216 - Caries Progression and Risk Factors in a Pediatric Cohort

Objective: To identify which age-specific caries risk assessment (CRA) factors are most predictive of caries progression over time in a pediatric population with an established dental home.

Methods: A retrospective longitudinal analysis was conducted using electronic health record data from children followed for a minimum of two years (n = 767). Bivariate analyses (Chi-square) were used to screen candidate variables. A multivariable logistic regression model was constructed to evaluate independent predictors of change in caries status. A secondary model examined associations between preventive fluoride application and neurological condition to explore patterns of care delivery.

Results: The caries model was statistically significant (p < 0.001), with moderate explanatory power (Nagelkerke R² = 0.309). Snacking behavior (OR = 2.497; p < 0.001) and age at last visit (OR = 1.478; p < 0.001) were the strongest predictors of caries progression. Fluoridated water exposure (OR = 0.684; p = 0.045) and private insurance (OR = 0.530; p = 0.009) were associated with lower odds of progression. Musculoskeletal conditions were also associated with reduced odds (OR = 0.591; p = 0.019). Professionally applied fluoride was not associated with caries progression. In the secondary model (n = 779), fluoride application was strongly associated with neurological condition (OR = 0.253; p < 0.001), although the model demonstrated low explanatory power (Nagelkerke R² = 0.075).

Conclusions: Caries progression is primarily driven by behavioral, temporal, and socioeconomic factors. Environmental fluoride provides modest protection, while preventive treatments alone do not offset risk. Associations between fluoride application and neurological condition reflect differences in care delivery rather than causation. This study was supported by the UTSD Postgraduate Research Program.