Evaluation of a computer program for caries risk assessment in schoolchildren

A comparative evaluation of the effects of respiratory diseases on dental caries

PURPOSE

The aim of this study is to evaluate the susceptibility of patients suffering from asthma and chronic obstructive pulmonary disease (COPD) to dental caries by analyzing the physical, chemical, and microbiological characteristics of saliva, which are influenced by the medications they use.

METHODS

A cohort of 104 individuals, spanning from 18 to 70 years of age, underwent a meticulous categorization based on their unique medical profiles and prescribed medication routines. Subsequently, a comprehensive evaluation was conducted to elucidate potential risk factors associated with dental caries. Alongside the assessment of decayed, missing, and filled teeth (DMFT index), decayed, missing, and filled surfaces (DMFS index), and Green and Vermillion Oral Hygiene Index-Simplified (G&V OHI-S) values, measurements were performed to gauge salivary flow rate, buffering capacity, and the presence of S. mutans, L. casei, S. aureus, and C. albicans. The acquired data were then inputted into the Cariogram software, enabling the derivation of personalized caries risk profiles for each individual.

RESULTS

The diseased group exhibited significantly elevated levels of DMFT, DMFS, and G&V OHI-S values in comparison to the control group (p < 0.01). Moreover, the caries risk levels derived from the Cariogram were found to be significantly higher in patients diagnosed with asthma and COPD (p < 0.01). Notably, no substantial distinction was observed between these two experimental groups. Furthermore, it was discerned that COPD patients utilizing two or three distinct medications did not display any discernible variation in terms of their susceptibility to dental caries (p > 0.05).

CONCLUSION

Asthma and COPD patients exhibit an increased susceptibility to dental caries as a result of their medication regimens. Hence, it is highly advisable for these individuals to demonstrate heightened vigilance in terms of oral hygiene practices and seek regular dental check-ups for continuous monitoring and preventive care.

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia

AIM

To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia.

MATERIALS AND METHODS

A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23.

RESULTS

All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child.

CONCLUSION

Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene.

CLINICAL SIGNIFICANCE

Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

Multivariable prediction models of caries increment: a systematic review and critical appraisal

BACKGROUND

Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.

METHODS

Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.

RESULTS

Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.

CONCLUSIONS

The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.

TRIAL REGISTRATION

PROSPERO CRD#152,467 April 28, 2020.

Predictive validity of the reduced Cariogram model for caries increment in non-cavitated and cavitated lesions: cohort study

BACKGROUND

The aim of this study is to assess the caries prediction of the reduced Cariogram by comparing baseline caries risk profiles with non-cavitated and cavitated lesions over periods of six, twelve, and 18 months.

METHODS

From May 2016 to October 2017, seven schools in Bhakkar, Pakistan, participated in a cohort study. First base line examination was conducted followed by examinations at 6, 12 and 18 months. Children intraoral examinations were performed on portable dental chair with in school premises by a trained examiner. A modified ICDAS index was used to measure caries at baseline and at follow-up examinations after 6, 12, and 18-months. A receiver operating curve (ROC) analysis was performed to evaluate its effectiveness for predicting dental caries increment.

RESULTS

About 40% of children had a low-risk status, 30.5% medium risk, and 29.7% high risk, at baseline risk assessment. At 18 months, 73% of high-risk children, 59% of medium-risk children, and 41% of low-risk children showed a caries increment. For the reduced Cariogram model, the area under the curve on the 6, 12 and 18 months follow-up was 0.63, 0.65 and 0.70 respectively.

CONCLUSIONS

Our findings indicates that a reduced Cariogram can predict the progression of caries in both cavitated and non-cavitated lesions and model exhibits a level of discriminatory ability. While it might not achieve a very high accuracy, it suggests that the model is able to predict caries increment effectively than random guessing.

Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations—Adults and children

This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups’ data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: “low risk”  =  61–100% or 81–100% chance to avoid caries, “moderate risk”  =  41–60% or 21–80% and “high risk”  =  0–40% or 0–20%, named model 1 and 2; b) four risk categories with two different thresholds as: “low risk”  =  61–100% or 76–100%, “moderate/low risk” = 41–60% or 51–75%; “moderate/high risk” = 21–40% or 26–50% and “high risk” = 0–20% or 0–25%, model 3 and 4; c) five risk categories as: “very low risk”  =  81–100%; “low risk”  =  61–80% “moderate risk” = 41–60%; “high risk” = 21–40% and “very high risk” = 0–20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen’s kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen’s Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen’s Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children’s samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups’ convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.

Effect of Probiotic Streptococcus salivarius K12 and M18 Lozenges on the Cariogram Parameters of Patients With High Caries Risk: A Randomised Control Trial

Purpose: To evaluate the effect of Probiotic Streptococcus Salivarius K12 and M18 Lozenges on the Cariogram (Cariogram Mobile application Version 1.3 developed by Wong Jung Ming, Faculty of Dentistry, National University of Singapore) parameters of patients with high caries risk.

