Caries-risk Assessment in the Public Dental Service, Ireland: Pilot Results

Background: In recent years, strategies for managing dental caries in children and adolescents have emphasised the concept of risk assessment. The Public Dental Service in the Republic of Ireland, which provides free dental services to children and adolescents, does not currently perform formal caries-risk assessment for individual patients.

Objectives: To determine the perceived usefulness of a caries-risk-assessment checklist for the Public Dental Service and to assess how well caries-risk status determined by the checklist agreed with the dentist's subjective assessment of caries risk.

Methods: The caries-risk-assessment checklist was developed by a multidisciplinary group using evidence from Irish epidemiological data, systematic reviews of risk factors for caries and from good-quality guidelines on caries prevention. The checklist comprised two sections: a clinical/medical history section and a behavioural/socio-economic section. The dentist's subjective assessment of caries risk was also recorded. A convenience sample of 11 dentists in 5 dental areas piloted the checklist with children who had not attended a dentist for over one year.

Results: 160 checklists were completed. The mean age of participants was 8.7 (range 4-15). 122 children (76%) were categorised as “high-risk” by the checklist and

101 children (63%) were considered “high-risk” in the dentist's opinion. There was agreement on caries risk categorisation between the dentist and the checklist in 139 children (87% agreement). Although all dentists found the checklist easy to use, only 5 (45%) said that they would use it on a daily basis.

Conclusions: The high percentage of “high-risk” children in this pilot was unforeseen and in such populations, the use of an individual caries-risk checklist is of limited value. The pilot has shown good agreement between the checklist and dentist assessment of caries risk. We intend to refine the checklist and to re-pilot in a representative sample of dental areas.

Supported by the Health Research Board,Grant No. S/A013