Table 2 Included predictors and model performance of final multivariable prediction models of caries increment

Studies of model development

  Coronal caries

Angulo,

1995 [13]

N = 3

• Oral biological (˃ 10⁴ ms/ml saliva, ˃ 10⁴ lbc/ml saliva)

• Caries experience (DS ˃ 3 cavity)

Sens 0.19, Spec 0.86, PPV 0.36, NPV 0.71

LR + 1.36 (0.43–4.31)

LR − 0.94 (0.74–1.20)

High ms counts + high lbc counts + Caries experience presented higher specificity but lower sensitivity than Caries experience alone

Sample with low socioeconomic status. Caries prevalence at baseline NR

Caries increment

(1.5 years) 45%

Demers,

1992 [14]

Model 1 (full model) N = 5

• Societal structural (parents’ education)

• Oral biological (≥ 10⁵ ms/ml saliva, ≥ 10⁵ lbc/ml saliva debris index-screening level ≥ 1.9)

• Caries experience (dmfs ˃ 0 cavity)

Model 2 (Socioeconomic model) N = 3

• Societal structural (parents’ education, family structure)

• Life-style situational (fluoride supplements)

Model 1 (full model)

Sens 0.94, Spec 0.41

Model 2 (socioeconomic model)

Sens 0.86, Spec 0.35

Model 1 (full model)

LR + 1.60 (1.40–1.83)

LR − 0.14 (0.07–0.28)

Model 2 (socioeconomic model)

LR + 1.31 (1.15–1.50)

LR − 0.40 (0.26–0.64)

Caries experience reached sensitivity and specificity values close to the best model over 1 year. More predictors add to costs and complexity of screening

Caries prevalence at baseline NR

Caries increment (1 years) 47%

Disney,

1992 [15]

Aiken N = 23; Portland N = 22

• Societal structural (referral caries score)

• Life-style situational (between-meal snacks, Tooth-brushing–2 predictors, F-rinse)

• Physiological (age, race)

• Oral biological (ms in saliva, lbc in saliva, plaque score)

• Tooth (tooth morphology, fluorosis, sound permanent surfaces, sealants)• Caries experience (dmfs, DMFS, white spot lesions)

• Other predictors (examiner agreement–4 predictors, predicted caries score, fluorosis x white spot lesions)

Aiken age 6.6 years

Sens 0.59, Spec 0.83

Portland age 6.9 years

Sens 0.59, Spec 0.84

Aiken age 10.7 years

Sens 0.62, Spec 0.81

Portland age 10.8 years

Sens 0.62, Spec 0.84

Aiken age 6.6 years

LR + 3.47 (2.89–4.16)

LR − 0.49 (0.42–0.58)

Portland age 6.9 years

LR + 3.69 (3.05–4.45)

LR − 0.49 (0.42–0.57)

Aiken age 10.7 years

LR + 3.26 (2.73–3.91)

LR − 0.47 (0.40–0.55)

Portland age 10.8 years

LR + 3.88 (3.19–4.71)

LR − 0.45 (0.38–0.54)

Models will be useful for predicting those at low and high risk of caries increment. Clinical predictors were the most important group

ms, lbc, sociodemographic, and dental behavior data contributed little over a 3-year follow-up

Caries prevalence at baseline NR

Caries increment (3 years):

Aiken 6.6 years 58%

10.7 years 66%

Portland 6.9 years 31%

10.8 years 46%

Thresholds for ms, lbc, and some other predictors NR

Fontana,

2011 [16]

N = 3–7 in 11 models

Predictor common for all models except for model 11

• Societal structural (caregiver (CG) does not consider child’s oral health to be very good)

1 year follow-up

ICDAS ≥ 3 Models 1, 2, 3

Model 1 N = 4

• Life-style situational (time elapsed since last dental visit)

• Caries experience (tooth extracted, tooth restored)

Model 2 N = 5

Model 1 + dmfs/DMFS ICDAS ≥ 3 at end

Model 3 N = 7

Model 1 + dmfs/DMFS ≥ 3 at start and

• Societal structural: (CG received a referral note for child)

• Life-style situational (soda drinks, soda between meals)

ICDAS ≥ 1 Models 4, 5

Model 4 N = 3

dmfs/DMFS ICDAS ≥ 3 at end + 

• Caries experience (tooth extracted)

Model 5 N = 3

dmfs/DMFS ICDAS ≥ 3 at start + 

• Caries experience (tooth extracted)

2 years follow-up

ICDAS ≥ 3 Models 6, 7, 8

Model 6 N = 3

• Life-style situational (time elapsed since last dental visit)

• Caries experience (tooth restored)

Model 7 N = 4

Model 6 + dmfs/DMFS ICDAS

 ≥ 3 at end

Model 8 N = 3

dmfs/DMFS ICDAS ≥ 3 at start + 

• Caries experience (child had tooth restored)

ICDAS ≥ 1 Models 9, 10, 11

Model 9 N = 4

• Societal structural (CG has current caries, CG received a referral note for child)

• Caries experience (current caries, tooth restored)