Materials and Methods: Fourty-two subjects were randomly allocated to Group 1 and 2 who received BLIS K12^TM and BLIS M18^TM probiotics (Blis Probiotics, Dunedin, New Zealand) respectively along with oral hygiene instructions and Group 3 (control) received only oral hygiene instructions with 1:1:1 allocation ratio. Subjects were instructed to follow the instructions and use the probiotics for a period of three months. Their caries risk was assessed using Cariogram software at baseline and 30 days after the use of probiotics. Change in the chance to avoid new cavities was recorded and statistically analysed using appropriate statistical tests.

Results: About 38 subjects completed the trial with a drop-out count of eight. Multiple imputations were carried out for the missing data using an expectation-maximization algorithm. The mean percentage of actual chance to avoid new cavities was found to be 47.14 ± 6.837; 41.36 ± 16.04 and 32.50 ± 14.54 among the subjects in Group 1, Group 2, and Group 3 respectively. The mean percentage difference between the three groups was found to be statistically significant (p-value = 0.047). Dunn’s pair-wise comparison showed a significant mean percentage difference between Group 1 (BLIS K12) and Group 3 (control) (p=0.020).

Conclusion: It can be concluded that the use of BLIS K12^TM and BLIS M18^TM probiotics for three months resulted in a considerable decrease in the caries risk. Further long-term clinical trials are needed to evaluate the difference in caries risk following the use of BLIS K12^TMand BLIS M18^TM among different age and risk groups.

Motivational interviewing for caries prevention in adolescents: a randomized controlled trial

OBJECTIVE

The objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents.

METHODS

Five hundred and twelve adolescents with unfavorable caries-related behaviors ("snacking three times or more a day" and/or "toothbrushing less often than twice a day") were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24 months post-intervention, a self-administered questionnaire gathered information of participants' sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner.

RESULTS

After 24 months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48-10.33)] and group III [OR (95% CI): 6.33 (2.46-16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79-12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△D_{ICDASII 3-6}MFT) [β (95% CI): - 0.19 (- 0.37, - 0.01) and - 0.20 (- 0.38, - 0.02), respectively], whereas increment of total carious lesions (△D_{ICDASII 1-6}MFT) was lower in group III [β (95% CI): - 0.63 (- 1.24, - 0.02)].

CONCLUSION

MI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents.

CLINICAL RELEVANCE

Incorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes.

TRIAL REGISTRATION

HKUCTR-1852 ( http://www.hkuctr.com/ ) (Hong Kong, 2013).

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Taste Perception in School Children: Is There an Association with Dental Caries?

Background/Aim: Individuals make food choices based on a number of physiological, nutritional, environmental and socioeconomic factors but sensory qualities of food namely the taste has priority as the determinant in food selection. The purpose of the study is to evaluate sweet, salty, sour and bitter taste perceptions of school children and compare them in term of caries experience.

Material and Methods: Two hundred children aged from 6-13 were included in the study. The dental examinations of children were performed using DMF(T), DMF(S), df(t) and df(s) indices. Questionnaires were presented to parents to record the socioeconomic and educational levels, oral health knowledge, child’s general health, oral health habits and fluoride exposure. Children rinsed sucrose (12g/L; 24g/L), sodium chloride (2g/L; 4g/L), citric acid (0,6g/L; 1,20g/L) and caffeine (0,27g/L; 0,54g/L) solutions randomly and the taste perception was recorded. Relationship between the taste perception and caries experience were evaluated.

Results: A significant correlation was found between 2 g/L of NaCl and age (p= 0,007, r= 0,178). When occlusal or approximal caries of the children aged from 6 to 9 were discriminated, the Spearman’s test found a weak positive correlation between occlusal caries and higher sweet taste (24 g/L sucrose) (r= 0,232; p= 0,021) and a weak negative correlation between approximal caries and higher salty taste (4 g/L NaCl) (r= –0,225; p= 0,025).

Conclusions: Age should be considered in the assessment of taste perception of children. Additionally, there is a weak relationship between taste perceptions and dental caries. These data suggest that further studies need to focus on the effect of taste preferences on dental caries.

Validation of Cariogram in Caries Prediction in Women and Their Children 4 Years After Pregnancy - Longitudinal Study

BACKGROUND

Cariogram®, an algorithm-based software model, for predicting caries risk has been used to assess the caries risk profile of many different groups. The aims of the study were to evaluate Cariogram caries risk assessment during pregnancy with DMFT/dmft incidence in mothers and their children 4 years after pregnancy and to check if there is an association between children's caries risk profiles using Cariogram and caries risk profiles (by Cariogram) of their mothers during pregnancy.

METHODS

The study population consisted of 96 pregnant women (average age 27.4±7.2 years at baseline) who completed clinical baseline examination and salivary tests. The follow-up study was initiated 4 years later and the 80 pairs of mother and children (from that pregnancy) were re-examined using the same procedure at baseline. An individual caries risk profile and DMFT/dmft incidence were made for each woman and child. The prediction of the Cariogram was compared to the actual dental experience in 4 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for two cut-offs were calculated to express the outcome.

