The value of a baseline caries risk assessment model in the primary dentition for the prediction of caries incidence in the permanent dentition

Childhood Factors and Dental Caries in the Permanent Dentition: Findings of an 8-Year Study Under a Nationwide School Dental Service

OBJECTIVE

This study, using a retrospective analysis of nationwide dental records of school-going children over 8 years, aims to identify childhood factors associated with dental caries incidence in the permanent dentition up to adolescence.

METHODS

Students studying in primary and secondary schools in Singapore are eligible for free basic dental care under the nationwide School Dental Service (SDS). All available dental records, general health records, and sociodemographic data from 2009 to 2017 were extracted as anonymised records, for a full cohort of 29,617 students that were enrolled in Primary 1 in 2009. Multiple logistic regression and modified Poisson regression were applied to identify risk factors for caries incidence in the permanent dentition over 8 years.

RESULTS

Caries occurred in the permanent dentition of 9389 (31.7%) students in the 8 years. Risk of caries incidence in the permanent dentition was associated with baseline caries in the primary (risk ratio [RR]: 1.88; 95% CI: 1.81, 1.95) and permanent (RR: 1.54; 95% CI: 1.47, 1.61) dentition, tooth hypoplasia (RR: 1.58; 95% CI: 1.49, 1.68), and poor baseline oral hygiene (RR: 1.07; 95% CI: 1.03, 1.12). Sociodemographic predictors of caries incidence include a lower socioeconomic status, Chinese ethnicity, female gender, and enrolment in nonmainstream schools or schools in the Eastern and Western regions of Singapore.

CONCLUSIONS

Both clinical and sociodemographic factors in childhood are associated with caries incidence in the permanent dentition and can be used for structuring dental service provision and identifying caries-susceptible individuals and groups for early prevention and intervention.

Assessment of dental pain in children with intellectual disability using the dental discomfort questionnaire

OBJECTIVE

This study aimed to compare the Dental Discomfort Questionnaire (DDQ) scores in children with and without intellectual disability (ID) and to measure correlation between the total DDQ and the Decayed, Missing, and Filled Teeth (DMFT/dmft) scores, as well as the condition of the tooth causing pain.

METHOD

This cross-sectional study included 81 children with normal intellectual development who attended the Departments of Pediatric Dentistry at two Turkish Universities and 80 children with different levels of intellectual disability who reported dental pain in special education centers. The 12-question DDQ (Turkish version) was applied to the parents of the patients with their consent. The relationship of the DDQ scores with tha of the DMFT/dmft, dental status, and demographic data was evaluated.

RESULTS

When the DDQ scores of children with intellectual disabilities were evaluated, it was found that the majority of the answers given to the questions were statistically similar (p < 0.05) to those of children with normal cognitive level. In the questions in which "pain when eating and brushing teeth" was evaluated, a higher score was obtained, which led to an increase in the total DDQ score (p < 0.001). There was a statistically significant difference between the groups in terms of the distribution of dental conditions (p < 0.001). When compared to the normal cognitive group, patients with mild and severe intellectual disabilities had more deep dentin caries, thoughy, frequent periapical abscess was less common in those groups (p < 0.001 and p = 0.022). There was no statistically significant relationship between DMFTscores.

CONCLUSION

The DDQ was found to be a descriptive, functional, and easy-to-use questionnaire for children with intellectual disabilitiesin terms of detecting the presence of dental pain. No correlation was found between DMFT/dmft, dental status and DDQ scores.

Assessing the Impact of Early Childhood Caries on the Development of First Permanent Molar Decays

Aim: The aim of this study was to evaluate whether the treated and untreated severe early childhood caries (ECC) in children would make any impact on the Permanent First Molar (PFM) decays. Materials and Methods: Our descriptive epidemiological study was conducted in Ataturk University, Faculty of Dentistry, Department of Pediatric Dentistry/Erzurum-Turkey, between 2011 and 2017. We included a total of 90 children (44 girls, 46 boys), and divided them into 3 equal groups. They were 6-9 years old with a mean age of 7.38 ± 0.89. Group 1 consisted of the patients who had previously been treated under GA, Group 2 included the patients with untreated ECC and with no previous dental treatment, and Group 3 consisted of the patients who had been periodically treated in normal clinical settings. Each patient was processed through; dmft scoring and PFM caries evaluation process in accordance with International Caries Detection and Assessment System (ICDAS), respectively. The obtained data was analyzed with SPSS v20.0. And also, we used One-way ANOVA, Kruskal-Wallis and Mann Whitney U tests. Results: In accordance with ICDAS, we found that Group 3 had the highest mean number of PFMs (2 ± 1.43) and Group 2 had the lowest (1.43 ± 1.45). In Group 2, the number of ICDAS-determined carious PFMs were significantly lower than the other groups (p < 0.05). However, ICDAS score 6 was 0 in Group 1, while it was determined higher as 4.2% in Group 2. Conclusion: In respect to our research outcomes, which revealed that regardless of treated or not severe ECC had a significant impact on the PFMs, we strongly recommend that the parent of the children experiencing ECC should be informed about the risk of future caries in PFMs.