Model 10 N = 5

Model 9 + dmfs/DMFS ICDAS ≥ 3 at end

Model 11 N = 3

dmfs/DMFS ICDAS ≥ 3 at start + 

• Societal structural (CG has current caries, CG received a referral note for child)

1 year follow-up

ICDAS ≥ 3

Model 1 Sens 0.80, Spec 0.58, AUC 0.75

Model 2 Sens 0.81, Spec 0.58, AUC 0.77

Model 3 Sens 0.81, Spec 0.57, AUC 0.79

ICDAS ≥ 1

Model 4 Sens 0.79, Spec 0.58, AUC 0.77

Model 5 Sens 0.79, Spec 0.58, AUC 0.77

2 years follow-up

ICDAS ≥ 3

Model 6 Sens 0.73, Spec 0.61, AUC 0.70

Model 7 Sens 0.73, Spec 0.61, AUC 0.73

Model 8 Sens 0.73, Spec 0.61, AUC 0.70

ICDAS ≥ 1

Model 9 Sens 0.82, Spec 0.59, AUC 0.75

Model 10 Sens 0.84, Spec 0.59, AUC 0.76

Model 11 Sens 0.75, Spec 0.61, AUC 0.77

1 year follow-up

ICDAS ≥ 3

Model 1 LR + 1.90 (1.57–0.31)

LR − 0.34 (0.26–0.46)

Model 2 LR + 1.93 (1.59–2.34)

LR − 0.33 (0.24–0.44)

Model 3 LR + 1.88 (1.65–0.28)

LR − 0.33 (0.25–0.45)

ICDAS ≥ 1

Model 4 LR + 1.88 (1.34–2.64)

LR − 0.36 (0.26–0.50)

Model 5 LR + 1.88 (1.34–2.64)

LR − 0.36 (0.26–0.50)

2 years follow-up

ICDAS ≥ 3

Model 6 LR + 1.87 (1.49–2.35)

LR − 0.44 (0.35–0.56)

Model 7 LR + 1.87 (1.49–2.35)

LR − 0.44 (0.35–0.56)

Model 8 LR + 1.87 (1.49–2.35)

LR − 0.44 (0.35–0.56)

ICDAS ≥ 1

Model 9 LR + 2.00 (1.35–2.95)

LR − 0.31 (0.22–0.43)

Model 10 LR + 2.05 (1.39–3.02)

LR − 0.27 (0.19–0.39)

Model 11 LR + 1.92 (1.28–2.89)

LR − 0.41 (0.30–0.56)

Items related to caries experience in child or caregiver and caregiver’s rating of child’s oral health could be used to screen at-risk children (aged 5–13) in this rural population. The models were fair in their ability to predict caries

Caries prevalence at baseline NR

Caries increment:

-1 year 89% had ≥ 1 Surface with any Progression and 61% With progression Towards cavitation

-2 years 91% had ≥ 1 Surface with any Progression and 68% With progression Towards cavitation

ICDAS Ismail et al,. [34]

Code 1: when seen wet no evidence of any change in colour attributable to carious activity, but after prolonged air drying a carious opacity (white or brown lesion) is visible that is not consistent with the clinical appearance of

sound enamel

Code 3: localized enamel breakdown because of caries with no visible dentin or underlying shadow

Gao.

2010 [17]

N = 6–12 predictors in 5 models

Predictor common for all models

• • Physiological (age)

Prediction models

Model 1 (screening) N = 8

• Societal structural (father’s education,

• Life-style situational (between-meal-sweets)

• Physiological (race, months of breastfeeding, no health problems)

• Oral biological (plaque index)

• Caries experience (dmft ˃ 2 cavities)

Model 2 (full-blown) N = 12

• Societal structural (father’s education, no annual dental checks, age regarded by parents as appropriate for dental check

• Life-style situational (months of breastfeeding, using fluorides)

• Physiological (age, no health problems)

• Oral biological (plaque index, ms in saliva, lbc in saliva, average pH)

• Caries experience (dmft ˃ 2 cavities)

Risk models

Model 3 (screening) N = 7

• Societal structural (never lived in non-fluoridated community

• Life-style situational (bedtime feeding, between-meal-sweets, bedtime sweets, months of breastfeeding)

• Physiological (age)

• Oral biological (plaque index)

Model 4 (full-blown) N = 6

• Life-style situational (months of breastfeeding)

• Physiological (age)

• Oral biological (plaque index, ms in saliva, lbc in saliva, average pH)

Model 5 Community-screening model N = 6

• Societal structural (parent’s belief about “Tooth worm”, parents do not know about bedtime milk, child’s dental status according to parents)

• Life-style situational (using fluorides)

• Physiological (race)

Prediction models

Model 1 (screening)

Sens 0.82, Spec 0.73, AUC 0.85

Model 2 (full-blown)

Sens 0.90, Spec 0.90, AUC 0.96

Risk models

Model 3 (screening)

Sens 0.81, Spec 0.62, AUC 0.77

Model 4 (full-blown)

Sens 0.83, Spec 0.92, AUC 0.95

Model 5 Community-screening model

Sens 0.82, Spec 0.81, AUC 0.89

Prediction models

Model 1 (screening)

LR + 3.06 (2.73–3.43)

LR − 0.24 (0.21–0.29)