RESULTS

The results showed a strong association between the risk categories of pregnant women and their offspring as well as between caries development in offspring and the Cariogram risk categories of pregnant women. Sensitivity and PPV for new DMFT (ΔDMFT>0) 4 years after for women were  high (>80%) for those participants assessed with 0-60% "chance to avoid caries", as well as diagnostic accuracy (74.00%). High specificity (91.00%), very high PPV (95.00%) and clinically useful values according to Youden's index (0.53) were obtained for moderate-risk and two lowest-risk groups for dmft in children.

CONCLUSION

Cariogram was valid in the authors' sample only and highly predictive in caries risk assessment in investigated children based on caries risk assessment of their mothers in pregnancy.

Dental plaque pH in predicting caries relapse after general anaesthesia - an exploratory study

OBJECTIVES

Numerous caries risk assessment tools have been proposed in the literature, with few validated in preschool children especially those receiving oral rehabilitation under general anaesthesia (GA). Past caries experience, the best predictor thus far, may not be a reliable indicator after effective clinical intervention. Hence, this longitudinal study was aimed to explore the potential role of plaque pH in predicting future caries incidence after GA among preschool children.

METHODS

Oral examination, plaque pH measurements and questionnaire survey were performed, among pre-schoolers indicated for GA, at baseline (n = 92), 6-month (6M; n = 83), 12-month (12M; n = 79) and 24-month (24M; n = 66) recall visits after GA. Multivariable logistic regression and receiver-operating characteristic analysis were performed to evaluate the predictive value of models with plaque pH and past caries experience.

RESULTS

Individuals with low resting plaque pH at 6M and 12M were shown to be at high risk of 1-year caries incidence at 12M [relative risk (RR) 1.41, 95% confidence interval (CI) 1.09-1.48] and 24M (RR 1.61, 95% CI 1.22-1.73) recall visit, respectively. Moreover, plaque pH demonstrated a statistically significant predictive value in the 12M and 24M models (12M/24M: 85%/77%) compared with past caries experience, which was not a significant predictor in both models (both P > 0.05).

CONCLUSIONS

Plaque pH may be a promising prognostic and predictive marker for early identification of high-risk children undergoing oral rehabilitation under GA.

Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk

BACKGROUND

Caries risk assessment in preschool children has been limited validated.

AIM

To validate caries predictive ability of Cariogram using different combinations of factors and settings in preschool children from areas with high caries risk.

DESIGN

Two to five years old children (N = 175) were examined for caries (cavitated and non-cavitated lesions), at baseline and after 1 and 2 years. Mutans streptococci counts (MS) and saliva buffer capacity (SBC) were measured with chair side tests. Diet and oral health attitude were assessed through a parental questionnaire. Baseline caries risk was calculated using standard and high-risk group variables in Cariogram either with nine factors or excluding MS and SBC. Poisson regression models, ROC analysis and information criteria (AIC and BIC), P < 0.05, were used to investigate the predictive ability of Cariograms and to quantify the associations.

RESULTS

Accuracy of Cariogram was found limited. Cariograms with MS showed higher sensitivity but lower specificity than those without bacterial counts. Standard set Cariograms with MS counts performed slightly better than the other models, but the difference was not statistically significant. Caries prediction with standard and high set Cariograms was also found limited.

CONCLUSIONS

Cariogram with various factors and settings displayed suboptimal ability to predict caries in this population.

"Setting the scene in early childhood" - an MID approach for life

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review

BACKGROUND

Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment.

METHODS

Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment.

RESULTS

One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels.

CONCLUSIONS

The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

MMP-12 and S100s in saliva reflect different aspects of periodontal inflammation

Matrix metalloproteinase (MMP)-12, S100A8/A9, and S100A12 are involved in innate immune responses. We addressed whether different aspects of oral health and non-disease-related covariates influence their levels in saliva. 436 participants were clinically examined, completed a health questionnaire, and provided stimulated saliva. Salivary levels of MMP-12, S100A8/A9, and S100A12 were determined by enzyme-linked immunosorbent assays. Lower MMP-12 levels were observed in individuals 40-64 years old (yo) compared to < 40 yo, and higher S100A8/A9 levels were found in individuals > 64 yo compared to 40-64 yo. Smokers exhibited lower MMP-12 and S100A12 levels compared to non-smokers. All three proteins were elevated in individuals with bleeding on probing (BOP) > 20% compared to those with BOP ≤ 20%, and the S100A8/A9 levels were higher in individuals having ≥ 10% gingival pocket depths (PPD) ≥ 4 mm compared to the ones with shallow pockets < 4 mm. The extent of alveolar bone loss or presence of manifest caries did not alter any of the markers. MMP-12, S100A8/A9, and S100A12 levels were higher in participants with high periodontal inflammatory burden. All three proteins correlated positively to BOP, PPD, and to several inflammatory mediators. The explanatory variables for MMP-12 in saliva were age, smoking, presence of any tumor, and percentage of PPD ≥ 4 mm. The determinant of salivary S100A8/A9 was percentage of BOP, while S100A12 levels were associated with percentage of BOP and presence of any tumor. Taken together, MMP-12 and the S100/calgranulin levels in saliva reflect different aspects of periodontal inflammation. Smoking and age should be taken into account in further investigation of these proteins as biomarker candidates of periodontal disease.

