Caries patterns in primary dentition in 3-, 5- and 7-year-old children: spatial correlation and preventive consequences

Patterns of site-level periodontal disease and within-mouth correlation among older adults in the Hispanic Community Health Study/Study of Latinos

OBJECTIVES

Clinical measures of periodontal disease such as attachment loss (CAL) and probing depth (PD) vary considerably between and within individuals with periodontitis and are known to be influenced by person-level factors (e.g. age and race/ethnicity) as well as intraoral characteristics (e.g. tooth type and location). This study sought to characterize site-level disease patterns and correlations using both person-level and intraoral factors through a model-based approach.

METHODS

This study used full-mouth, six sites per tooth, periodontal examination data collected from 2301 Hispanic/Latino adults aged 60-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The presence of site-level CAL ≥3 mm and PD ≥4 mm was estimated using generalized estimating equations (GEE), explicitly modelling pairwise periodontal site correlations, while adjusting for number of teeth, sex and Hispanic/Latino background. Subsequently tooth- and tooth-site patterns of intraoral CAL ≥3 mm and PD ≥4 mm were estimated and visualized in the HCHS/SOL population.

RESULTS

The findings showed that posterior sites had the highest odds of CAL ≥3 mm and PD ≥4 mm. Sites located in the interproximal space had higher odds of PD ≥4 mm but lower odds of CAL ≥3 mm than non-interproximal sites. Mexicans had the lowest odds of CAL ≥3 mm among all Hispanic/Latino backgrounds. While Mexicans had lower odds of PD ≥4 mm than Central Americans and Cubans, they had higher odds than Dominicans and Puerto Ricans. Site-level proportions and pairwise correlations of PD ≥4 mm were generally smaller than those of CAL ≥3 mm.

CONCLUSIONS

The patterns of site-level probabilities of clinical measures of periodontal disease can be defined based on tooth, site and individual-level characteristics. Intraoral correlation patterns, while complex, are quantifiable. The risk factors for site-level CAL ≥3 mm may differ from those of PD ≥4 mm. Likewise, participant risk factors for site-level clinical measures of periodontal disease are distinct from those that affect individual-level periodontitis prevalence. Future epidemiological investigations should consider model-based approaches when examining site-level disease probabilities to identify intra-oral patterns of periodontal disease and make inferences about the larger population.

Knowledge, attitudes, and practices regarding the oral health of children

Parents are responsible for their children’s health care, and their oral health-related knowledge, attitude, and habits can affect their children’s oral health. Aim: The objective of this study was to evaluate parents’ knowledge, attitudes, and practices regarding their children’s oral health. Methods: In this study, a sample of 398 parents of 4- to 6-year-old children completed a self-designed questionnaire. The parents’ oral health-related knowledge, attitudes, and practices were assessed. Children’s oral health was evaluated using decayed, missing, and filled tooth index (dmft). Data were analyzed using the SPSS version 23.0 with a p < 0.05 as statistically significant. Categorical data were reported as frequency (%), and continuous data were reported as mean ± SD. Moreover, Spearman’s correlation, multiple regression, Mann-Whitney test, Kruskal Wallis test, and Kolmogorov-Smirnov test were used. Results: Most of the parents had a satisfactory level of knowledge and positive attitudes regarding their children’s oral health. The knowledge and attitude scores were higher among parents with higher education (p<0.001), and the knowledge score was higher among mothers (p=0.004). Also, the attitude score was correlated with the number of decayed, missed, and filled teeth of children (p=0.01, p=0.04, and p=0.007, respectively). However, there was no significant relationship between dmft and the parents’ knowledge, attitudes, and practices using multiple regression. The mean dmft of children was 6.86 ± 3.56, and most of the parents had poor oral health-related practices. Conclusion: The parents’ level of knowledge and attitudes were satisfactory, but they had poor oral health practices. Moreover, there was no significant relationship between children’s oral health and their parents’ level of knowledge, attitudes, and practices. Educating programs and strategies are needed to enhance parents’ oral health-related attitudes and knowledge and, more importantly, change their oral health practices.

