Diagnostic Testing Accuracy of Sucrose-stimulated Salivary pH for Screening Early Childhood Caries Diagnosis and Severity: An Observational Study

PurposeThe purpose of this study was to determine the diagnostic testing accuracy of child and maternal sucrose-stimulated salivary pH as screening tools for early childhood caries diagnosis and severity. MethodsFrom a sample population of 642 mother-child dyads, with child-subjects under age six years old, child and maternal sucrose-stimulated saliva specimens were collected to measure salivary pH thirty minutes after consumption of sucrose by mouth. Immediately after the pH measurement and oral clinical examination, the pediatric dentist provider determined for child-subjects their diagnoses for early childhood caries and severity, respectively guided by the gold-standard classifications promulgated by the American Academy of Pediatric Dentistry and International Caries Detection and Assessment System. Salivary pH of 6.0 was statistically calculated as the screening cut-off point. Statistical analyses calculated values for true positive, false positive, true negative, false negative, and the diagnostic testing accuracy metrics for prevalence, specificity, sensitivity, diagnostic odds ratio, positive and negative predictive values, positive and negative likelihood ratios, and Youdens Index. Regression models were utilized to determine the respective odds ratio associations between child and maternal sucrose-stimulated salivary pH versus the diagnosis and severity of early childhood caries. ResultsFor early childhood caries diagnosis, child sucrose-stimulated salivary pH yielded diagnostic test accuracy metrics of 47.7 percent prevalence, 72.42 percent specificity, 59.47 percent sensitivity, 66.30 percent positive predictive value, and 66.20 percent negative predictive value, and diagnostic odds ratio 3.85. The results for maternal sucrose-stimulated salivary pH for caries severity were similar in value. Maternal sucrose-stimulated salivary pH displayed lower overall DTA metrics compared to child sucrose-stimulated salivary pH, but both child and maternal sucrose-stimulated salivary pH had higher specificity than sensitivity and displayed moderate levels of positive and negative predictive values. Child sucrose-stimulated salivary pH less than 6.0 had 3.89 times higher odds for ECC diagnosis and 3.56 times higher odds of moderate-extensive caries severity than child sucrose-stimulated salivary pH greater than 6.0. Maternal sucrose-stimulated salivary pH less than 6.0 had 1.60 times higher odds of moderate-extensive caries severity than maternal sucrose-stimulated salivary pH greater than 6.0. ConclusionChild and maternal sucrose-stimulated salivary pH screening tests are useful as a screening tool to identify children at high-risk for early childhood caries.