of early childhood oral health in North Carolina, United States. Tooth surfaces were treated as latent class indicators and responses were dichotomized according to caries experience (ICDAS>2 threshold). Latent class analysis (LCA) was carried out to identify clinical disease subtypes (i.e., latent classes). The model with optimal number of classes was determined using a combination of criteria including information-heuristic measures of relative fit (i.e., Akaike and Bayesian Information Criterion, Lo-Mendell/Vuong-Lo-Mendell Rubin and Bootstrap Likelihood Ratio Tests), and clinical relevance. The LCA was done first in the entire sample and then stratified according to dental treatment status (i.e., restored vs. non-restored disease). We used Mplus v.8.3 (Muthén & Muthén, Los Angeles, USA) for all analyses.
Results: We identified five distinct and clinically relevant ECC subtypes within the entire sample with class membership probabilities ranging from 48% (low probability on occlusal of molars) to 8% (all surfaces of molars and upper incisors). Dental treatment-stratified analyses identified 5 and 4 classes for the restored and non-restored groups, respectively. The unrestored ECC subtypes segregated according to recognizable patterns of caries lesion distribution, e.g., affected maxillary anteriors, molars, and both molars and maxillary incisors.
Conclusions: The identified clinical subtypes of ECC are important as they offer an additional framework to- under the paradigm of precision oral health- childhood dental disease. Upon validation, this classification can further inform ECC diagnosis, risk assessment and disease management.