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

Background

Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis.

Methods

In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I² index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software.

Findings

In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased.

Conclusion

The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals.

Korean National Oral Health Survey Data on the Symmetry of Primary Dentition Surface Caries

OBJECTIVES

This study evaluated the intraoral symmetry of dental caries in primary teeth as part of a study of caries patterns in primary dentition.

STUDY DESIGN

The data for 4,800 5-year-old and 4,379 8-year-old children in this study were from the 2012 Korean national oral health survey. Pearson correlation coefficients of the decayed and filled surface (dfs) values ranged from 0.436 (lower primary canines) to 0.835 (upper primary central incisors) for the right and left primary teeth and from 0.084 (right primary central incisor) to 0.457 (left primary second molar) for the upper and lower primary dentition (P< 0.01).

RESULTS

The upper and lower dfs values differed significantly (P< 0.05) when the right and left primary second molars were excluded. The left or right primary data without caries ranged from 56.4% (lower of first and second primary molars) to 99.7% (lower primary central incisors). The bilateral caries among cases with one or more in the right or left primary teeth ranged from 25.0% (lower lateral primary incisor) to 72.7% (upper primary central incisors).

CONCLUSIONS

These results suggested that dental caries in primary teeth show bilateral symmetry and differences in the degree of symmetry according to the teeth set or surface set of the homologous teeth.

Prevalence of dental caries among male students aged 15-17 years in southern Asir, Saudi Arabia

Background

Dental caries had been studied by several studies in Saudi Arabia among different age groups and at various places. According to World Health Organization (WHO), assessment of caries at 15 years of age is more meaningful. The objective of this survey was to assess the prevalence of dental caries among 15–17-year teenage students in Abha, Saudi Arabia. Results of the present study can be used as baseline data for future oral health interventions for the population.

Methods

A stratified cluster random sampling was followed in selecting the students. The clinical data was collected using dentition status component of WHO oral health assessment form 2013. Five investigators were trained and calibrated with 20 subjects for two successive days (Cronbach's Alpha = 0.91). Data was analyzed for descriptive statistics and Mann-Whitney U test was applied to compare the DMFT scores.

Results

Prevalence of dental caries among the study population was found to be 72.9%. The DMFT scores were found to be highest in the posteriors (90.7%). First permanent molar was the most common tooth affected by dental caries in all quadrants.

Conclusion

The present study revealed that there is a high prevalence of dental caries among students aged 15–17 years in Abha, Saudi Arabia. Caries prevalence was highest in mandibular posterior segments, however, it was lowest in mandibular anterior segments. There is an urgent need for both preventive and curative dental health services in the region. It is recommended that a coordinated school dental program may be initiated in the area.

Comparative Evaluation of Caries Status in Primary and Permanent Molars in 7-8-year-old Schoolchildren of Shimla Using Caries Assessment Spectrum and Treatment Index

Background:

A new epidemiological index is introduced for full assessment of dental caries which is known as caries assessment spectrum and treatment (CAST). “Spectrum” is considered backbone of this index as it covers from no lesion to advanced stage progression of caries. We aimed to evaluate and compare the status of caries in primary and permanent molars of 7–8-year-old schoolchildren of Shimla using CAST index and to find if any correlation exists between the status of caries in evaluated teeth.

Methods:

Three hundred and one schoolchildren with age group of 7–8 years were selected from schools in Shimla. CAST codes were determined for primary molars and first permanent molars. The distribution of CAST codes in the examined molars is correlated with the help of Spearman's rank correlation coefficient. The level of statistical significance was established at P < 0.05. The intraexaminer reliability was determined by the unweighted kappa coefficient.

Results:

Caries was assessed in 6.3%–12.3% of the permanent molars in contrast to primary molars, in which caries was near about 50%. The correlation was stronger for first and second deciduous molars for the right side of the mouth than the left side (r = 0.293 and 0.257 in the maxilla and 0.503 and 0.319 in the mandible [P < 0.001], respectively, while correlation for teeth in opposite jaws was moderate [r = 0.20–0.47]). The intraexaminer reliability was examined (k = 0.90 for the primary and 0.85 for permanent molars).

