Validating the Usage of Cariogram in 5- and 12-year-old School-going Children in Paonta Sahib, Himachal Pradesh, India: A 12-month Prospective Study

Survival Rate of Atraumatic Restorative Treatment Restorations in Primary Posterior Teeth in Children with High Risk of Caries in the Republic of Kosovo-1-Year Follow-up

OBJECTIVE

 Atraumatic restorative treatment (ART) may be beneficial for disadvantaged populations with no or limited access to dental services. This study aimed to evaluate the survival rate of single-surface ART restorations in primary posterior teeth in children with high caries risk.

MATERIALS AND METHODS

 This study was conducted in six rural areas of the Republic of Kosovo, and 100 children aged 3 to 8 years participated in the study. Information was obtained from each parent/guardian regarding their children, such as sociodemographic characteristics, general health, dental history, dietary habits, oral hygiene, and fluoride exposure. The reduced Cariogram was used to estimate the risk of caries in the participants based on the seven factors specified in the program, and all the provided information were collected and entered in a computer program of the Cariogram. A pediatric dentist, accompanied by two assistants, performed 100 ART restorations in school settings using high-viscosity glass-ionomer cement (Fuji IX) following the nine steps of the ART procedure. The restorations were evaluated at 3, 6, 9, and 12 months using the ART restoration criteria.

STATISTICAL ANALYSIS

 Percentages, mean value, standard deviation, mean interquartile range, and difference test between arithmetic mean values were used to analyze the research results.

RESULTS

 Review of the average of reduced Cariogram showed that the majority of children, 72%, were at high risk of developing caries, with only 28% having a good chance of avoiding caries in the future. A total of 77% of the children in the study had never visited dentists before due to poor economic conditions and the lack of dentists in the area. The success rates of ART restorations performed in single-surface cavities in primary teeth were very encouraging, with more than 97% success rates after a 1-year follow-up period.

CONCLUSION

 Our results demonstrate that ART is efficient, affordable, and practical for the treatment of single-surface cavities in primary posterior teeth. Owing to its low price and atraumatic nature, ART can potentially help disadvantaged children in Kosovo access dental care.

The Influence of Preventive Regimens Containing Different Toothpastes on Caries Risk of High-Risk Patients: A Randomized Clinical Trial

BACKGROUND: The main objective of conservative dentistry is maintaining the health of the dentition and restored teeth free from dental caries. The prevention of dental caries can be achieved by personal prevention programs at home, dental health care professional, and public health application programs. Based on knowledge related to the etiology and pathogenesis of dental caries, this provides a chance for application of effective prevention program for the prevention of dental caries. AIM: This study aimed to evaluate the effect of different preventive regimens using different toothpastes on caries risk using cariogram and decayed, missing, and filled (DMF) scores of high caries risk patients. MATERIALS AND METHODS: The study was conducted on 66 participants with high caries risk. Participants were divided into three groups, 22 participant each. According to the test regimen, where (A1) participants were exposed to a regimen including dual zinc plus arginine-based toothpaste (Colgate total), (A2) participants were exposed to a regimen including zinc-based toothpaste (Crest complete), and (A3) control group was participants that were exposed to a regimen including fluoride-based toothpaste (Signal). The study was carried for 1 year, assessment of cariogram and DMF scores was done in four intervals: T0: baseline, T3: after 3 months, T6: after 6 months, and T12: after 12 months. RESULTS: According to cariogram, there was a statistically significant difference between Groups A1, A2, and A3, where p < 0.001. However, DMF scores of all groups showed no statistically significant difference between the three groups. CONCLUSIONS: Dual zinc plus arginine-based toothpaste is a superior caries preventive regimen in high caries risk patients. CLINICAL SIGNIFICANCE: The benefits of preventive regimen to the practitioner will be providing a non-invasive, and cost-efficient method to prevent dental caries. Benefits to the patient will be an improvement of oral hygiene, prevention of dental caries, and maintain healthy dental supporting structures.

Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

OBJECTIVES

To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses.

DATA/SOURCES

We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

STUDY SELECTION

A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00.

CONCLUSION

The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies.

CLINICAL SIGNIFICANCE

Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.

Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities <0.5 and underestimates the risk for forecast probabilities >0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required.

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.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

BACKGROUND

This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018.

AIM

The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy.

DESIGN

This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC.

RESULTS

Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care.

CONCLUSIONS

This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.