Caries risk profiles in orthodontic patients: A 4-year follow-up study using the Cariogram model in governmental vs. private clinics

OBJECTIVES

To (1) analyze caries-related factors and (2) evaluate caries risk using the Cariogram model for governmental and private orthodontic patients at de-bonding and 4 years after de-bonding.

MATERIALS AND METHODS

Forty orthodontic patients with mean age of 26.4 years were recruited from a governmental (G) group (n = 20) and private (P) group (n = 20) and were examined at de-bonding (T1) and 4 years after de-bonding (T2). The examination included a questionnaire, plaque scoring, caries examination, bitewing radiographs, and assessment of salivary secretion rate, buffering capacity and cariogenic microorganisms. The data were entered into the Cariogram program to illustrate the caries risk profiles.

RESULTS

The chance to avoid new cavities was higher in P-group compared to G-group at T1 (58% and 31%, respectively) (P < 0.01) and T2 (77% and 52%, respectively) (P < 0.001). Plaque index was significantly higher in G-group, and fluoride was used significantly more in P-group at T1 and T2 (P < 0.05). The chance to avoid new cavities was higher at T2 compared to T1 (64% and 44%, respectively) (P < 0.001). Saliva secretion rate and buffer capacity were significantly increased, and the plaque index was significantly decreased at T2 compared to T1 (P < 0.01).

CONCLUSION

According to the Cariogram, orthodontic patients were less likely to avoid new cavities at de-bonding and 4 years after de-bonding in government clinics compared to private clinics, and the caries risk significantly decreased 4 years after orthodontic treatment for all patients, regardless of the location of treatment.

Influence of dental plaque pH on caries status and salivary microflora in children following comprehensive dental care under general anesthesia

BACKGROUND/PURPOSE

There is no report in examining dental plaque pH after dental care under general anesthesia. This study investigated the effects of comprehensive dental rehabilitation under general anesthesia on the oral environment of children with severe early childhood caries (S-ECC) and the influence of dental plaque pH on caries recurrence and salivary microflora.

MATERIALS AND METHODS

Thirty-seven children (mean age, 51.08 ± 9.68 months) with S-ECC who underwent comprehensive dental treatment under general anesthesia were selected. Caries index, plaque pH, and Streptococcus mutans (SM) and Lactobacillus (LB) counts were evaluated during the initial examination and 6-month and 12-month follow-ups.

RESULTS

The plaque pH was significantly greater at the 6-month follow-up examination than at the initial examination (P = 0.006) and at the 12-month follow-up (P = 0.002), but there was no significant difference in plaque pH between the initial examination and the 12-month follow-up (P = 0.942). SM and LB counts at the sixth and twelfth months were significantly lower than the initial counts (P < 0.001). Plaque pH did not show strong correlations with caries index and SM and LB counts at the three time-points (P > 0.05).

CONCLUSION

The comprehensive dental rehabilitation under general anesthesia for children with S-ECC caused a temporary significant increase in the plaque pH at the sixth month and a significant reduction in the salivary microflora during the 12-month follow-up. Plaque pH did not demonstrate any strong correlations with caries status and salivary microflora in children with S-ECC.

Beyond Streptococcus mutans: clinical implications of the evolving dental caries aetiological paradigms and its associated microbiome

Aetiological concepts of dental caries have evolved over the years from being considered as a disease initiated by nonspecific microorganisms, to being regarded as an 'infectious' disease caused by specific bacteria, to the current paradigms that emphasise a 'mixed bacterial-ecological approach' as being responsible for lesion initiation and pathogenesis. These aetiological paradigms are not just intellectual concepts but have important implications on how clinicians manage this age-old disease in the twenty-first century. Despite evidence-backed recommendations for adopting more biological measures to counter the disease, a significant proportion of dentists continue following traditional caries management guidelines in their daily clinical practice. This paper will review the evolving dental caries aetiological concepts and highlight the current evidence for adopting a more ecological approach to caries prevention, risk assessment, and treatment.

A Comparative Evaluation of Bifidobacteria Levels in Early Childhood Caries and Severe Early Childhood Caries

Background:

Bifidobacteria levels in saliva were found to be significantly correlated in adults with dental caries but less information available in the literature regarding its role in children.

Aim:

The aim is to compare the salivary levels of Bifidobacteria in children who are caries free with that of early childhood caries (ECC) and severe ECC (S-ECC).

Materials and Methods:

Saliva was collected using the tongue-loop method from a total of 60 children between the age group of 3–5 years and they were further divided into 3 groups. In addition, the age and gender of the children, sugar amount in diet, sugar frequency in diet, were recorded.