Is severe early childhood caries predictive of caries and fluorosis in permanent teeth? Ten-year follow-up

Abstract Introduction Severe early childhood caries is defined as the presence of any sign of decay in children younger than three years. Objective This retrospective longitudinal observational study investigated caries and fluorosis in children with S-ECC from a city with fluoridated water. Material and method We included children under the age of three years who followed a maternal and child dental care program between the years of 1997 and 2003. The children were divided into 2 groups: group 1 (S-ECC) and group 2 (no caries). Guardians were contacted by telephone or mail. Caregivers completed questionnaire on socio-demographic and behavioral variables. The clinical dental examinations were performed in a dental clinic to assess caries experience and dental fluorosis. Multiple linear regression was used to determine factors associated with DMFT, and multivariate analysis by multiple logistic regression was used to determine the possible independent factors associated with the occurrence of fluorosis. Result The sample consisted of 126 patients aged 8-12 years, of whom 52.4% were male. The presence of S-ECC increased the DMFT by an average of 0.84 (p = 0.02). Both the frequency of tooth brushing and the use of standard toothpaste were protective factors from the development of caries in the permanent dentition (p <0.05). Parents who reported that their children refused to brush their teeth had 70% less chance of developing fluorosis (p = 0.02). Conclusion The presence of S-ECC was a risk factor for the development of caries in the permanent dentition, but not for the development of fluorosis.

Risk factors and prevalence of dental fluorosis and dental caries in school children of North India

The aim of the study was to assess the prevalence of dental fluorosis, dental caries, and associated risk factors in the school children of district Fatehgarh Sahib, Punjab, India, using a cross-sectional study design. Oral health status of children aged between 8 and 15 years was assessed using World Health Organization (WHO) 2013 criteria. Dental fluorosis was assessed using Dean's index, and dental caries were recorded using decayed, missing, filled/decayed, extracted, filled (DMF/def) indices. Four hundred school children were examined, of which 207 were in the 8-11-year-old group and 193 were in the 12-15-year-old group. The overall prevalence of dental fluorosis was 4.1%, which might be linked to a high concentration of fluoride in drinking water at certain locations of rural Punjab. The prevalence of dental caries was 36.5% with a mean DMF score of 0.3 and def score of 0.6. Risk factors for dental caries include oral hygiene behavior and sugar consumption patterns. The study highlights the need to increase awareness about the oral health and hygiene among the school children in India.

Polymorphisms in sweet taste genes (TAS1R2 and GLUT2), sweet liking, and dental caries prevalence in an adult Italian population

The aim of the study was to assess the relationship between sweet taste genes and dental caries prevalence in a large sample of adults. In addition, the association between sweet liking and sugar intake with dental caries was investigated. Caries was measured by the decayed, missing, filled teeth (DMFT) index in 647 Caucasian subjects (285 males and 362 females, aged 18-65 years), coming from six villages in northeastern Italy. Sweet liking was assessed using a 9-point scale, and the mean of the liking given by each individual to specific sweet food and beverages was used to create a sweet liking score. Simple sugar consumption was estimated by a dietary history interview, considering both added sugars and sugar present naturally in foods. Our study confirmed that polymorphisms in TAS1R2 and GLUT2 genes are related to DMFT index. In particular, GG homozygous individuals for rs3935570 in TAS1R2 gene (p value = 0.0117) and GG homozygous individuals for rs1499821 in GLUT2 gene (p value = 0.0273) showed higher DMFT levels compared to both heterozygous and homozygous for the alternative allele. Furthermore, while the relationship sugar intake-DMFT did not achieve statistical significance (p value = 0.075), a significant association was identified between sweet liking and DMFT (p value = 0.004), independent of other variables. Our study showed that sweet taste genetic factors contribute to caries prevalence and highlighted the role of sweet liking as a predictor of caries risk. Therefore, these results may open new perspectives for individual risk identification and implementation of target preventive strategies, such as identifying high-risk patients before caries development.

