Comparative Evaluation of Caries Risk Assessment using Three Different Tools among Toddlers and Preschoolers

Context: Early childhood caries remains a significant public health concern globally. Caries risk assessment (CRA) tools are essential for early identification and prevention, yet comparative evidence in young children is limited. Aim: To compare three CRA tools – American Academy of Pediatric Dentistry (AAPD), American Dental Association (ADA) and Caries Management by Risk Assessment (CAMBRA) – in children aged 1–6 years. Settings and Design: Cross-sectional study at a tertiary care dental hospital in South India. Materials and Methods: One hundred and nineteen children (61 males, 58 females; mean age 2.8 ± 0.9 years) were examined. All three CRA tools were applied simultaneously by a single calibrated examiner. Risk categories were compared across age groups (<3 years vs. ≥3 years) and gender. Statistical Analysis Used: Cohen’s kappa coefficient assessed inter-tool agreement. Chi-square and Fisher’s exact tests compared distribution ( P < 0.05). Results: AAPD identified significantly more high-risk children (4.2%) than ADA and CAMBRA (0.8% each), most pronounced in children under 3 years (5.1% vs. 0%). ADA and CAMBRA showed almost perfect agreement (κ = 0.885, 98.3%), while AAPD showed moderate agreement with ADA (κ = 0.596) and CAMBRA (κ = 0.520). No significant differences were observed across age groups or gender ( p > 0.05). Conclusion: All three tools are effective for pediatric CRA with varying sensitivity. AAPD may be more sensitive for early risk detection in toddlers, while ADA and CAMBRA demonstrate higher concordance. Tool selection should be guided by clinical context and whether sensitivity or specificity is prioritized.