Results:

Bifidobacteria was isolated from all the three groups, but more were from S-ECC, followed by ECC and very few cases of caries-free children and was found to statistically significant (P < 0.001). Salivary levels of Bifidobacteria were significantly correlated with amount of sugar in the diet and frequency of sugar consumption.

Conclusions:

Salivary levels of Bifidobacteria were significantly associated with S-ECC and ECC, followed by caries free group. In future, it can be used as a salivary marker for caries risk assesment.

Development of Caries Risk Assessment Tool for Iranian Preschoolers: A Primary Validation Study

BACKGROUND

The aim of the present study was to develop a dental caries risk assessment tool for Iranian preschoolers.

METHODS

In a validation and cross-sectional study, a random sample of 150 preschool children was involved. This study was conducted in three phases: questionnaire design (expert panel and peer evaluation), questionnaire testing (pilot evaluation and field testing), and validation study. The initial assessments include interview, dental examination, and laboratory investigations. Validity and reliability indices, content validity index (CVI), content validity ratio (CVR), impact score, and test-retest and Cronbach's alpha were measured. Decayed, missing, filled teeth (dmft) scores were calculated according to the WHO guidelines.

RESULTS

The Iranian version of caries risk assessment (CRA) questionnaire contained 17 items. Cronbach's alpha coefficient (0.86) indicated a suitable internal consistency. The mean scores for the CVI and the CVR were 0.87 and 0.78, respectively. The prevalence rate of dental caries in the study group was 69.3%, and the mean dmft was 4.57 (range 0-19).

CONCLUSIONS

The Persian version of CRA questionnaire was adapted to the Iranian population. The findings demonstrated overall acceptable validity and also reliability in the application of test-retest. The results of the present study provide initial evidence that the designed CRA form could be a useful tool for CRA in the Iranian preschoolers.

Motivational Interviewing to Promote Oral Health in Adolescents

PURPOSE

Motivational interviewing (MI) is a counseling strategy to help people change their behaviors. This single-blinded randomized controlled trial evaluated the effectiveness of MI in improving adolescents' oral health.

METHODS

Fifteen secondary schools were randomly assigned to three groups: (I) prevailing health education, (II) MI, and (III) MI coupled with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with unfavorable oral health behaviors (infrequent toothbrushing and/or frequent snacking) were recruited; 161, 163, and 188 in groups I-III, respectively. Participants in the three groups received their respective interventions. At baseline and after 6 and 12 months, participants completed a questionnaire on their oral health self-efficacy and behaviors. Their oral hygiene (dental plaque score) and dental caries (number of decayed surfaces/teeth status) were recorded.

RESULTS

Compared with group I, subjects in groups II and III were more likely to reduce their snacking frequency (odds ratios [95% confidence intervals {CIs}]: 7.12 [1.80-28.16] and 11.17 [2.90-42.98], respectively) and increase their toothbrushing frequency (odds ratios [95% CIs]: 5.26 [2.28-12.16] and 11.45 [4.99-26.26], respectively) after 12 months. Taking group I as a reference, groups II and III had lower number of new carious teeth △D _{ICDAS II 1-6}MFT (β [95% CI]: -.24 [-.44 to -.04] and -.31 [-.51 to -.11], respectively).

CONCLUSIONS

MI was more effective than prevailing health education strategy in eliciting positive changes in adolescents' oral health behaviors and preventing dental caries.

Colony stimulating factor-1 in saliva in relation to age, smoking, and oral and systemic diseases

Colony stimulating factor (CSF)-1 is a growth factor that stimulates the survival, proliferation and differentiation of mononuclear phagocytes, which has been implicated in several inflammatory diseases. This study evaluated the possible influence of age, sex, smoking, periodontitis, caries, and several systemic conditions on salivary levels of CSF-1. Four-hundred and forty-one individuals were enrolled in this study. All participants answered a health questionnaire and underwent a comprehensive oral examination. Stimulated saliva was collected and CSF-1 levels were analysed by enzyme-linked immunosorbent assay. Salivary levels of CSF-1 were significantly increased in participants over 64 years old and in non-smoking individuals, whereas no difference was observed between men and women. Individuals having periodontitis and manifest caries had significantly higher levels of CSF-1. Participants with muscle and joint disease exhibited increased CSF-1 levels as compared to those without. Age, smoking, percentage of pockets ≥4 mm, number of manifest caries lesions, and presence of tumor were associated with CSF-1 levels. Salivary levels of CSF-1 are associated with age, smoking, periodontitis, manifest caries, and the presence of muscle and joint diseases and tumors. CSF-1 might be a promising biomarker candidate in saliva of both local and systemic conditions that needs further investigation.

Caries Risk Assessment in School Children Using Reduced Cariogram Model

Objective:

To estimate the percentage of children with low, moderate and high caries risk; and to determine the predictors of caries risk amongst 11-12 year old Pakistani school children.

Methods:

Subjects’ caries risk was assessed using the Cariogram programme. The survey was done among school children in Bhakkar district of Punjab, Pakistan. Caries and plaque level were assessed using the DMFT and Sillnes and Loe indices respectively, while diet content and frequency were assessed using a three-day diet diary.