Monitoring caries risks before the window of infection and later caries increment: a caries prediction study on rapid detection of Streptococcus mutans using monoclonal antibodies

A new semi-quantitative enumeration system has been developed for the detection of Streptococcus mutans in saliva. Using two kinds of species-specific monoclonal antibodies, this system can quickly detect salivary S. mutans within 30 min and classify the results into three levels. The aim of this study was to evaluate the potential of this test kit in determining risk for the development of caries. Saliva samples collected during a compulsory dental examination from 56 children aged 18-months were tested. The children were classified into 3 groups according to the level of salivary S. mutans determined. After 18 months, 36 of the children underwent a second examination to investigate whether there was a correlation between salivary S. mutans level at the first examination and subsequent increment in caries. The results showed a good correlation between the two. This indicates that salivary S. mutans level before the window of infection is an indicator of caries risk and can be quickly detected using this test kit. This rapid test should be particularly useful in assessing risk of future caries in very young children.

Caries risk assessment. A systematic review

OBJECTIVE

To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents.

STUDY DESIGN

A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach.

RESULTS

Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited.

CONCLUSIONS

Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

The impact of gender on caries prevalence and risk assessment

Dental caries remains a common disease worldwide. There is evidence indicating that many caries risk factors provide a gender bias, placing women at a higher caries risk. Generally, dental caries disproportionally affects the poor and racial or ethnic minorities worldwide, with women suffering more from the disease. Differences in access to care as reflected by untreated caries rates also reflect gender disparities. There is a lack of evidence in regard to gender differences and dental caries. Therefore, there is an urgent need to develop the evidence necessary to meet the oral health needs of both women and men worldwide.

Oral hygiene and dental caries in 5- to 6-year-old children in Ajman, United Arab Emirates

OBJECTIVE

To investigate the association between oral hygiene and dental caries in young children in the Emirate of Ajman, United Arab Emirates.

METHODS

A one-stage cluster sample was used to randomly select children. Clinical examinations were conducted by a single examiner. Parents completed questionnaires seeking information on child and family characteristics, dietary habits and oral hygiene practices.

RESULTS

The total number of children sampled was 1297. Dental examination and questionnaire data were obtained for 1036 (79.9%). Frequency of eating per day and snack consumption level were both significantly associated with plaque score. Children who brushed their teeth more often had lower plaque scores. The observed association between mean plaque score and mean decayed, missing, filled teeth suggests that children with high plaque scores are more likely to experience caries.

CONCLUSIONS

Brushing with fluoride toothpaste was under-utilized in Ajman. Tooth brushing therefore needs better promotion and reinforcement.

A model for the analysis of caries occurrence in primary molar tooth surfaces

Recently methods of caries quantification in the primary dentition have moved away from summary 'whole mouth' measures at the individual level to methods based on generalised linear modelling (GLM) approaches or survival analysis approaches. However, GLM approaches based on logistic transformation fail to take into account the time-dependent process of tooth/surface survival to caries. There may also be practical difficulties associated with casting parametric survival-based approaches in a complex multilevel hierarchy and the selection of an optimal survival distribution, while non-parametric survival methods are not generally suitable for the assessment of supplementary information recorded on study participants. In the current investigation, a hybrid semi-parametric approach comprising elements of survival-based and GLM methodologies suitable for modelling of caries occurrence within fixed time periods is assessed, using an illustrative multilevel data set of caries occurrence in primary molars from a cohort study, with clustering of data assumed to occur at surface and tooth levels. Inferences of parameter significance were found to be consistent with previous parametric survival-based analyses of the same data set, with gender, socio-economic status, fluoridation status, tooth location, surface type and fluoridation status-surface type interaction significantly associated with caries occurrence. The appropriateness of the hierarchical structure facilitated by the hybrid approach was also confirmed. Hence the hybrid approach is proposed as a more appropriate alternative to primary caries modelling than non-parametric survival methods or other GLM-based models, and as a practical alternative to more rigorous survival-based methods unlikely to be fully accessible to most researchers.

