A Systematic Review to Assess the Methodological Quality of Studies on Measurement Properties for Caries Risk Assessment Tools for Young Children

Background: At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. The evidence to inform CRAT selection however is unclear. Aim: This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. Design: MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity, and responsiveness) informed the quality assessment. Results: The search resulted in 10 papers, reporting on eight different CRATs. The identified CRATs were as follows: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan paediatric dental clinic caries risk assessment sheet, and American Academy of paediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. Conclusions: The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties, and as a result, this tool attained a higher quality rating than other CRATs studied.