Estimating prevalence and severity of caries in the mixed dentition: A comparison of two screening protocols

Objective: Most oral health surveys examine and record data on individual teeth or surfaces (STD), providing valid estimates of caries prevalence and severity. Simplified screening protocols based on assessments at the person level (Stop-After-First-Encounter - SAFE) have been validated for assessment of prevalence. We developed an alternative protocol (SENTINEL), which examined the 12 teeth at highest risk for caries and compared how it performed to SAFE and STD for surveillance and evaluation. Methods: We used data from the Third National Health Nutrition and Examination Survey for children aged 8 to 12 years to analyze the feasibility of assigning STD estimates of severity to children designated by SAFE as having caries. SENTINEL was tested for accuracy of estimating prevalence and severity against STD. In addition, we used subsampling to test the frequency with which SAFE and SENTINEL agreed with STD in identifying the highest risk population. Finally, we compared the mean number of teeth and the recorded data elements for each protocol. Results: Assigning national estimates of severity to SAFE provided inaccurate estimates. SENTINEL agreed with STD in identifying the survey group with the highest severity more frequently than did SAFE (96 percent vs 74 percent). SAFE on average examined nine more teeth than SENTINEL Conclusions: Both SAFE and SENTINEL could serve as surveillance tools, depending on the system's purpose/objectives. However, it is unlikely that SAFE would provide adequate information to evaluate sealant programs.