Risk factors for early childhood caries in disadvantaged populations

Early childhood caries is a significant international public health problem. The aim of this paper was to review the current evidence of the risk factors for dental caries in disadvantaged children under 6 years of age. Medline, Cochrane, and PubMed database searches were conducted. Systematic reviews were used where available, or meta-analyses; randomized, controlled trials; and cohort, case-control, and cross-sectional studies (in that order). Studies were restricted to those published in English from 1990 to October 2010. Early childhood caries has a complex etiology with biological, behavioral, and sociodemographic influences. Evidence suggests that young children are most likely to develop caries if Streptococcus mutans is acquired at an early age, although this is influenced by other factors, such as oral hygiene, fluoride, diet, dental visit patterns, socioeconomic status, ethnicity, and health literacy. Etiological pathways should be taken into consideration when designing interventions to prevent dental caries in disadvantaged preschool children.

Epidemiological assessment of predictors of caries increment in 7-10- year-olds: a 2-year cohort study

Objective

The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds.

Material and Methods

The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chisquare).

Results

The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years.

Conclusion

The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.

A systematic review of dental disease in patients undergoing cancer therapy

INTRODUCTION

This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies.

REVIEW METHOD

A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies.

RESULTS

Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%.

CONCLUSIONS

Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.

Dental caries risk studies revisited: causal approaches needed for future inquiries

Prediction of high-risk individuals and the multi-risk approach are common inquiries in caries risk epidemiology. These studies prepared the ground for future studies; specific hypotheses about causal patterns can now be formulated and tested applying advanced statistical methods designed for causal studies, such as structural equation modeling, path analysis and multilevel modeling. Causal studies should employ measurements, analyses and interpretation of findings, which are in accordance to causal aims. Examples of causal empirical studies from medical and oral research are presented.

Association between enamel hypoplasia and dental caries in primary second molars: a cohort study

The purpose of this study was to assess the longitudinal relationships between enamel hypoplasia and caries experience of primary second molars. The study sample was 491 subjects who received dental examinations at both age 5 and 9 by the calibrated examiners. Four primary second molars (n = 1,892) were scored for the presence of enamel hypoplasia for each participant. Caries presence and number of decayed and filled surfaces (dfs) were determined at age 5 and 9. The relationships between enamel hypoplasia and caries experience were assessed. Among primary second molars, 3.9% of children and 1.7% of primary second molars had enamel hypoplasia. At age 5, 36.8% of children with hypoplasia had caries, while 16.9% of children without enamel hypoplasia had caries. At age 9, the corresponding numbers were 52.6% for children with hypoplasia and 34.5% for children without hypoplasia, respectively. At the tooth level, for age 5, 28.1% of teeth with hypoplasia had caries (mean dfs = 0.40), and 7.6% of teeth without hypoplasia had caries (mean dfs = 0.11). At age 9, the corresponding numbers were 41.9% (mean dfs = 0.76) for teeth with hypoplasia and 18.3% (mean dfs = 0.34) for teeth without hypoplasia. In multivariable logistic regression analyses, teeth of subjects with enamel hypoplasia had a significantly higher risk for caries at age 5 and 9 after controlling for other risk factors. Enamel hypoplasia appears to be a significant risk factor for caries and should be considered in caries risk assessment.

Clinical, salivary, and bacterial markers for caries risk assessment in schoolchildren: a 4-year follow-up

BACKGROUND

In Mexico, there is a high prevalence of dental caries and large groups of children still show extensive untreated dental damage.

AIM

This study aims to evaluate, in a cohort of 6-year-old Mexican children, the relationship between caries increment at 4 years and the following caries risk markers: fissure morphology, caries experience, salivary flow rate, Snyder test results, and mutans and lactobacilli counts.

DESIGN

To predict new caries lesions in 110 schoolchildren, clinical, salivary, and bacteriological caries risk markers were used, including fissure morphology, caries experience, salivary flow rate, Snyder test, and Streptococcus mutans and lactobacilli counts. To determine the validity of these markers, the baseline data were compared with the caries increment after 4 years.

RESULTS

The risk model's capacity to predict caries was moderate (specificity 79.6% and sensitivity 78.6%). Caries experience (P = 0.0001), Snyder test (P = 0.002), and fissure morphology (P = 0.024) had the strongest association with caries increment. Salivary flow rate, lactobacilli, and S. mutans counts did not contribute significantly to the prediction of caries lesions in these children.

CONCLUSION

In addition to the initial caries experience, tooth morphology and Snyder test proved to be useful predictors for caries. These three risk markers may be particularly useful in targeting caries prevention efforts in developing countries.