Model 2 (full-blown)

LR + 9.04 (7.41–11.03)

LR − 0.11 (0.08–0.13)

Risk models

Model 3 (screening)

LR + 2.15 (1.96–2.35)

LR − 0.30 (0.26–0.36)

Model 4 (full-blown)

LR + 10.26 (8.20–12.84)

LR − 0.18 (0.16–0.22)

Model 5 Community-screening model

LR + 4.37 (3.80–5.04)

LR − 0.22 (0.19–0.22)

Risk models were established for a range of uses in community and clinical setting

Caries prevalence at baseline 40%

Caries increment

(1 year) 44% (dmft)

Hänsel Petersson,

2002 [18]

N = 12 Cariogram

• Societal structural (school, dental clinic)

• Life-style situational (diet content, diet frequency, fluoride program)

• Physiological (sex, related diseases)

• oral biological (ms in saliva, saliva secretion, saliva buffer, plaque amount)

• Caries experience (DMFT with cavities)

Sens 0.41, Spec 0.80

LR + 2.03 (1.48–2.79)

LR − 0.74 (0.63–0.87)

Cariogram predicted caries increment in this population (aged 10–11) more accurately than any included single-factor model

Data collected as lbc counts used as a measure of cariogenic diet

Predictors in oral biological and caries experience levels given a score according to a predetermined scale with 3–4 scores

Caries prevalence at baseline 40%

Caries increment (2 years) 31%

Pang,

2021 [19]

N = 7

• Societal structural (one-child family)

• Physiological (sex)

• Oral biological (plaque index, cariostat score)

• Tooth (genetic markers rs3790506-enamel formation gene, rs1996315-water channel protein gene AQP5

• Caries experience (DMFT ICDAS codes 3–6 =  > 0 decayed teeth)

Total AUC 0.70 (0.66–0.74)

Low caries risk (DMFT ≤ 1 caries lesion)

Sens 0.41, Spec 0.74, PPV 0.42, NPV 0.73

Moderate caries risk

Sens 0.46, Spec 0.69, PPV 0.49, NPV 0.66

High caries risk

Sens 0.54, Spec 0.69, PPV 0.74, NPV 0.48

Very high caries risk

Sens 0.68, Spec 0.75, PPV 0.95, NPV 0.25

Low caries risk

LR + 1.57 (1.24–1.99)

LR − 0.80 (0.71–0.89)

Moderate caries risk

LR + 1.48 (1.20–1.82)

LR − 0.79 (0.69–0.89)

High caries risk

LR + 1.73 (1.42–2.12)

LR − 0.67 (0.58–0.77)

Very high caries risk

LR + 2.71 (2.18–3.38)

LR − 0.43 (0.3–0.51)

Model based on both environmental and genetic factors using an algorithm based on machine learning

Caries prevalence at baseline 34%

Caries increment (1.7 years) 58%

Presents calibration. Study of model validation described below

ICDAS Pitts and Ekstrand, [35]

Code 3 = clinically detectable “cavities” limited to enamel, Codes 4,5 = clinically detectable lesions in dentine, Code 6 = lesions into pulp

Sánchez-Pérez,

2009 [20]

N = 4

• Oral biological (acid production by bacteria in saliva)

• Tooth (total teeth present, fissure morphology)

• Caries experience (dmfs + DMFS ≥ 1 cavity)

Sens 0.79, Spec 0.80, AUC 0.88

LR + 3.85 (2.04–7.27)

LR − 0.27 (0.16–0.46)

In a developing country, caries experience was most powerful to predict caries in 6-year-old children over 3 years, but prediction was improved by fissure morphology and bacterial acid production

Caries prevalence at baseline 58%

Caries increment (3 years) 59%

  Coronal and root caries

Powell,

1991 [21]

N = 3

• Physiological (sex)

• Oral biological (salivary secretion)

• Caries experience (root caries index)

Threshold ≥ l new caries

Sens 0.88, Spec 0.60

Threshold ≥ l new caries

LR + 2.20 (0.74–6.53)

LR − 0.20 (0.04–0.90)

Model was sensible and variables easy to collect

Caries prevalence at baseline 53%

Caries increment coronal and/or root caries (1 year) 76%

  Root caries

Ritter,

2016 [22]

N = 8–13 predictors in 5 models

Predictors common for model 1 and all other models

Model 1 N = 8

• Physiological (age, sex, race)

• Caries experience (at-risk years, at-risk root surfaces, at-risk root surfaces squared, root caries index, root caries index squared)

Model 2 N = 9

Model 1 + 

• Life-style situational (tobacco use)

Model 3 N = 13

Model 1 + 

• Life-style situational (cereals + sugar, tea/coffee + sugar, drinks and juices, juices, sweets)

Model 4 N = 11

Model 1 + 

• Life-style situational (toothbrush use, how often toothbrush is replaced)

• Physiological (wears removable prosthesis–appliances)

Model 5 N = 11

Model 1 + 

• Societal structure (income, education, insurance)

Primary data analysis (sample n = 155)