Conclusion:

The correlation between primary and permanent molars regarding the caries status in primary molars is weak while strongest correlation was present on the right side of the mouth for first and second deciduous molars. The study also showed the applicability of the CAST index in epidemiological surveys.

Clinical consequences of untreated dental caries in German 5- and 8-year-olds

Background

About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children.

Methods

Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne’s (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The ‘untreated caries-pufa ratio’ was calculated, and the Spearman’s rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test.

Results

Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %).

Conclusions

Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.

Oral health research: A source for innovative new statistical developments

This article reviews the challenges and opportunities that oral health research may offer to a statistician. To illustrate this, we focus on the Signal Tandmobiel® study, a longitudinal oral health survey that triggered many statistical explorations and developments over the last two decades. For example, non-standard distributions are more the rule than the exception in oral health research. In addition, often measurement error problems need to be addressed. The hierarchical structure of the oral health data also poses non-standard challenges. For instance, caries experience in the mouth is spatially correlated with, however, a specific metric defining the distance between two occurrences. In addition, since caries experience in the context of an epidemiological study is only measured at intervals, analysis of survival involves interval-censoring. Finally, when analyzing a realistic data set in oral health, all the above issues may have to be dealt with simultaneously.

Dental caries in primary and permanent molars in 7-8-year-old schoolchildren evaluated with Caries Assessment Spectrum and Treatment (CAST) index

BACKGROUND

No reports on a caries pattern covering the full spectrum of the disease could be found in the literature. The aim of this study was to evaluate caries in primary and first permanent molars of 7-8-year-old Polish children by the Caries Assessment Spectrum and Treatment (CAST) index and to find whether there was any correlation between the caries stages in such teeth.

METHODS

The study covered 284 7-8-year-old children from randomly selected schools in the Bialystok District, Poland. The prevalence of CAST categories was evaluated with regard to the first and second primary, and first permanent, molars. The Spearman's rank correlation coefficient was used to explore the correlation of the distribution of CAST codes among the evaluated teeth. The level of statistical significance was established at p < 0.05. The intra-examiner reliability was determined by the unweighted kappa coefficient.

RESULTS

With regard to the permanent molars, caries was observed in 14.8% to 17.3% of the molar and most lesions were scored at the non-cavitation level. Caries in primary molars was most often recorded at the stage of cavitated dentine lesion. Teeth with pulpal involvement, sepsis and extracted due to caries were found to be more prevalent in first, and then in second primary molars. A strong correlation was found between the status of teeth from the right and left sides of the oral cavity. The correlation of the status of first and second primary teeth was stronger for the left than for the right side of the mouth, r was 0.627 and 0.472 in maxilla and 0.513 and 0.483 in mandible (p < 0.001), respectively. For the neighbouring primary and permanent molars the correlation was assessed to be weak. With regard to the teeth situated in opposite jaws the study revealed that the correlations were moderate - r between 0.33 and 0.49. The intra-examiner reliability was established at 0.96 for the primary dentition and at 0.878 for permanent molars.

CONCLUSION

The strongest correlation found in the evaluated population concerned the distribution of caries in primary molars on the left side of the mouth. The study proved the usefulness of the CAST index in epidemiological surveys.

Impact of caries onset on number and distribution of new lesions in preschool children

BACKGROUND

Caries in preschool children remains an important public health issue.

AIM

To determine (i) which teeth and tooth surfaces are most susceptible to dental caries by age 3, (ii) where do caries lesions develop during 2-year follow-up, and (iii) to evaluate the impact of caries onset on the distribution of new caries experience.

DESIGN

One thousand and fifty seven consecutively born children were recruited in Flanders (Belgium). Parents completed validated questionnaires on oral health-related behaviour and trained dentists examined the children at ages 3 and 5.