Risk indicators and risk predictors of dental caries in schoolchildren

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.

Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review

AIM

To provide a review of the existing literature on early childhood caries (ECC) with particular reference on the nomenclature, case definition, epidemiology, etiology and risk assessment.

METHODS

An electronic search was used to identify and critically review papers that have been published and are pertinent to the above issues, evaluate and compile the reported evidence.

RESULTS

The term ECC has been adopted to more accurately describe dental caries that affects primary dentitions, replacing previously used terminology that associated the disease with the nursing habit. Suggested ECC case definition uses caries patterns as defining criteria, however, further refinement to include different clinical expressions of a varying severity is necessary. Significant percentages of preschool child populations are affected by ECC today, with the disease concentrating disproportionately in deprived families. Early colonization by mutans streptococci (MS) is associated with increased ECC development, with bacteria being transmitted in both vertical and horizontal ways. Dietary factors related to sugar consumption predispose to early MS colonization and establishment and increase the risk for ECC development, being part of the causal chain. Inappropriate bottle and breast-feeding behaviors also increase the risk, without showing a direct causal relationship. High risk children belong to ethnic minority groups and to low income families with poor parental behaviors and attitudes.

CONCLUSIONS

Further high-quality studies are needed to explore the role bacteria other than MS may play in caries initiation and progression, elucidate the interaction of the saliva immune defence system with a potentially defective tooth, and investigate the effect distant behavioral factors have on the causal chain that leads to ECC development.

Prospective study of 5-year caries increment among children receiving comprehensive dental care in the New England children's amalgam trial

OBJECTIVE

To measure the 5-year caries increment among high-risk children during their participation in the New England Children's Amalgam Trial (NECAT), and to evaluate sociodemographic factors that may account for any observed disparities.

METHODS

NECAT recruited 534 children aged 6-10 with at least two decayed posterior occlusal surfaces from urban Boston and rural Maine. After restoration of baseline caries and application of sealants to sound surfaces, NECAT continued to provide free comprehensive semiannual dental care to participants. The net caries increment of children who completed the 5-year follow-up (n = 429) was calculated and predictors of caries increment were investigated using multivariate negative binomial models.

RESULTS

The majority of children (89%) experienced new caries by the end of the 5-year follow-up. Almost half (45%) had at least one newly decayed surface by the first annual visit. At year 5, the mean number of new decayed teeth was 4.5 +/- 3.6 (range 0-25) and surfaces was 6.9 +/- 6.5 (range 0-48). Time trends showed a noticeably higher increment rate among older children and young teenagers. Multivariate models showed that age (P < 0.001), number of baseline carious surfaces (P < 0.001), and toothbrushing frequency (<1/day versus >or=2/day, P = 0.04) were associated with caries increment. Only 48 children (11%) did not develop new caries.

CONCLUSIONS

Despite the receipt of comprehensive semiannual dental care, the vast majority of these high-risk children continued to develop new caries within 5 years. While disparities were observed by age, extent of prior decay, and toothbrushing frequency, no other sociodemographic factors were associated with caries increment, suggesting that the dental care provided during the trial reduced sociodemographic disparities in prior caries experience that were observed at baseline.

Caries increment in the permanent dentition of Mexican children in relation to prior caries experience on permanent and primary dentitions

OBJECTIVE

To evaluate the likelihood of caries increment in schoolchildren, based on their prior caries experience.

MATERIAL AND METHODS

We undertook a longitudinal study in 452 six-to-nine year olds between 1999 and 2001 in Mexico, with dental exams conducted by two standardized examiners (kappa>0.85). The dependent variable was the DMFT increment, dichotomized as without increment, and at least one unit of increment. Independent variables estimated caries experience at baseline. Data were analyzed using non-parametric tests and generalized linear models (log-binomial) to calculate relative risk (RR) adjusted for age and sex.

RESULTS

The percentage of caries-free children diminished by 20.5% from 1999 to 2001. DMFT index increased two-fold, from 0.25+/-0.70 in 1999 to 0.77+/-1.30 in 2001 (p<0.001). The overall risk for this sample was 24%. The DMFT increment was higher (p<0.001) in children with DMFT>0 and dmft>0 in 1999 (RR=1.89, 95% CI=1.37-2.62; RR=2.71, 95% CI=1.94-3.76, respectively). The likelihood for DMFT increment from the 1999 levels was: (1) 2.78 times higher (95% CI=2.06-3.76) if schoolchildren had caries in any of the first permanent molars and (2) 1.62 times higher (95% CI=1.20-2.19) if schoolchildren were affected by high severity caries at baseline.

