A methodological study to assess the measurement properties (reliability and validity) of a caries risk assessment tool for young children.

OBJECTIVES: To assess the CAMBRA caries risk assessment tool (CRAT) in terms of its measurement properties: reliability, validity and responsiveness to change in caries estimates over time. METHODS: Secondary data from the VicGeneration (VicGen) birth cohort study were used. Caries risk status at child age18 months was compared against caries development at 36 and 48 months. Questionnaire data for the 18-month-old children, were used to generate the CRAT item responses. Five examiners assessed the caries risk profile for each 18-month-old child and assigned a risk status. The analytic method was informed by the COnsensus-based Standards for the selection of health Measurement INstruments Checklist. RESULTS: Each examiner applied the CAMBRA CRAT to 214 cases from the VicGen study. At 18 months of age, the proportion of low-, moderate- and high-risk children were 17 %, 17 % and 66 %, respectively. Caries prevalence at 36 and 48 months of age was 18 % and 35 %, respectively. Almost perfect reliability (both inter- and intra-reliability) was achieved in caries risk categorisation. For criterion validity and responsiveness, the area under the curve was approximately 0.50. For the dichotomised risk, the sensitivity of the CAMBRA CRAT to predict caries at 36 and 48 months, was 74 % and 70 %, respectively. The corresponding specificity scores were 35 % and 36 %, respectively. CONCLUSIONS: The results from this study show that the CAMBRA CRAT, in its current form, is not a good predictor of future caries among young Victorian children and in fact overestimates the proportion of children at high-risk of future disease. As such, it may not be ideal for use among young Victorian children and it is highly likely it's use could be driving over treatment. CLINICAL SIGNIFICANCE: This study provides evidence for the applicability of the CAMBRA CRAT with young Victorian children to inform decision making on caries risk-based management. It also highlights the important measurement properties and related analytics (applicable to any CRAT) that should be considered when selecting a CRAT for use in clinical practice.

Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study.

OBJECTIVES: The aim of this birth cohort study was to identify concurrent associations between early childhood caries and putative risk and protective factors. METHODS: Data were collected in seven waves over five years. The study outcome measure, d3-6mfs, was modelled in a set of sequential negative binomial regressions that introduced the variables in steps starting from health determinants most distal to the child and ending with the more proximal ones. The goodness of fit of each model at each step was tested using the quasi-likelihood under independence model criterion (QIC). A final model included all significant factors identified in the sequential modelling. Bacterial composition of the child's saliva was determined by 16S RNA gene sequencing. RESULTS: Overall, 467 children (48.6 % female) participated, of whom 419 (89.7 %) had at least one follow-up visit after baseline. Of the 419 children included in the analyses, 133 (31.7 %) had their saliva samples sequenced for microbiomic determination. Independent protectors of surface cavitation included water fluoridation, and older age of mothers. Risk for d3-6mfs was significantly higher among children whose mothers were current smokers (IRR 3.29, 95 % CI 1.09-9.88, p = 0.034), children who went to bed with a bottle (IRR 2.67, 95-6.88, p = 0.041) and whose saliva sample sequencing over time showed higher percentages of Streptococcus mutans (IRR 1.39, 95 % CI 1.11-1.74, p = 0.005). Model fit was mostly improved by child's proximal variables. Household and mother covariates did not substantially improve model fit. CONCLUSION: This analysis highlights the relevance and importance of child-proximal risk factors in childhood dental cavitation. CLINICAL SIGNIFICANCE: The study findings inform clinical decision making for the management of early childhood caries at both the individual and population level. At an individual and family level these risk factors should be incorporated into caries risk assessment tools for more precise identification of risk and evidence-informed interventions by health professionals.

Familiarity with social sounds alters c-Fos expression in auditory cortex and interacts with estradiol in locus coeruleus.

When a social sound category initially gains behavioral significance to an animal, plasticity events presumably enhance the ability to recognize that sound category in the future. In the context of learning natural social stimuli, neuromodulators such as norepinephrine and estrogen have been associated with experience-dependent plasticity and processing of newly salient social cues, yet continued plasticity once stimuli are familiar could disrupt the stability of sensorineural representations. Here we employed a maternal mouse model of natural sensory cortical plasticity for infant vocalizations to ask whether the engagement of the noradrenergic locus coeruleus (LC) by the playback of pup-calls is affected by either prior experience with the sounds or estrogen availability, using a well-studied cellular activity and plasticity marker, the immediate early gene c-Fos. We counted call-induced c-Fos immunoreactive (c-Fos-IR) cells in both LC and physiologically validated fields within the auditory cortex (AC) of estradiol or blank-implanted virgin female mice with either 0 or 5-days prior experience caring for vocalizing pups. Estradiol and pup experience interacted both in the induction of c-Fos-IR in the LC, as well as in behavioral measures of locomotion during playback, consistent with the neuromodulatory center's activity being an online reflection of both hormonal and experience-dependent influences on arousal. Throughout core AC, as well as in a high frequency sub-region of AC and in secondary AC, a main effect of pup experience was to reduce call-induced c-Fos-IR, irrespective of estradiol availability. This is consistent with the hypothesis that sound familiarity leads to less c-Fos-mediated plasticity, and less disrupted sensory representations of a meaningful call category. Taken together, our data support the view that any coupling between these sensory and neuromodulatory areas is situationally dependent, and their engagement depends differentially on both internal state factors like hormones and external state factors like prior experience.