Model 1

Sens 0.74, Spec 0.61, AUC 0.83

Model 2

Sens 0.76, Spec 0.66, AUC 0.84

Model 3

Sens 0.71, Spec 0.61, AUC 0.84

Model 4

Sens 0.74, Spec 0.62, AUC 0.83

Model 5

Sens 0.75, Spec 0.63, AUC 0.83

Model 1

LR + 1.88 (1.38–2.55)

LR − 0.43 (0.29–0.66)

Model 2

LR + 2.23 (1.60–3.10)

LR − 0.36 (0.23–0.56)

Model 3

LR + 1.81 (1.33–2.47)

LR − 0.48 (0.32–0.71)

Model 4

LR + 1.94 (1.42–2.65)

LR − 0.42 (0.28–0.64)

Model 5

LR + 2.04 (1.49–2.81)

LR − 0.39 (0.26–0.60)

Model 2 presented best performance. The results can inform identification of high-risk root caries individuals only in a caries-active population

Caries (coronal and root) prevalence at baseline 100%

Caries increment (3 years) 49%

Sánchez-García,

2011 [23]

N = 6

• Life- style situational (dental mouthwash–oral hygiene routines, smoking)

• Physiological (limitations in basic daily activities–general health)

• Oral biological (ms ≥ 10⁵ CFU/ml saliva)

• Caries experience (healthy root surfaces, root caries index)

Sens 0.16, Spec 0.98, PPV 0.67, NPV 0.81

AUC 0.75

LR + 7.09 (3.29–15.30)

LR + 0.86 (0.80–0.93)

A good prediction model for 21-month root caries incidence in elderly (mean age 71.8; range 60–74)

Caries prevalence at baseline

coronal caries 100%

root caries 44%

Caries increment (1 year) 22%

Studies of model validation

  Coronal caries

Beck,

1992 [24]

Modified models of high-risk model Disney et al. [15]

N = 20 Model 1 Any risk prediction model

• Societal structural (education-head of household, referral caries score)

• Life-style situational (tooth-brushing, F-tablets, dental visit last year–3 predictors)

• Physiological (race)

• Oral biological (ms in saliva, lbc in saliva)

• Tooth (tooth morphology, sound permanent surfaces)

• Caries experience (baseline dmfs, baseline DMFS, white spot lesions)

• Other predictors (examiner agreement–4 predictors, predicted caries score)

N = 13 Model 2 Any risk etiologic model

• life-style situational (dental visit last year–2 predictors)

• Tooth (tooth morphology, fluorosis, sound permanent surfaces, sealants)

• Oral biological (ms in saliva, lbc in saliva, mean plaque score)

• Other predictors (examiner agreement–4 predictors, predicted caries score)

Model 1 Any risk prediction model

Aiken age 6.6 years

Sens 0.80, Spec 0.61, PPV 0.73, NPV 0.69

Portland age 6.9 years

Sens 0.66, Spec 0.78, PPV 0.57, NPV 0.84

Aiken age 10.7 years

Sens 0.84, Spec 0.54, PPV 0.78, NPV 0.64

Portland age 10.8 years

Sens 0.76, Spec 0.71, PPV 0.68, NPV 0.78

Model 2 Any risk etiologic model

Aiken age 6.6 years

Sens 0.74, Spec 0.55, PPV 0.68, NPV 0.62

Portland age 6.9 years

Sens 0.59, Spec 0.74, PPV 0.51, NPV 0.80

Aiken age 10.7 years

Sens 0.81, Spec 0.50, PPV 0.75, NPV 0.58

Portland age 10.8 years

Sens 0.69, Spec 0.65, PPV 0.62, NPV 0.71

Model 1 Any risk prediction model

Aiken age 6.6 years

LR + 2.05 (1.82–2.31)

LR − 0.33 (0.28–0.39)

Portland age 6.9 years

LR + 3.00 (2.57–3.50)

LR − 0.44 (0.37–0.51)

Aiken age 10.7 years

LR + 1.83 (1.62–2.06)

LR − 0.30 (0.24–0.36)

Portland age 10.8 years

LR + 2.62 (2.27–3.03)

LR − 0.34 (0.28–0.40)

Model 2 Any risk etiologic model

Aiken age 6.6 years

LR + 1.64 (1.47–1.84)

LR − 0.47 (0.40–0.55)

Portland age 6.9 years

LR + 2.27 (1.95–2.64)

LR − 0.55 (0.48–0.63)

Aiken age 10.7 years

LR + 1.62 (1.44–1.82)

LR − 0.38 (0.31–0.46)

Portland age 10.8 years

LR + 1. 97 (1.73–2.25)

LR − 0.48 (0.41–0.56)

Any risk etiologic models with fewer significant variables, appear to have similar, but slightly lower utility (sensitivity and specificity) compared to Any risk prediction models and appear to be more broadly applicable across populations

Caries prevalence at baseline NR

Caries increment (3 years)

Aiken

6.6 years 57%

10.7 years 66%

Portland

6.9 years 31%

10.8 years 45%

High-risk model identical with that presented by Disney et al. [15]

Birpou,

2019 [25]

N = 7–9 predictors in 8 modified Cariogram models with 1- and 2 years follow-up

Standard set

Model 1 Cariogram 1 N = 9

• Life-style situational (diet content, diet frequency, fluoride programme)