CONCLUSIONS

Both caries prevalence and mean DMFT had significant increments in 18 months. Dental caries in the primary (dmft) and permanent (DMFT) dentitions at baseline are goods indicators of subsequent caries development in this group of children in a medium income country. This relationship became stronger when the occurrence of caries in the first permanent molars was included.

Assessment of Dental Caries Predictors in a Seven-year Longitudinal Study

OBJECTIVE

To identify, in a group of 6-8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition.

METHODS

Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment.

RESULTS

Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable.

CONCLUSION

Caries experience and mother's educational level were predictors of caries increment in permanent dentition.

Dental Discomfort Questionnaire: assessment of dental discomfort and/or pain in very young children

OBJECTIVE

To present and analyse the Dental Discomfort Questionnaire (DDQ) for very young children and to assess the possible differences in pain-related behaviours displayed by children with or without reported toothache, and by children with or without decayed teeth.

METHODS

Based on parental interviews of toddlers referred to a dental care practice 12 pain-related behaviours were identified which formed the DDQ. The DDQ was filled out by parents on behalf of their children (n = 146; mean age 47 months). Two-third (n = 94) of the children were referred to a special dental care centre and one-third (n = 52) were controls from a day care centre.

RESULTS

The results show that the 12 items of the DDQ seem to measure one dimension. However, four items do not correlate with the presence of reported toothache, when these items are removed the DDQ-8 has a satisfactory reliability. All eight behaviours from the DDQ-8 occur significantly more often in children with decayed teeth and toothache than in children without decayed teeth or toothache. Especially behaviours concerning eating or brushing teeth are found to be more often present in children with decayed teeth and toothache.

CONCLUSIONS

It seems useful to take the child behaviour into account in assessing toothache. The DDQ has shown to be a reliable instrument, which could be helpful in the future for both parents and dentists in identifying toothache in young children.

Employing dmft score as a risk predictor for caries development in the permanent teeth in Japanese primary school girls

The aim of this study was to examine the significance of evaluating dmft for predicting the incidence of permanent teeth caries in Japanese girls. The subjects were two birth cohorts in a Primary girls' school: cohort I composed of 45 girls born in 1981 and 1982 and cohort II composed of 53 girls born in 1989 and 1990. In both cohorts, there was a significant correlation between the dmft score in the first grade and the DMFT score in the sixth grade. The validity of employing dmft score was examined by receiver operating characteristic (ROC) curve and risk ratios. The shape of the curve and areas under the curve were similar in the two cohorts. In cohort II, sensitivity and specificity for the optimal cut-off level (dmft >or= 5) were 0.519 and 0.923, respectively. The positive and negative predictive values for that level were 0.875 and 0.649, respectively. In cohort I, sensitivity and specificity were 0.741 and 0.722 for that level and positive and negative predictive values were 0.800 and 0.650, respectively. In both cohorts, the risk ratio for permanent teeth caries was significant for many cut-off levels of dmft. The results indicated that the dmft score is a useful predictor of the permanent teeth caries in Japanese primary school girls.

Risk Assessment Criteria Applied to a Screening Exam: Implications for Improving the Efficiency of a Sealant Program

OBJECTIVES

The present study aimed to determine the ability of first-grade screening exam findings to predict carious lesions in permanent first molars by fourth grade. The ability to identify high-risk children would be useful in the rational allocation of limited public health resources, such as the application of sealants.

METHODS

Screening exams were performed on 204 children in 1st grade and 4th grade. Analyses were conducted at both the child- and molar- levels. Cross-tabulations were used to identify the threshold dmfs + DMFS in first grade that had the highest sensitivity and highest negative predictive value for discriminating between children with and without permanent caries (1) in the entire population and (2) in subpopulations defined by race/ethnicity, gender, and language spoken at home. This threshold then was entered into logistic regression models.

RESULTS

On the child and molar level, the study determined that dmfs + DMFS > 0 had the highest sensitivity (child: 69.4%, molar: 74.7%) and negative predictive value (child: 87.8%, molar: 94.4%). Using this test criterion, univariate logistic regression of the child-level data revealed an odds ratio of 2.72 (p = 0.012) for presence of permanent tooth caries experience. Controlling for gender, grade, race/ethnicity, and language spoken at home, the odds ratio increased slightly to 2.76 (p = 0.012).