Results:

A total of 226 children participated in this study, giving a response rate of 75%. Most subjects (39.8%) were in the low risk category with DMFT score of 0. The overall mean DMFT score was 1.49 (±0.63). Linear and multiple regressions were performed to evaluate the predictability of caries risk. Previous experience of dental caries was found to be the most relevant predictor of caries risk (40%).

Conclusion:

The levels of caries risk amongst Pakistani 11-12 year old school children were generally low. Past caries experience was the most significant factor in predicting future caries lesion in this sample population.

Effectiveness of Different Preventive Programs in Cariogram Parameters of Young Adults at High Caries Risk

Objective

To evaluate the effectiveness of different preventive programs in young adults at high caries risk using Cariogram software.

Methods

Sixty-six young adults with high caries risk were evaluated. Dental caries risk for all subjects was determined according to WHO criteria. Subjects were divided into three different preventive groups (control: OH, fluoride varnish: FV, and chlorhexidine varnish: CV). They were followed for 12 weeks (baseline: T0, 1 week: T1, 4 weeks: T2, and 12 weeks: T3). Plaque index, diet frequency, and salivary chairside tests (to record the flow rate, buffer capacity, and mutans streptococci and lactobacillus counts) were performed at each visit. Based on these data, ten caries-related variables were collected and inserted into the Cariogram software to calculate the predicted chance of avoiding caries for each subject.

Results

Significant changes were obtained about the Cariogram parameters (diet, bacteria, susceptibility, circumstances, and Cariogram risk group). No significant differences were found between the three methods regarding mean Cariogram scores after 3 months (p > 0.05).

Conclusions

The regular and effective short-term (three months) use of 1450 ppm fluoridated toothpaste, one visit application of fluoride, and chlorhexidine varnishes were effective for reducing caries risk in young adults, which can be clearly demonstrated using Cariogram software.

Effects of Lactobacillus casei Shirota intake on caries risk in children

Background/purpose

Yakult is a well-known probiotic beverage consisting of a single live bacterial species, Lactobacillus casei Shirota. However, the potential cariogenic/cariostatic effects of Yakult intake among children have not been studied yet. Hence, this study aimed to investigate the clinical effects of short-term Yakult intake on oral biofilm acidogenicity, cariogenic bacterial counts, and caries risk in children.

Materials and methods

Eighteen children, 7–11 years of age, consumed standard Yakult daily for 7 days. Prior to and after intervention, functional oral biofilm acidogenicity characterized by the Stephan curve, Lactobacillus and Streptococcus mutans counts, and caries risk were determined.

Results

Probiotic intervention demonstrated significant increase in minimum pH from 4.88 to 5.14 (P = 0.02), 18.2% reduction in area under the Stephen curve [area under the curve (AUC)], and 29.3% decrease in pH recovery time, although these two differences were not statistically significant. No difference was observed in S. mutans and Lactobacillus counts or caries risk after intervention (all P > 0.05). However, on subgroup analysis using “reduction of AUC” to separate “responders” from the “nonresponders”, the significant cariostatic effects on oral biofilm acidogenicity, among “responders”, were revealed by an increase in minimum pH (P = 0.005) and a reduction in pH recovery time (P = 0.003).

Conclusion

There may be a potential cariostatic effect of short-term Yakult intake in reducing functional biofilm acidogenicity in children with certain oral biofilm and risk profile. Further studies may be needed to validate this probiotic effect. Quality risk assessment may be critical prior to prescribing/recommending Yakult as an adjunct caries-preventive treatment for children.

Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need

Background

Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or “gut feeling” or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient’s own perception of future oral treatment need correspond with the sum of examiners risk score.

Methods

Clinical examinations were performed on randomly selected individuals 20–89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram.

Results

For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients’ perception of future oral treatment need correlated to some extent with the sum of examiners risk score.

Conclusions

The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.

Caries Risk Assessment Item Importance: Risk Designation and Caries Status in Children under Age 6

BACKGROUND

Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children under age 6-years.

OBJECTIVES

Assess the relative importance of pediatric CRA items in dental providers' decision-making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally.

METHODS

CRA information was abstracted retrospectively from electronic patient records of children initially ages 6-72 months at a university pediatric dentistry clinic (N=3810 baseline; N=1315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay.

RESULTS

Thirteen individual CRA items, including all clinical indicators and all but one risk indicator, were independently and statistically significantly associated with student/resident providers' caries-risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%), moderate (30.6%), to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and one risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor.

CONCLUSIONS

In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers' risk determination than with future caries status. These university dental providers considered many items in decision-making regarding patient risk, suggesting that in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management.

Factors associated with the risk of caries development after comprehensive dental rehabilitation under general anesthesia

Background/purpose

The aims of this cross-sectional study were to determine the possible risk factors of caries development in children with early childhood caries (ECC) and to perform a caries risk assessment using Cariogram over a 12-month period. There is no report in examining caries risk assessment under 6 years old children in Taiwan.