• Physiological (related diseases)

• Oral biological (ms in saliva with four thresholds, saliva buffer, plaque amount)

• Caries experience (dmft with two thresholds)

• Other predictors (clinical judgement)

Model 2 Cariogram 2 N = 8

Model 1 excluding saliva buffer

Model 3 Cariogram 3 N = 8

Model 1 excluding ms in saliva

Model 4 Cariogram 4 N = 7

Model 1 excluding saliva buffer and ms in saliva

High risk set

Model 5 Cariogram 5 N = 9

Same predictors as Model 1

Model 6 Cariogram 6 N = 8

Model 1 excluding saliva buffer

Model 7 Cariogram 7 N = 8

Model 1 excluding ms in saliva

Model 8 Cariogram 8 N = 7

Model 1 excluding saliva buffer and ms in saliva

Standard set

Model 1 Cariogram 1

1 year follow-up

Sens 0.66, Spec 0.57, AUC 0.62

2 years follow-up

Sens 0.68, Spec 0.59, AUC 0.65

Model 2 Cariogram 2

1 year follow-up

Sens 0.65, Spec 0.57, AUC 0.62

2 years follow-up

Sens 0.66, Spec 0.59, AUC 0.62

Model 3 Cariogram 3

1 year follow-up

Sens 0.60, Spec 0.65, AUC 0.61

2 years follow-up

Sens 0.64, Spec 0.68, AUC 0.65

Model 4 Cariogram 4

1 year follow-up

Sens 0.56, Spec 0.65, AUC 0.61

2 years follow-up

Sens 0.60, Spec 0.68, AUC 0.65

High risk set

Model 5 Cariogram 5

1 year follow-up

Sens 0.66, Spec 0.57, AUC 0.62

2 year follow-up

Sens 0.68, Spec 0.58, AUC .65

Model 6 Cariogram 6

1 year follow-up

Sens 0.65, Spec 0.65, AUC 0.62

2 years follow-up

Sens 0.66, Spec 0.59, AUC 0.66

Model 7 Cariogram 7

1 year follow-up

Sens 0.57, Spec 0.65, AUC 0.61

2 years follow-up

Sens 0.61, Spec 0.68, AUC 0.65

Model 8 Cariogram 8

1 year follow-up

Sens 0.56, Spec 0.65, AUC 0.62

2 years follow-up

Sens 0.60, Spec 0.68, AUC .66

Standard set

Model 1 Cariogram 1

1 year follow-up

LR + 1.55 (1.13–2.13)

LR − 0.59 (0.41–0.85)

2 years follow-up

LR + 1.63 (1.17–2.26)

LR − 0.55 (0.38–0.82)

Model 2 Cariogram 2

1 year follow-up

LR + 1.52 (1.11–2.09)

LR − 0.61 (0.42–0.88)

2 years follow-up

LR + 1.60 (1.15–2.22)

LR − 0.58 (0.40–0.84)

Model 3 Cariogram 3

1 year follow-up

LR + 1.69 (1.17–2.44)

LR − 0.62 (0.45–0.86)

2 years follow-up

LR + 1.97 (1.33–2.90)

LR- 0.54 (0.38–0.76)

Model 4 Cariogram 4

1 year follow-up

LR + 1.58 (1.09–2.30)

LR − 0.68 (0.50–0.93)

2 years follow-up

LR + 1.88 (1.24–2.74)

LR − 0.60 (0.43–0.83)

High risk set

Model 5 Cariogram 5

1 year follow-up

LR + 1.55 (1.13–2.13)

LR − 0.59 (0.41–0.85)

2 years follow-up

LR + 1.63 (1.17–2.26)

LR − 0.55 (0.38–0.82)

Model 6 Cariogram 6

1 year follow-up

LR + 1.85 (1.29–2.65)

LR − 0.54 (0.38–0.77)

2 years follow-up

LR + 1.60 (1.15–2.22)

LR − 0.58 (0.40–0.84)

Model 7 Cariogram 7

1 year follow-up

LR + 1.62 (1.12–2.35)

LR − 0.66 (0.49–0.90)

2 years follow-up

LR + 1.88 (1.27–2.79)

LR − 0.58 (0.42–0.80)

Model 8 Cariogram 8

1 year follow-up

LR + 1.58 (1.09–2.30)

LR − 0.68 (0.50–0.93)

2 years follow-up

LR + 1.84 (1.24–2.74)

LR − 0.60 (0.43–0.83)

Cariogram with various factors and settings displayed suboptimal ability to predict caries in this population (aged 2–5)

Caries prevalence at baseline 37%

Caries increment

1 years 52%

2 years 53%

Considering the high prevalence of caries increment it may have been expected that the high set would result in higher sensitivity and specificity than standard set

Campus,

2012 [26]

N = 7 Modified Cariogram

• Life-style situational (diet content, diet frequency, fluoride programme)

• Physiological (related diseases)

• Oral biological (≥ 10⁵ ms in saliva, plaque amount)

• Caries experience (cavity from 0–caries-free to 3 as sum of dmft and DMFS)

Sens 0.83, Spec 0.85, AUC 0.93

LR + 5.53 (4.36–7.03)

