Within-subject coronal caries distribution patterns: an evaluation of randomness with respect to the midline

PREVALENCE OF CARIES PATTERNS IN THE 21ST CENTURY PRESCHOOL CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

This systematic review aimed to describe and evaluate the caries patterns among the 21st century preschool children globally.

METHOD

Six electronic databases (Pubmed, Embase, Medline, Web of Science, EBSCOhost, and Scopus) were searched using predetermined terms. Dual independent screening of all retrieved abstracts was performed to identify studies conducted after year 2000 and the caries pattern among preschool children was investigated. Data regarding the prevalence of caries by tooth type and surface were extracted. Meta-analyses, subgroup analyses and meta-regression were carried out with the statistics software Stata using the random-effects model.

RESULTS

A total of 2642 records were screened, and 43 observational studies were finally included. Cavitated caries lesions were commonly found in the maxillary incisors and molars in both arches among preschool children. The highest caries prevalence was found in the maxillary central incisors (29.1%, 95%CI: 25.5%-32.7%) and the mandibular second molars (28.5%, 95%CI: 24.7%-32.3%), while the mandibular lateral incisors had the lowest prevalence (1.7%, 95%CI: 1.5%-2.0%). Occlusal surfaces of the mandibular molars were the most frequently affected by caries, whereas caries hardly affected the lingual surfaces of lower anterior teeth. Caries pattern on the left and right sides was symmetrical. The overall caries prevalence was significantly higher in the maxillary teeth. Caries prevalence was higher in the older children, whereas the caries pattern was not significantly different among children from countries with different human and economic development levels.

CONCLUSION

Cavitated carious lesions were more commonly observed in the maxillary incisors and molars in both arches. The prevalence of caries varies significantly with child's age and primary tooth type. However, preschool children exhibit a similar pattern of caries, regardless of the time, socioeconomic status or geographical location.

Using the Caries Assessment Spectrum and Treatment Index to Determine the Caries Incidence in Primary and Permanent Molars Among School Children of Kolkata: A Cross-Sectional Study

INTRODUCTION

Caries in their early stages cannot be properly classified using the decayed, missing, and filled teeth (DMFT) index because it does not record precavitated lesions. Thus, the caries assessment spectrum and treatment (CAST) index is a good alternative as it is equipped to record the whole range of dental illnesses and count restored teeth as healthy ones.

MATERIALS AND METHODS

The participants in this cross-sectional study included 300 children who were seven-to-eight years of age. We used the CAST index to assess the extent of caries in the deciduous and permanent molars of these children. For this, all the permanent and baby teeth, the primary and secondary permanent molars, as well as the first and second deciduous molars were examined to determine the prevalence of each carious stage. The correlation of the distribution of the CAST codes between the first and second molars, the second and first molars, the right and left sides of the dental bend, and the opposing jaws was analyzed using Spearman's rank correlation coefficient, while the cut-off for statistical significance was a p-value of 0.05. The quantitative analysis was conducted using IBM SPSS Experiences Version 20 for Windows.

RESULTS

By comparing CAST codes in the right and left molars, we were able to observe how the development of caries in paired teeth might affect one another. The rank correlation value was found to be less than 0.5 only in the primary second molars (55/65 and 85/75), which were found exclusively in the deciduous first molars. Moreover, the r values for the neighboring deciduous and permanent molars were found to be below 0.3, i.e., 65/64 (0.497), 74/75 (0.327), and 84/85 (0.411), which indicated a weak connection between them. When comparing the teeth in different jaws, we found reasonable correlations (r = 0.33-0.49), with only 64/74 outliers (0.501).

CONCLUSIONS

We found that, in the examined population, there was a well-established correlation between the stages of caries development in the deciduous molars on the left side of the mouth.

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.

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.

Left-to-right distribution of periodontal disease

AIM

Symmetry is a property established in many human biological systems and it is reasonable to expect that it may also exist in the mouth. The objective of this study was to examine whether there is a similar left-to-right distribution in periodontal disease.

METHOD

Records of 197 patients from the Periodontics department of The Royal Dental Hospital of Melbourne were analysed. The clinical parameters recorded were pocket probing depth, recession, bleeding on probing, mobility and furcation involvement.

RESULTS

The average age of our sample group was 47.5 years old, with 34.5% men and 65.5% women. The results demonstrated significant left-to-right distribution with all the periodontal indices recorded.

CONCLUSION

The findings support previous studies that show that a similar left-to-right distribution exists in the population studied.

Modeling the long-term cost-effectiveness of the caries management system in an Australian population

OBJECTIVES

The Monitor Practice Program demonstrated that regular monitoring and noninvasive management of dental caries is effective in reducing the incremental DMFT (decayed, missing, and filled teeth) in patients, within the construct of a 3-year randomized clinical trial. This analysis evaluates the long-term cost-effectiveness of the preventive approach underpinning the Caries Management System, used in the general practice setting and modeled to the Australian population.

METHODS

An individual patient-simulation Markov model was developed to compare the long-term costs and outcomes of the Caries Management System versus standard dental care in a hypothetical sample representative of the Australian population. Eight Markov submodels were developed, representing eight molar teeth (excluding wisdom teeth), each consisting of 11 health states simulating the incidence and progression of dental caries, and future interventions such as fillings and crowns. Transition probabilities and costs assigned to health states were based on claims data from the second largest private health insurer in Australia. The economic evaluation was performed from the Australian private dental practitioner perspective. The incremental cost per DMFT avoided was calculated at three time points: 2 years, 3 years, and lifetime. Univariate sensitivity analysis was conducted to test the robustness of the results.