Materials and methods

Seventy-nine children (mean age 48.80 ± 10.71 months) with ECC indicated for comprehensive dental reconstruction under general anesthesia were selected. A questionnaire was completed by the parents to assess the possible caries-related factors at a 12-month follow-up. Data were collected for caries index, plaque index, Streptococcus mutans (SM) and Lactobacillus (LB) counts, and salivary buffering capacity at the initial examination and at the 12-month follow-up. Children were divided into two groups: caries-free (decayed, extracted, and filled teeth = 0) and caries-recurrent (decayed, extracted, and filled teeth > 0). The children's caries risk was assessed using the Cariogram software program.

Results

At the 12-month follow-up, 79.7% of the children had developed new caries. No significant differences were found in parents' education levels, child's oral health practices, or parental knowledge and attitudes toward oral health (P > 0.05) between the caries-free group and the caries-recurrent group. The SM count (P = 0.001) and caries risk assessment (CRA) score (P < 0.001) were found to be significantly associated with new caries development.

Conclusion

This study has shown that SM count and CRA score were associated with new caries development in ECC children who needed to be treated under general anesthesia. The modified Cariogram used in this study is another significant tool for predicting new carries development in this particular population.

Predicting Dental Caries Outcomes in Children: A "Risky" Concept

In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as "precision medicine" and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)-a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and "precision dentistry" at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology.

WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME?

BACKGROUND

Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan.

AIMS

Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care.

DESIGN

Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles.

RESULTS

In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans.

CONCLUSIONS

The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.

Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk for dental caries: results of a randomized, controlled study

Dental caries is the most common chronic disease of childhood. Cariogram is a well-recognized algorithm-based software program based on different caries-related risk factors and intended to aid clinicians in performing more objective and consistent dental caries risk assessments. This type of approach precedes the diagnosis of caries and allows the dentist to identify at-risk patients and then take appropriate preventive measures before caries develop further. One of the etiological factors favoring the development of dental caries is the mutans streptococci. These acidogenic dental plaque inhabitants can be effectively antagonized by the activity of bacteriocins released by the probiotic Streptococcus salivarius M18 (salivarius M18). Moreover, salivarius M18 after colonizing the human oral mucosa produces the enzymes dextranase and urease that are able to counteract plaque formation and saliva acidity, respectively. Seventy-six subjects at high risk of dental caries were randomized and then either treated or not treated for 90 days with an oral formulation containing the oral probiotic salivarius M18 (Carioblis(®)). The results indicate that the use of salivarius M18 increases the chances of avoiding new dental caries development in children, and its application could be proposed as a new tool in the dentist's armory to be adopted in subjects considered at high risk on the basis of their Cariogram outcome.

Comparing caries risk profiles between 5- and 10- year-old children with cleft lip and/or palate and non-cleft controls

BACKGROUND

Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model.

METHODS

The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low".

RESULTS

Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67% but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95% CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk.

CONCLUSION

Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.

Risk assessment - can we achieve consensus?

OBJECTIVE

The object of this conference paper was to review and discuss caries risk assessment in general practice from the questions i) 'Why', ii) 'When', and iii) 'How'.

METHOD

Narrative review.

RESULTS

i) Patient caries risk assessment is the basic component in the decision-making process for adequate prevention and management of dental caries and for determination of individual recall intervals. ii) Caries risk assessment should always be performed at a child's first dental visit and then regularly throughout life, and especially when social or medical life events are occurring. iii) There are several risk assessment methods and models available for but the evidence for their validity is limited. Although there is no clearly superior method for predicting future caries, the use of structured protocols combining socioeconomy, behavior, general health, diet, oral hygiene routines, clinical data, and salivary tests or computer-based systems are considered best clinical practice. The accuracy ranges between 60% and 90%, depending on age. Caries risk assessment is more effective in the selection of patients at low risk than those with high caries risk.

CONCLUSION

As evidence suggests that past caries experience is far from ideal but the most important single risk component for more caries at all ages, any clinical sign of likely active demineralization on smooth, occlusal, and proximal tooth surfaces should be taken as a signal for the implementation of individually designed preventive and disease management measures.

Caries management pathways preserve dental tissues and promote oral health

In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided.

Caries risk assessment in young adults: a 3 year validation of the Cariogram model

Background

To validate baseline caries risk classifications according to the Cariogram model with the actual caries development over a 3-year period in a group of young adults living in Sweden.

Methods

The study group consisted of 1,295 19-year-old patients that completed a comprehensive clinical baseline examination, including radiographs and salivary tests. An individual caries risk profile was computed and the patient was placed in one of five risk categories. After 3 years, 982 patients (75.8%) were re-examined and caries increment for each patient was calculated. The outcome was expressed as sensitivity, specificity and predictive values and compared with a risk assessment scheme used in Public Dental Service.

Results

The drop-outs displayed more risk factors and a significantly higher caries burden at baseline compared with those that remained in the project (p < 0.05). There was a strong association between the Cariogram risk categories and the 3-year caries increment on cavity level but the predictive values were modest. The high or very high caries risk categories yielded high specificities (>90%) but poor sensitivities. The low risk groups displayed higher sensitivities on expense of impaired specificities. No combinations proved clinically useful values according to Yuoden’s index.