LR − 0.2 (0.16–0.25)

Results showed high validity of Cariogram in schoolchildren

Data collected as lbc counts used as a measure of cariogenic diet

Caries prevalence at baseline 29%

Caries increment (2 years)

54%

Christian,

2020 [27]

N = 13 Modified CAMBRA

• Societal structure (parent/caregiver: low socioeconomic status and/or low health literacy, mother/caregiver: decay-free last three years, mother/caregiver: xylitol chewing-gum/lozenges 2–4 × daily)

• Life-style situational (developmental problems, no dental home/episodic dental care, dental home and regular dental care, frequent between-meal snacks of sugars/cooked starch/sugared beverages, continually uses bottle—contains fluids other than water, sleeps with a bottle or nurses on demand, lives in a fluoridated community, or takes fluoride supplements, fluoridated toothpaste daily)

• Oral biological (obvious plaque on teeth and/or gums bleed easily)

Follow-up 1.5 years

Sens 0.74, Spec 0.35,

PPV 0.20, NPV 0.86, AUC close to 0.5

Follow-up 2.5 years

Sens 0.70, Spec 0.36¸

PPV 0.37, NPV 0.69, AUC close to 0.5

Follow-up 1.5 years

LR + 1.14 (0.92–1.41), LR − 0.74 (0.42–1.31)

Follow-up 2.5 years

LR + 1.09 (0.90–1.33), LR − 0.83 (0.55–1.26)

CAMBRA in its current form may not be ideal for use in risk-based disease management among young Victorian children. Due to its low specificity, it is highly likely that the use of this risk assessment tool could be driving over-treatment

Caries prevalence at baseline 0%

Caries increment

1.5 years 18%

2.5 years 35%

Dolic,

2020 [28]

N = 9 Cariogram

• Life-style situational (diet content, diet frequency, fluoride programme)

• Physiological (related diseases)

• Oral biological (ms in saliva, saliva secretion, saliva buffer, plaque amount)

• Caries experience (cavity)

Threshold 1 (moderate, low, and very low risk)

Sens 0.54, Spec 0.69, PPV 0.78, NPV 0.42

LR + 1.47, LR − 0.66

Threshold 2 (moderate, high, and very high risk)

Sens 0.81, Spec 0.58, PPV 0.80, NPV 0.60

LR + 1.92, LR − 0.32

Threshold 1 (moderate, low, and very low risk)

LR + 1.74 (0.93–3.25)

LR − 0.67 (0.45–0.98)

Threshold 2 (moderate, high, and very high risk)

LR + 1.93 (1.21–3.09)

LR − 0.33 (0.17–0.62)

Cariogram can be a useful tool for caries prediction. It is valid and highly predictive

Data collected as lbc counts (Dentocult) used as a measure of cariogenic diet

Caries prevalence at baseline NR

Caries increment NR

No report of thresholds for ms, lbc, or caries experience

Gao,

2013 [29]

N = 5–14 in 10 different models

Model 1 NUS-CRA Comprehensive N = 11

• Societal structure (family socioeconomic status)

• Life-style situational (infant feeding history, diet, fluoride. plaque index)

• Physiological (age, ethnicity, systemic health)

• Oral biological (ms in saliva, lbc in saliva)

• Caries experience (cavity)

Model 2 NUS-CRA screening N = 9

Model 1 excluding ms and lbc in saliva

Model 3 Cariogram Comprehensive N = 9 predictors see study below by Hänsel Petersson et al. [30]

Model 4 Cariogram screening N = 5 Model 3 excluding saliva secretion, saliva buffer, ms in saliva, lbc in saliva

Model 5 CAT Comprehensive I

N = 12

• Societal structural (family socioeconomic status, dental attendance)

• Life-style situational (diet, fluoride, oral hygiene, dental appliance)

• Physiological (systemic health)

• Oral biological (ms in saliva, saliva secretion)

• Caries experience (past caries, white spot lesion, enamel defects)

Model 6 CAT comprehensive II

N = 11

Model 5 without family socioeconomic status

Model 7 CAT screening I N = 10

Model 5 excluding saliva secretion and ms in saliva

Model 8 CAT screening II N = 9

Model 7 without socioeconomic status

Model 9 CAMBRA Comprehensive N = 14

• Societal structural (family socioeconomic status)

• Life-style situational (infant feeding history, diet, fluoride, oral hygiene, dental appliance, dental attendance)

• Physiological (systemic health, medication)

• Oral biological (ms in saliva, lbc in saliva, saliva secretion)

• Caries experience (past caries, white spot lesion)