CONCLUSIONS

There is a relationship between carious lesion experience in 1st grade and carious lesion incidence in the first permanent molars by 4th grade. Using the dmfs + DMFS > 0 criterion may help public health providers determine which children should receive sealants when resources do not allow the delivery of sealants to all children.

Dental discomfort questionnaire for young children before and after treatment

OBJECTIVE

To present a follow-up using the Dental Discomfort Questionnaire (DDQ) before and after the treatment of children, under the assumption that the number of toothache-related behaviors diminishes as a result of treatment, and to see whether this effect is related to the site of the carious teeth or to the treatment itself.

METHODOLOGY

Sixty-one parents completed the DDQ before and after the treatment of their child, aged between 30 and 59 months. The available dental records were used to assess the status of the caries and the consecutive treatment.

RESULTS

Overall, there was a significant decrease in the average number of post-treatment behaviors displayed by children. However, children with extractions during treatment or children with caries in their front teeth did not change their behavior. These children continued to have difficulty with chewing and biting.

CONCLUSIONS

The dental treatment of children leads to reduced toothache-related behaviors. Our study showed the DDQ to be a useful instrument for acquiring insight into the behavioral aspects of young children as a consequence of toothache or dental treatment, thereby underlining the importance of a behavioral approach in young children.

Dental caries among the prehispanic population from Gran Canaria

The island of Gran Canaria was inhabited in pre-Hispanic times by people of North African origin who arrived on the island towards the second half of the first millennium BC. In previous studies, we reported that there are some differences between the coastal inhabitants from Gran Canaria, mainly buried in tumuli, and those from the central mountains, mainly buried in caves. For example, the prevalence of auricular exostoses is higher among the population interred in coastal tumuli when compared with the inland population. This finding may be explained by the practice of marine activities, as supported by chroniclers' reports, by archaeological data, and by bone trace-element analysis, which point to a more intense consumption of marine products by the inhabitants of the coastal regions. Dental caries epidemiology is one of the most important ways in which the diet of past populations can be reconstructed. The purpose of this study is to assess the prevalence and intensity of caries among the pre-Hispanic population of Gran Canaria, in order to increase our knowledge about the dietary habits of these people, and to search for differences among the population buried in caves and that buried in tumuli. We studied a total of 791 individuals. Sex was estimated in 561 cases, and age at death, following Brothwell's criteria, in 549. We found that 66.95% of individuals buried in caves and 58.91% of those buried in tumuli showed at least one carious lesion. The proportion of carious teeth was significantly higher among the population buried in caves (median = 15.71%, interquartile range (IR) = 0-33.33%) than among the population buried in tumuli (median = 6.25%, IR = 0-20%, P = 0.001). Type of burial is the main factor associated with the proportion of carious teeth.These data suggest that the population buried in caves had a different dietary pattern from that of those buried in tumuli.

Effect of caries experience in primary molars on cavity formation in the adjacent permanent first molar

This study sought to address the influence of a sound versus affected first and/or second deciduous molar on the incidence of visible caries experience in the adjacent permanent first molar. Clinical and questionnaire data were obtained from a 6-year prospective oral health screening project in Flanders, Belgium (Signal-Tandmobiel project), where 4,468 children (born in 1989) were examined annually during their primary school time. A multiple survival model allowing for dependent data with possible censoring was applied. The impact of timing of tooth emergence (determining the period at risk), gender, presence of sealants and reported oral hygiene habits was also considered. Cavity formation in permanent first molars was clearly influenced by the status of the adjacent primary molars;the effect of the second deciduous molar was most pronounced. Moreover, if both deciduous molars experienced caries and the child presented with poor oral hygiene, a peak in cavity formation of the permanent first molar 1-2 years after emergence was noticed. On the other hand, if a child presented with good oral hygiene, no peak was observed; caries risk increased slightly over time. No significant benefit from restoring primary molars could be demonstrated, possibly because of methodological limitations.

Prevalencia de caries dental en escolares de 6-12 años de edad de León, Nicaragua

OBJECTIVE

To determine the prevalence of caries, deft and DMFT indices (sum of decay, messing, and filling tooth in primary and permanent dentition), and the Significant Caries Index (SiC) in scholars from Leon, Nicaragua.

PATIENTS AND METHOD

Dental data from a representative sample of 1,400 children were collected and analyzed in a cross-sectional study (year 2002). All subjects were clinically evaluated by one of two calibrated and standardized examiners.