RESULTS

Children with visible caries experience at age 3 were significantly more vulnerable in developing additional caries during follow-up. In this group, new caries experience developed primarily in the occlusal and distal surfaces of the mandibular first molars and the occlusal surfaces of the maxillary second and first molars, whereas in the caries-free group, the occlusal surfaces of both mandibular and maxillary second molars ranked first.

CONCLUSIONS

This paper confirms the higher vulnerability for further caries development in those children with caries experience at age 3. Visible caries develops most frequently in the occlusal surfaces of the second molars: in high-risk children already by age 3 and in children who were caries free at baseline by age 5.

Age, period, and cohort analysis of regular dental care behavior and edentulism: a marginal approach

Background

To analyze the regular dental care behavior and prevalence of edentulism in adult Danes, reported in sequential cross-sectional oral health surveys by the application of a marginal approach to consider the possible clustering effect of birth cohorts.

Methods

Data from four sequential cross-sectional surveys of non-institutionalized Danes conducted from 1975-2005 comprising 4330 respondents aged 15+ years in 9 birth cohorts were analyzed. The key study variables were seeking dental care on an annual basis (ADC) and edentulism. For the analysis of ADC, survey year, age, gender, socio-economic status (SES) group, denture-wearing, and school dental care (SDC) during childhood were considered. For the analysis of edentulism, only respondents aged 35+ years were included. Survey year, age, gender, SES group, ADC, and SDC during childhood were considered as the independent factors. To take into account the clustering effect of birth cohorts, marginal logistic regressions with an independent correlation structure in generalized estimating equations (GEE) were carried out, with PROC GENMOD in SAS software.

Results

The overall proportion of people seeking ADC increased from 58.8% in 1975 to 86.7% in 2005, while for respondents aged 35 years or older, the overall prevalence of edentulism (35+ years) decreased from 36.4% in 1975 to 5.0% in 2005. Females, respondents in the higher SES group, in more recent survey years, with no denture, and receiving SDC in all grades during childhood were associated with higher probability of seeking ADC regularly (P < 0.05). The interaction of SDC and age (P < 0.0001) was significant. The probabilities of seeking ADC were even higher among subjects with SDC in all grades and aged 45 years or older. Females, older age group, respondents in earlier survey years, not seeking ADC, lower SES group, and not receiving SDC in all grades were associated with higher probability of being edentulous (P < 0.05).

Conclusions

With the use of GEE, the potential clustering effect of birth cohorts in sequential cross-sectional oral health survey data could be appropriately considered. The success of Danish dental health policy was demonstrated by a continued increase of regular dental visiting habits and tooth retention in adults because school dental care was provided to Danes in their childhood.

Bayesian latent variable models for spatially correlated tooth-level binary data in caries research

Analysis of dental caries is traditionally based on aggregated scores, which are summaries of caries experience for each individual. A well-known example of such scores is the decayed, missing and filled teeth or tooth surfaces index introduced in the 1930s. Although these scores have improved our understanding of the pattern of dental caries, there are still some fundamental questions that remain unanswered. As an example, it is well believed among dentists that there are spatial symmetries in the mouth with respect to caries, but this has never been evaluated in a statistical sense. An answer to this question requires the analysis to be performed at subunits within the mouth, which necessitates the use of methods for correlated data. We propose a Bayesian generalized latent variable model coupled with an undirected graphical model to investigate the unique spatial distribution of tooth-level caries outcomes in the mouth. Data from the Signal Tandmobiel(®) study in Flanders, a dental longitudinal survey, are used to illustrate the methodology.

