Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment: A Systematic Review and Meta-Analysis

Background: Dental caries remains the most prevalent chronic disease-affecting children globally, with early childhood caries (ECC) disproportionately impacting underserved populations despite being largely preventable. Caries risk assessment (CRA) tools have developed to stratify patients and guide preventive interventions, yet the evidence base for their predictive validity and the comparative effectiveness of risk-based management protocols remains fragmented.Objectives: This systematic review and meta-analysis aimed to (۱) evaluate the predictive performance of existing CRA tools for future caries development in children, (۲) assess the clinical effectiveness of prevention and management protocols stratified by caries risk category, and (۳) quantify the comparative efficacy of individual preventive interventions including fluoride varnish, silver diamine fluoride (SDF), and fissure sealants.Methods: A comprehensive literature search conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus from inception to March ۲۰۲۶. Randomized controlled trials and prospective cohort studies evaluating CRA tools or risk-stratified preventive protocols in children aged ۰-۱۸ years were included. Risk of bias assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and Cochrane RoB ۲.۰ tool. Meta-analyses performed using random-effects models.Results: Thirty-eight studies (n=۴۷,۸۳۲ participants) met inclusion criteria. Meta-analysis of six CRA models demonstrated moderate discriminatory performance (pooled AUC: ۰.۷۹, ۹۵% CI: ۰.۷۳-۰.۸۴) with significant heterogeneity (I²=۷۸%). All CRA models exhibited high risk of bias per PROBAST criteria. For preventive interventions, SDF demonstrated superior caries arrest rates compared to placebo (RR: ۲.۳۴, ۹۵% CI: ۱.۷۸-۳.۰۸) and fluoride varnish (RR: ۱.۴۲, ۹۵% CI: ۱.۱۲-۱.۷۹). Fissure sealants showed higher caries prevention efficacy than fluoride varnish over ۳۶ months (RR: ۰.۶۸, ۹۵% CI: ۰.۵۴-۰.۸۶).Conclusions: Current CRA tools show modest predictive accuracy with significant methodological limitations. Risk-stratified protocols incorporating SDF for high-risk children and sealants for permanent molars supported by moderate-quality evidence. Future research must prioritize external validation of prediction models.

کلیدواژه ها:

Caries risk assessment ، Pediatric Dentistry ، Silver diamine fluoride ، fissure sealants ، and early childhood caries