Model 10 CAMBRA Screening

N = 11

Model 9 excluding ms in saliva, lbc in saliva, saliva secretion

Model 1 NUS-CRA comprehensive

Sens 0.78, Spec 0.85, AUC 0.88

Model 2 NUS-CRA screening

Sens 0.74, Spec 0.88, AUC 0.85

Model 3 Cariogram comprehensive

Sens 0.65, Spec 0.79, AUC 0.78

Model 4 Cariogram screening

Sens 0.63, Spec 0.78, AUC 0.76

Model 5 CAT comprehensive I

Sens 1, Spec 0.04

Model 6 CAT comprehensive II

Sens 0.99, Spec 0.04

Model 7 CAT creening I

Sens 0.98, Spec 0.05

Model 8 CAT screening II

Sens 0.98, Spec 0.05

Model 9 CAMBRA comprehensive

Threshold ≥ Moderate

Sens 0.92, Spec 0.40

Threshold ≥ High

Sens 0.84, Spec 0.63

Model 10 CAMBRA Screening

Threshold ≥ Moderate

Sens 0.98, Spec 0.20

Threshold ≥ High

Sens 0.94, Spec 0.44

Model 1 NUS-CRA comprehensive

LR + 5.31 (4.01–7.03)

LR − 0.26 (0.19–0.34)

Model 2 NUS-CRA screening

LR + 4.81 (3.64–6.35)

LR − 0.31 (0.24–0.40)

Model 3 Cariogram comprehensive

LR + 3.0 (2.36–3.82)

LR − 0.45 (0.37–0.55)

Model 4 Cariogram screening

LR + 2.85 (2.24–3.61)

LR − 0.48 (0.39–0.58)

Model 5 CAT comprehensive I

LR + 1.04 (1.02–1.06)

LR − 0

Model 6 CAT comprehensive II

LR + 1.03, (1.01–1.06)

LR − 0.15 (0.02–1.10)

Model 7 CAT screening I

LR + 1.04 (1.01–1.08)

LR − 0.21 (0.05–0.92)

Model 8 CAT Screening II

LR + 1.04 (1.0–1.08)

LR − 0.31 (0.09–1.04)

Model 9 CAMBRA Comprehensive

Threshold ≥ Moderate

LR + 1.52 (1.37–1.68)

LR − 0.21 (0.13–0.35)

Threshold ≥ High

LR + 2.26 (1.92–2.65)

LR − 0.26 ( 0.18–0.37)

Model 10 CAMBRA Screening

Threshold ≥ Moderate

LR + 1.22 (1.15–1.30)

LR- 0.14 (0.06–0.33)

Threshold ≥ High

LR + 1.66 (1.50–1.86)

LR − 0.14 (0.08–0.26)

Our findings supported algorithm modelling. NUS-CRA appeared to be a

baseline useful program with sufficient sensitivity and specificity in Hong Kong children

Caries prevalence at baseline 35%

Caries increment (1 year) 37%

Hänsel Petersson,

2015 [30]

N = 9 Cariogram

• Life-style situational (diet content, diet frequency, fluoride programme)

• Physiological (related diseases)

• Oral biological (ms in saliva with four thresholds, saliva secretion, saliva buffer, plaque amount)

• Caries experience (DMFT cavity with four thresholds)

Threshold % DFS new lesions

80% Sens 0.89, Spec 0.34

PPV 0.42, NPV 0.85

60% Sens 0.61, Spec 0.71

PPV 0.53, NPV 0.77

40% Sens 0.26, Spec 0.91

PPV 0.60, NPV 0.69

20% Sens 0.12, Spec 0.95

PPV 0.55, NPV 0.67

Threshold % DFS new lesions

80% LR + 1.34 (1.26–1.43)

LR − 0.32 (0.23–0.45)

60% LR + 2.11 (1.82–2.45)

LR − 0.55 (0.47–0.63)

40% LR + 2.72 (2,02–3.68)

LR − 0.82 (0.77–0.88)

20% LR + 2.29 (1.48–3.55)

LR − 0.93 (0.89–0.97)

Cariogram did not perform better than a risk assessment scheme based on past Caries experience and caries progression, over a 3-year period in young adults

Data collected as lbc counts used as a measure of cariogenic diet

Caries prevalence at baseline 77%

Caries increment (3 years) 35%

Hänsel Petersson,

2010 [31]

Model 1 Cariogram N = 9

• Life-style situational (diet content, diet frequency, fluoride program)

• Physiological (related diseases)

• Oral biological (ms in saliva with four thresholds, saliva secretion, saliva buffer, plaque amount)

• Caries experience (dentin caries DMFS with four thresholds)

Model 2 N = 8

Model 1 excluding ms in saliva

Model 3 N = 8

Model 1 excluding saliva buffer

Model 4 N = 8

Model 1 excluding saliva secretion

Model 5 N = 6

Model 1 excluding ms in saliva, saliva buffer, saliva secretion

Model 1 Sens 0.73, Spec 0.60

PPV 0.45, NPV 0.83, LR + 1.80, LR- 0.45

AUC 0.75

Model 2 Sens 0.84, Spec 0.47

PPV 0.41, NPV 0.86, LR + 1.60, LR − 0.36

AUC 0.73

Model 3 Sens 0.79, Spec 0.51

PPV 0.42, NPV 0.85, LR + 1.60, LR − 0.41

AUC 0.75

Model 4 Sens 0.77, Spec 0.49

PPV 0.41, NPV 0.83, LR + 1.50, LR − 0.45

AUC 0.75

Model 5 Sens 0.90, Spec 0.20

PPV 0.34, NPV 0.82, LR + 1.10, LR − 0.50

AUC 0.72

Model 1

LR + 1.83, (1.52–2.19)