RESULTS

28.6% children were caries free in both dentitions. Caries prevalence in primary teeth in 6-years-old children was 72.6% and 45.0% in permanent teeth in 12-years-old children. Mean deft and DMFT were 2.98 +/- 2.93 (n = 1,125) and 0.65 +/- 1.43 (n = 1,379), respectively. The SiC at 12 years of age was 4.12. Children with caries experience in primary teeth were more likely to have caries in permanent teeth (odds ratio = 2.48; 95% confidence interval, 1.66-3.79) than children without caries in primary teeth.

CONCLUSION

Low caries prevalence and experience were observed in the permanent dentition, with a substantial proportion of filled teeth. Such favorable finding was not observed in the primary dentition. Levels of caries failed to meet the oral health goal of FDI/WHO for the year 2000 in 6-years-old. However, the levels found in 12-year-olds had already met the goal for 2000. The present findings confirmed prior reports that the caries experience in primary teeth is associated with the experience of caries in permanent teeth.

Dental caries and associated factors in Mexican schoolchildren aged 6-13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6-13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85+/-2.73 and 1.44+/-2.05, respectively (DMFT = 3.11+/-2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR = 0.95) with caries in primary dentition. Caries experience in the primary dentition (OR = 6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.

The effectiveness of a 6-year oral health education programme for primary schoolchildren

OBJECTIVES

The aim of this study was to evaluate the effect of a 6-year oral health education programme in primary schoolchildren.

METHODS

This programme was part of the Signal-Tandmobiel project, a longitudinal collaborative project combining the registration of oral health data and oral health promotion. The intervention group comprised 3291 children with a mean age of 7.1 years (SD 0.43) at the start of the programme. Every year these children were examined clinically and a questionnaire, to be filled in by the parents, was administered to assess oral health behaviour. These children received an oral health education programme which consisted of a yearly 1-h instruction. Data collected using the same questionnaire and clinical examination in 676 12-year-old children were included as control group. The samples were obtained using stratified cluster sampling. The effect of the interventional programme was assessed by measuring differences in caries prevalence and incidence, levels of dental care and reported oral health behaviour.

RESULTS

Mean DMFT/S values, although higher in the control group, were not significantly different. The reported frequency of brushing was the same in both groups. Significant differences in favour of the intervention group were found in the number of between-meal snacks (P < 0.001) and the proper use of topical fluorides (P < 0.05). Children in the control group showed a significantly lower proportion of filled teeth than those in the intervention group (P < 0.01), with a care index of 73% versus 80%.

CONCLUSION

In conclusion, the implemented minimal school-based oral health education programme did not result in a significant reduction of the caries prevalence measured. The programme has been effective in improving reported dietary habits and the proper use of topical fluorides and resulted in a higher care index.

The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994

BACKGROUND

As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children.

METHODS

The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years.

RESULTS

The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth.

CONCLUSION

Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children.

PRACTICE IMPLICATIONS

Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

Approximal caries increment: a three-year longitudinal radiographic study

AIM

To determine, for different age groups, the approximal caries increment in a three-year longitudinal retrospective study and to investigate the relationship between the caries increment and self-reported measures for oral health behaviour, dental knowledge and attitude (cynicism, health concern and motivation).

SUBJECTS

14, 17, 20 and 23-year-olds, who participated in a clinical epidemiological survey. Bitewings were taken of approximately 52% of the participants. Longitudinally, three cohorts were followed radiographically for three years. The self-reported measures were derived from questionnaires with sufficient reliability.

RESULTS

For all participants, on average, 3.7 enamel lesions and 1.2 dentine lesions were found. The number of sound surfaces, adequate restorations and the D1FS score showed significant differences over a three-year period, for all age groups. Stepwise regression analysis showed that for the explanation of the change in number of sound surfaces, number of enamel lesions and D1S between the age of 17 and 20, the variable 'health concern' contributed significantly to the regression. The change in D3FS score was explained by the variable 'behaviour', while the change in D1Fs score was explained by both 'behaviour' and 'health concern'. Neither of the dental variables, 'dental knowledge' or 'motivation' contributed significantly. For the ages 14-17 and 20-23 no significant contributions were found.

CONCLUSIONS

A considerable caries increment was found in this three-year retrospective radiographic study, which was not related to dental knowledge and motivation, and only for one age group (17-20) to oral health behaviour and health concern.