Caries Risk Assessment and Referral Tool (CRA-RT)-A novel risk scoring system for early childhood caries in community settings

Abstract

Objective: To develop a brief and simple, easy-to-administer, culturally sensitive, reliable and valid risk scoring system for early childhood caries based only on behavioural and other nonclinical risk factors. The purpose was to allow risk scoring by child care providers without clinical examination in order to guide dental referral in a community setting.

Methods: A cross-sectional study using stratified multistage cluster sampling was conducted among 559 preschool children and their mothers in Anganwadi centres and Preprimary schools in Thiruvananthapuram district, Kerala, India. All steps in the development of a new tool were carried out. Exploratory factor analysis and principal component analysis with Varimax rotation were employed for item reduction. Reliability and validity assessments were also performed. Past caries experience was recorded as dmft scores and the validity hypothesis of higher dmft scores in children with higher caries risk scores was also verified as an additional measure of construct validity.

Results: The newly developed Caries Risk Assessment and Referral Tool (CRA-RT) is presented as a unidimensional, 11-item, discriminative tool which showed high test-retest reliability (ICC = 0.8), high inter-rater reliability (ICC = 0.8) and acceptable internal consistency (Cronbach's alpha = 0.6). Face, content and construct validity have been demonstrated. Children with higher CRA-RT scores were having higher dmft scores, and it provided an additional evidence for the construct validity of the tool.

Conclusion: CRA-RT is a simple, valid and reliable novel risk scoring system for ECC, to be used in a nondental, nonmedical setting. The proposed tool contains those behavioural risk or protective factors, the presence or absence of which could be assessed by interviewing the mother. The quick and the easy risk scoring pattern with a cut-off score can guide the dental referral of preschool children by child care providers in a community setting.

Keywords: Caries risk Assessment and Referral Tool; community dental referral; development and validation of a caries risk assessment tool; early childhood caries; reliability.