LR − 0.45 (0.33–0.61)

Model 2

LR + 1.58 (1.38–1.82)

LR − 0.34 (0.22–0.52)

Model 3

LR + 1.61 (1.38–1.88)

LR − 0.41 (0.29–0.59)

Model 4

LR + 1.51 (1.30–1.76)

LR − 0.47 (0.33–0.66)

Model 5

LR + 1.13 (1.03–1.22)

LR − 0.50 (0.28–0.90)

Accuracy of caries prediction in school children was significantly impaired when Cariogram was applied without enumeration of salivary tests. ms enumeration seemed to be most important of the salivary variables

Data collected as lbc counts used as a measure of cariogenic diet

Caries prevalence at baseline 40%

Caries increment (2 years) 31%

Holgerson,

2009 [32]

N = 7 Modified Cariogram

• Life-style situational (diet frequency, oral hygiene, fluorides)

• Physiological (related diseases)

• Oral biological (ms in saliva—counts with four thresholds)

• Caries experience (above average for age group)

• Other predictors (clinical judgement)

Sens 0.46, Spec 0.88

PPV 0.90, NPV 0.40, LR + 3.7, LR − 0.6

LR + 3.83 (1.39–10.58)

LR − 0.61 (0.40–0.94)

Modified Cariogram in 2-year-old children resulted in high sensitivity for future caries, but the method lacked accuracy and precision

Caries prevalence at baseline 3%

Caries increment (5 years) 71%

Clinical judgement added after result of Cariogram was obtained

Pang,

2021 [19]

N = 7

Predictors described below Pang 2021 in studies of model development described above

Total AUC 0.73 (0.68–0.79)

Low caries risk (DMFT ≥ 1 caries lesion)

Sens 0.29, Spec 0.63, PPV 0.29, NPV 0.63

Moderate caries risk

Sens 0.34, Spec 0.66, PPV 0.48, NPV 0.52

High caries risk

Sens 0.59, Spec 0.68, PPV 0.74, NPV 0.53

Very high caries risk

Sens 0.66, Spec 0.58, PPV 0.90, NPV 0.22

Low caries risk

LR + 0.78 (0.57–1.08)

LR − 1.13 (0.96–1.33)

Moderate caries risk

LR + 1.00 (0.73–1.38)

LR − 1.00 (0.85–1.18)

High caries risk

LR + 1.86 (1.39–2.48)

LR- 0.60 (0.49–0.74)

Very high caries risk

LR + 1.54 (1.22–1.94)

LR − 0.60 (0.47–0.76)

This caries risk prediction model can accurately identify a high-risk population. The model can be utilized as a powerful tool at community level

Sample different for studies of model development and model validation

Caries prevalence at baseline 40%

Caries increment (1.7 years) 63%

ICDAS codes 3–6, Pitts and Ekstrand, [35]

  Root caries

Hayes,

2017 [33]

N = 9 Model 1 Cariogram

• Life-style situational (diet content, diet frequency, fluoride programme)

• Physiological (related diseases)

• Oral biological (ms ≥ 10⁵ counts per ml saliva, saliva secretion, saliva buffer, plaque amount)

• Caries experience (normal caries experience: mean DMFT score 22.4 ± 5.3 range 17–28)

Model 2 N = 8

Model 1 excluding ms in saliva

Model 3 N = 8

Model 1 excluding saliva buffer

Model 4 N = 8

Model 1 excluding saliva secretion

Model 5 N = 6

Model 1 excluding ms in saliva, saliva buffer, saliva secretion

Model 1 Cariogram

Sens 0.79, Spec 0.63, PPV 0.40, NPV 0.90

AUC 0.77

Model 2 Model 1 excluding ms

Sens 0.74, Spec 0.73, PPV 0.48, NPV 0.90

AUC 0.80

Model 3 Model 1 excluding saliva buffer

Sens 0.79, Spec 0.58, PPV 0.39, NPV 0.89

AUC 0.76

Model 4 Model 1 excluding saliva secretion

Sens 0.79, Spec 0.58, PPV 0.39, NPV 0.89

AUC 0.77

Model 5 Model 1 excluding ms, saliva buffer, saliva secretion

Sens 0.73, Spec 0.66, PPV 0.42, NPV 0.88

AUC 0.79

Model 1 Cariogram

LR + 2.12 (1.71–2.63)

LR − 0.34 (0.21–0.54)

Model 2 Model 1 excluding ms

LR + 2.78 (2.14–3.62)

LR − 0.35 (0.23–0.52)

Model 3 Model 1 excluding saliva buffer

LR + 1.88 (1.53–2.29)

LR − 0.37 (0.23–0.59)

Model 4 Model 1 excluding saliva secretion

LR + 1.88 (1.53–2.29)

LR − 0.37 (0.23–0.59)

Model 5 Model 1 excluding ms, saliva buffer, saliva secretion

LR + 2.13 (1.68–2.69)

LR − 0.41 (0.28–0.61)

Cariogram may be clinically useful in determining future root caries in independently living older dentate adults (aged ˃ 65)

Data collected as lbc counts used as a measure of cariogenic diet

Caries prevalence at baseline NR

Caries increment (2 years) 25%