RESULTS

The incremental cost per DMFT avoided at 2 years, 3 years, and lifetime was estimated to be $1287.07, $1148.91, and $1795.06, respectively.

CONCLUSION

The analysis suggests that the Caries Management System is most cost-effective in patients with a high risk of dental caries.

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 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.

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

This study aimed to contribute to the descriptive information of oral health status in the primary dentition, especially concerning the distribution and spatial correlation of lesions. Data were obtained from two surveys. In the Signal-Tandmobiel project 4,468 7-year-old children in Flanders (Belgium) were selected by a stratified clustered random sample. In the Tandje de Voorste - Smile for Life (TDV) project, data were obtained from 1,291 3-year-old and 1,315 5-year-old children. The children were examined by trained dentists, using standardized and widely accepted criteria, based on the British Association for the Study of Community Dentistry criteria. At the population level, symmetry in the prevalence of caries experience across the midline was tested at the tooth and tooth surface levels using generalized estimating equations and alternating logistic regression (ALR) approaches. Individual symmetry was tested using an approach described by Hujoel et al. [J Dent Res 1994;73:1575-1580]. Descriptive observations suggested a symmetrical distribution of caries experience at the population level. The null hypothesis of symmetry could not be rejected at a 0.05 level, suggesting that caries experience might be symmetric in the deciduous dentition. Based on the ALR approach, 2 x 2 associations of caries experience at the tooth and surface levels, both in 5- and 7-year-olds, appeared to be strongest for the left-right pairs in the mandible, followed by the left-right pairs in the maxilla. At the individual level the hypothesis of random caries pattern was rejected (p < 0.0001). In conclusion, at the population level the null hypothesis of left-right symmetry could not be rejected, while at the individual level lesions tended to cluster on one side of the mouth.

Avaliação de índices CPOD simplificados em levantamentos epidemiológicos de cárie dentária

OBJETIVO: Analisar a utilização de dois índices simplificados "CPO em 6 Dentes" e "CPO em 2 Hemiarcos" em levantamentos epidemiológicos em saúde bucal, segundo a distribuição da cárie dental. MÉTODOS: A amostra foi proveniente de dados epidemiológicos de 29 municípios, totalizando 2.378 exames em escolares de 12 anos de idade. Considerando a média CPOD em cada localidade, obtiveram-se três grupos de prevalência (baixa, moderada e alta), para os quais foram estimados os índices simplificados. A análise estatística foi realizada utilizando o Coeficiente de Correlação Intraclasse, o Teste de Wilcoxon e o qui-quadrado, com significância de 5%. RESULTADOS: A correlação entre o índice CPOD e os índices simplificados variou de 0,82 a 0,95 (p<0,05). Não foram observadas diferenças significantes (p>0,05) entre as médias do índice CPOD com o índice simplificado "CPO em 2 Hemiarcos" nas prevalências estudadas, o que não ocorreu com o "CPO em 6 dentes". A proporção de dentes cariados, perdidos e obturados também foi semelhante entre o "CPO em 2 hemiarcos" e o CPOD (p>0,05). CONCLUSÕES: O índice simplificado "CPO em 2 Hemiarcos" pode ser utilizado em levantamentos epidemiológicos em baixa, moderada e alta prevalência de cárie dentária. Porém, o "CPO em 6 Dentes" deve ser melhor avaliado.

Grouping of tooth surfaces by susceptibility to caries: a study in 5-16 year-old children

BACKGROUND: The decline in caries has slowed and this may be indicative of variation in the susceptibility of differing teeth to caries. This study tests the hypothesis that in children, there are groups of tooth sites that exhibit differences in caries susceptibility. METHODS: Probit analysis of caries data collected from a 4-year longitudinal study of 20,000 schoolchildren aged between 5 and 16 years in 10 differing locations in the United States. RESULTS: The development of dental caries within the mouth followed a fixed hierarchy indicating that tooth surfaces show variation in caries susceptibility. Certain teeth and tooth sites have similar susceptibilities and can be grouped, the sizes of the groups vary. The most susceptible group consists of six tooth surfaces: the buccal pits and occlusal fissured surfaces of the first molar teeth. The second group consisted of 12 sites on the second molar and premolar teeth. The group formed by the least susceptible sites included the largest number of tooth surfaces and consists of the majority of the lower anterior teeth and canines. CONCLUSION: Variation in the caries susceptibility of tooth surfaces exists. Surfaces can be grouped according to caries susceptibility. An effect that reduces the cariogenic challenge of one of the sites within a group is likely to affect all the other sites within the particular group.

The distribution of stimulated saliva in children

OBJECTIVES

The need for an adequate quantity of saliva to maintain oral health has been widely reported. It is not only the quantity that is important, but also how the saliva is distributed once it enters the mouth. Several studies have looked at how saliva is distributed around adult mouths. The aim of this experiment was to describe the distribution of stimulated saliva around the mouth in children.

SAMPLE AND METHODS

In order to demonstrate the distribution of saliva around the mouth under stimulated conditions, 25 child subjects were asked to chew a piece of chewing gum containing 1.5 mg erythrosin for 3 min on one side of the mouth. The distribution of dye in the mouth was recorded on standardized charts.

RESULTS

In all cases, dye was present ipsilateral to the chewing side. In 13 cases (52%) the dye did not cross the midline and of the remaining 12 children the dye only reached the contralateral canines in four of them (16%).

CONCLUSIONS

Evidence is presented which suggests that during unilateral chewing in children, saliva is not well distributed around the mouth and has a tendency to stay on the side of the mouth from where it was secreted (P < 0.01).