Dental Caries Risk Varies Among Subgroups of Children with Special Health Care Needs

Purpose: Currently, caries risk assessment tools consider all children with special health care needs in tandem. The purpose of this study was to test this assumption by examining caries risk among and within five distinct groups of children, most with special health care needs (CSHCN): (1) autism (ASD); (2) congenital heart disease (CHD); (3) cerebral palsy (CP); (4) Down syndrome (DS); and (5) a control (non-CSHCN) group. Methods: A retrospective longitudinal cohort of 150 patients (30 per group) from a private pediatric dental practice was assembled, and information on caries diagnoses and 21 postulated caries risk factors from clinical records was extracted. Bivariate tests and multivariable Poisson regression modeling were used to estimate the caries incidence rate (IR), ratio (IRR), and 95 percent confidence interval (CI). Results: CSHCN hod a higher caries burden and caries risk (IR equals 0.049 per person per year) compared to the control group (IR equals 0.033). Caries risk was nearly double among CHD (IRR equals 1.9 [95 percent CI equals 0.72 to 5.2] versus controls) compared to DS (IRR equals 1.04 [95 percent CI equals 038 to 2.9]). Visible cavities or fillings was the only significant risk factor, yet it did not alter the between-CSHCN group (i.e., CHD greater than DS, controls) caries risk heterogeneity. Conclusions: Children with special health care needs comprise a heterogeneous group that must be treated in a precise, diagnosis-specific manner in caries risk assessment. Caries experience in the primary dentition was the only significant predictor of permanent dentition caries incidence.