Measurement, analysis and interpretation of examiner reliability in caries experience surveys: some methodological thoughts

Data obtained from calibration exercises are used to assess the level of agreement between examiners (and the benchmark examiner) and/or between repeated examinations by the same examiner in epidemiological surveys or large-scale clinical studies. Agreement can be measured using different techniques: kappa statistic, percentage agreement, dice coefficient, sensitivity and specificity. Each of these methods shows specific characteristics and has its own shortcomings. The aim of this contribution is to critically review techniques for the measurement and analysis of examiner agreement and to illustrate this using data from a recent survey in young children, the Smile for Life project. The above-mentioned agreement measures are influenced (in differing ways and extents) by the unit of analysis (subject, tooth, surface level) and the disease level in the validation sample. These effects are more pronounced for percentage agreement and kappa than for sensitivity and specificity. It is, therefore, important to include information on unit of analysis and disease level (in validation sample) when reporting agreement measures. Also, confidence intervals need to be included since they indicate the reliability of the estimate. When dependency among observations is present [as is the case in caries experience data sets with typical hierarchical structure (surface-tooth-subject)], this will influence the width of the confidence interval and should therefore not be ignored. In this situation, the use of multilevel modelling is necessary. This review clearly shows that there is a need for the development of guidelines for the measurement, interpretation and reporting of examiner reliability in caries experience surveys.

Dental caries analysis in 3- 5-years-old children: a spatial modelling

OBJECTIVES

The main objective of this study was modelling experienced caries of deciduous teeth in 3- 5-years-old children treated in Children's Department of Tehran University of Medical Sciences, Iran, using the spatial autologistic regression. The other objective was identifying a risk pattern of decayed dents of these children.

MATERIALS AND METHODS

The study group consisted of 400 children (3- 5-years-old). Two groups of postgraduate and under graduate dentistry students under consideration and approval of the professors of dentistry from the Tehran University of Medical Sciences diagnosed and categorised the caries statuses of deciduous dents of the children. The caries statuses were considered as spatially correlated binary data. The appropriate model was autologistic regression.

RESULTS

The fitted autologistic model showed that caries in the three nearest neighbours of a tooth, which includes the two adjacent and the one vertically opponent teeth, had significant effect on its caries. The computed risks based on the fitted model revealed a definite-spatial pattern of caries events.

CONCLUSIONS

Every decayed deciduous tooth in the mouth of a preschool child threatens the three nearest teeth. The risk pattern of caries in each quarter of the teeth lattice of children from incisors to molars has an ascending rate. The dents in maxilla and posterior locations have higher risks of caries than in mandible and anterior locations. These findings are valuable in preventive health care and therapeutic approaches in dentistry of children.

Caries and background factors in Norwegian and immigrant 5-year-old children

OBJECTIVES

The purpose of this study was to assess the caries status of 5-year-olds in a low caries area, and study associations between dental caries and parent-related factors: parents' education, national origin, oral health behaviours and attitudes.

METHODS

The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes.

RESULTS

Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non-western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child's tooth brushing (OR = 2.8), parents' brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8).

CONCLUSION

Caries prevalence in 5-year-olds was strongly associated with parent-related factors signifying that information on parents' socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non-western children whose parents have low education.

Caries prevalence and tooth surface distribution in a group of 5-year-old Italian children

AIM

This was to investigate caries experience and patterns in a sample of 5-year-old children attending nursery schools in the Veneto Region (Italy).

STUDY DESIGN

Cross sectional study.

METHODS

The study was carried out between September 2005 and May 2006 with 348 randomly selected 5-year-old children. Two calibrated dentists using an artificial light, a plane dental mirror and a dental probe performed clinical dental examination. World Health Organisation (WHO) diagnostic criteria for dental caries: dmft, dmfs and SiC indexes were used to measure the severity of the disease.

STATISTICS

dmfs scores were analysed either as a continuous continuous (calculating means and standard deviations) or as a categorical variable (providing proportions). Pearson's chi square test for comparison between groups and Wilcoxon signed-rank test for distribution of dmfs scores between pairs of contiguous molars were used.

RESULTS

The most commonly affected teeth were primary molars, (78% of the overall sample), especially in the mandible. The surfaces of molars most often affected were the occlusal (52%). Proximal surfaces were affected more in first than in second primary molars. Dental caries occurred most often in the maxilla. The frequency of caries in anterior teeth was low (12%).

CONCLUSIONS

Caries experience in the primary dentition showed a symmetrical distribution localized on primary molars, most often in their occlusal surface. Caries in anterior teeth was uncommon.