A Novel Approach to Screening High-Caries-Risk Children

Objectives: To evaluate the HKC screening system for prioritizing dental treatment in a high caries environment.
Methods: The present study is an evaluation of a sub-group of children participating in the HKC project from one public school in Phnom Penh, Cambodia. Children were screened and triaged by dental students and then re-examined using calibrated examiners to verify the initial referral diagnoses and the HKC triage level. Treatment was provided across three levels of care. All children received Level 1 (L1) care, which involved Silver Diammine Fluoride to arrest dental caries. Level 2 (L2) care involved use of atraumatic restorative techniques (ART) and fissure sealants for children between 6- and 8-years of age, and for those who had one or more cavitated lesions on permanent posterior teeth. Level 3 (L3) care involved conventional dental rehabilitation for those children with cavitated lesions in permanent anterior teeth, acute infection, or permanent posterior teeth that were not restorable using ART.
Results: 1192 children were screened using the HKC approach and a sample of 304 children 8-to 12-year old children were evaluated for this study. There were 77 (25.3%) children were referred by dental students for L2 treatment and 88 (28.9%) referred for L3. There was a significant difference in caries experience by referral level whereby those referred to higher levels of care had a more severe caries experience. The DMFT by level was L1 – 1.9 (SD 1.9), L2 – 2.5 (SD 2.1), L3 – 3.2 (2.4).
Conclusions: The application of the triage system initiated by dental students was successful in identifying children who most needed care (L3). Further research may better inform the training and screening accuracy of clinicians operating in high caries environments.