Conclusions

Within the limitations of the present study, the computer-based Cariogram did not perform better than a caries risk assessment scheme based on past caries experience and caries progression, over a 3-year period in young adults.

Dietary and oral hygiene habits of active athletes and adolescents attending ordinary junior high schools

BACKGROUND

Active sports require sufficient energy intake. How do young athletes meet this need? The aim of this study was to investigate self-reported health and oral behaviors of young athletes and to compare them with a population-based sample of ordinary adolescents.

DESIGN

A computer-based questionnaire on oral hygiene habits and dietary habits was conducted in two junior high schools with special classes for athletes in 2011. Adolescents of similar age (n=1230) attending ordinary classes had responded the same questionnaire earlier in the city of Oulu (in 2004) and in Kajaani, Finland (in 2006-2007). Answers to individual questions as well as sum scores of the answers were analyzed. The answers of the athletes and ordinary adolescents were analyzed by gender using cross-tabulation and chi-square testing.

RESULTS

The mean sum score of the athletes indicated their more favorable health behavior compared with the other adolescents. They also ate more frequently the four daily than the others; in addition, they ate the school lunch as an entity which it was intended. However, the athlete boys consumed more fizzy/soft drinks and ate chocolate more often than the rest. The athletes also brushed their teeth more frequently than ordinary adolescents. Oral health behavior of the girls was better than that of the boys.

CONCLUSIONS

Health behavior of the young athletes is better than that of other adolescents. Continuous oral health education should be targeted to all adolescents; growing boys should be target group of information on healthy sources of energy.

Caries risk assessment in schoolchildren--a form based on Cariogram software

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram software provides this analysis, and protocols simplifying the method were suggested.

OBJECTIVES

The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form.

MATERIAL AND METHODS

150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk.

RESULTS

Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources.

CONCLUSION

The use of the form based on the Cariogram software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk.

Caries-risk profile variations after short-term use of 5000 ppm fluoride toothpaste

OBJECTIVE

To assess the caries risk following 6 weeks' use of 5000 ppm F toothpaste using 'Cariogram' software.

MATERIALS AND METHODS

A total of 34 participants, 17 mothers and their teenage children, were enrolled in a 6-week clinical trial in which they were given 5000 ppm F toothpaste. They were followed consecutively for 6 weeks with visits that were 2 weeks apart (four in total). A clinical examination was done at baseline and salivary chair-side tests to record the buffer capacity and mutans streptococci (MS) and lactobacilli (LB) counts were performed at each visit. Based on these data, seven caries-related variables were collected and inserted into the Cariogram software to calculate the actual chance of avoiding caries.

RESULTS

The use of 5000 ppm F toothpaste resulted in a statistically significant modification of the caries-risk profile, increasing the actual chance of avoiding caries in the future among the mothers and teenagers at each visit following baseline (p < 0.01). The changes essentially related to the salivary parameters (buffer capacity, MS and LB counts). A statistically significant linear trend was observed for MS counts (p < 0.01) and the number of subjects with a salivary concentration of MS < 10(3) increased at each visit. The same trend was also observed for LB and buffer capacity scores (p = 0.04 and p = 0.03, respectively).

CONCLUSIONS

The short-term use of 5000 ppm F toothpaste is able to reduce the caries risk, which can be clearly demonstrated using 'Cariogram' software.

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.

Relationship between plaque pH and different caries-associated variables in a group of adolescents with varying caries prevalence

The pH response of the dental biofilm after a sugar challenge can be considered to mirror the acidogenic potential and thereby the caries risk of an individual. The aim of this cross-sectional study was to evaluate the relationship between plaque pH and different caries variables in adolescents with varying caries prevalence. One hundred individuals, aged 14-15 years, were examined regarding different caries-related variables: (i) caries score (DSm, DSi, DSm + i, DTm), (ii) salivary secretion rate and buffer capacity, (iii) oral microflora of plaque and saliva, (iv) plaque amount, (v) plaque pH and (vi) dietary intake, oral hygiene habits and fluoride use. Plaque pH was assessed using the microtouch method before and after a 1-min mouthrinse with 10 ml 10% sucrose. Depending on the minimum pH, the participants were divided into three groups: low pH (≤5.3), medium pH (>5.3-6.3) and high pH (>6.3). Statistically significant differences between the three groups (p < 0.01) were found for initial caries (DSi) and combined manifest and initial caries (DSm + i). A statistically significant difference was also found in the log values for salivary lactobacilli (p = 0.02) within the three groups, and for the total number of bacteria in plaque (p = 0.04); for both variables, the low-pH group had the highest values. The only covariate significantly associated was the Cariogram score in the medium-pH group (p < 0.01) and the number of meals per day in the high-pH group (p = 0.02). To conclude, plaque pH measured by the microtouch method is a method that can be used for discriminating between individuals with varying caries prevalence.