The Prevalence and Patterns of Dental Caries in Labrador Inuit Youth

Objectives: This study was undertaken to examine the prevalence of dental caries in Inuit (Eskimo) youth aged 5–22 years. Methods : Both tooth-oriented indices and child-oriented caries patterns were recorded in a field study conducted in 1991 in Nain and Hopedale, Northern Labrador. Seventy-eight percent (N=347) of all schoolchildren in these two locations were examined by a single examiner. Results : Three percent of the population were caries free and 88 percent of those with caries experience had untreated dental decay. The mean combined dmft and DMFT per child for all ages was 6.85, while the mean combined dmfs and DMFS was 15.72. About 38 percent of subjects had pit and fissure caries; 2 percent had hypoplastic lesions; 4 percent had faciolingual caries; 31 percent had molar-approximal caries and 22 percent had faciolingual and molar-approximal caries, the most destructive caries pattern. About 68 percent of the 5–6-year-olds and 26 percent of the 15–22-year-olds experienced the most destructive pattern of decay in their primary and permanent dentitions, respectively. Conclusions : Preventive measures should start well before the age of 5 years. Describing caries patterns according to the dentition type complemented the traditional indices.     

Clinical detection of caries in the primary dentition with and without bitewing radiography

Background:  Inadequate detection of caries in the primary dentition due to non-use of bitewing radiography is commonly encountered in paediatric practice. The present study investigated the increased benefits of using bitewing radiography in addition to the visual-tactile examination technique for detection of primary dentition caries in a non-fluoridated community, and determined the prevalence of "hidden" occlusal caries in the primary dentition.
Methods:  Primary teeth were scored for caries at the restorative threshold using a visual-tactile technique followed by bitewing radiographic examination in a sample of 611 schoolchildren aged 6.4 ± 0.5 yrs to 12.1 ± 0.8 yrs residing in a non-fluoridated city.
Results:  Overall, at the restorative threshold, the visual-tactile technique could detect 62 per cent of occlusal caries compared to 74 per cent for bitewing radiography (p < 0.001). The prevalence of "hidden" occlusal caries was 12 per cent. In contrast, for primary molar proximal surface caries, the visual-tactile technique could detect only 43 per cent of caries compared with 91 per cent for bitewing radiography (p < 0.001).
Conclusions:  In the primary dentition, use of bitewing radiography increases the detection rate of proximal surface caries substantially. It is recommended that bitewing radiography be included as part of the routine examination of children with proximal surfaces that cannot be visualized.     

Dental injury among Brazilian schoolchildren in the state of São Paulo

Abstract  – To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of São Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index – the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected – 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls ( P  < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren ( P  = 0.003), anterior maxillary overjet ≥3 mm ( P  < 0.001), and private school as a socio-economic proxy indicator ( P  = 0.048).     

Dental caries prevalence and dental health behaviour in HIV infected children

Objectives . To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour.
Design . Standardized epidemiological dental examination and structured interview.
Setting . Paediatric HIV outpatient department in a South London hospital.
Study population . HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants).
Methods . Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children's dental health behaviour: tooth-brushing, diet, fluoride; oral medication and dental attendance were explored.
Results . Sixty-three per cent ( n  = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4·4. Sixty per cent ( n  = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child's HIV status on dental attendance.
Conclusion . Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.     

PUFA – An index of clinical consequences of untreated dental caries

Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA – An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 2010; 38: 77–82. © 2009 John Wiley & Sons A/S   Abstract – 
Rationale:  Dental caries is a global public health problem, especially in children. Most caries in developing countries remains untreated. Only limited data are available on the clinical consequences of untreated dental caries because there is no measure to quantify the prevalence and severity of oral conditions resulting from untreated dental caries.
Objectives:  To present a new index to evaluate the prevalence and severity of oral conditions resulting from untreated dental caries. To validate the index within the Philippines National Oral Health Survey, 2006.
Methods:  The PUFA index records the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a).
Results:  Good kappa values show the reliability of the index. The prevalence of PUFA/pufa >0 was 85% and 56% for 6- and 12-year-olds, respectively. The mean number of teeth affected (PUFA/pufa) was 3.5 and 1.2 for 6- and 12-year-olds, respectively. In 6- and 12-year-olds, 40% and 41% of decayed teeth had progressed to odontogenic infections.
Conclusion:  The PUFA index complements classical caries indices with relevant information for epidemiologists and health care planners.     

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county

Background.  Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood.
Aim.  The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents.
Design.  From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3–19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records.
Results.  The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered.
Conclusions.  Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.     

Streptococcus mutans and dental caries in urban and rural schoolchildren in Thailand

Two groups of Thai schoolchildren aged 11-13 yr were examined for dental caries, dental fluorosis and Streptococcus mutans. One hundred children lived in an urban district, Bangkok, and 71 children in a rural district, Petchaboon. Saliva samples were analyzed for S. mutans by the spatula method. The fluoride content of the drinking waters was also determined. The prevalence of caries, diagnosed according to WHO, was 89% in Bangkok and 18% in the rural district. Mean DMFT was 3.46 and 0.38 respectively. S. mutans was found in 98% of the urban children and in 82% of the rural. The differences in distribution between S. mutans and DMFT classes were statistically significant for the total sample. Mild fluorosis was present in some of the rural children.     

Dental caries, gingivitis, and oral hygiene among schoolchildren in Kampala, Uganda

ABSTRACT – An epidemiologic survey of dental caries, gingivitis and oral hygiene was conducted on 875 schoolchildren aged 6–15 in Kampala, the capital of Uganda. Findings arc reported in detail for the African children, and in brief for the Asian children. Among the African children, DMF teeth averaged from 0.6–2.7, and def teeth from 0.0–1.9. A significantly higher proportion of the first permanent molars was carious among the 6 to 9-year-old than among the 10 to 14-year-old Africans, which is interpreted as a sign of the rapid increase in caries prevalence occurring during these years. Among the Asian children, dental caries was more prevalent and advanced. Generalized, mild gingivitis and moderate amounts of soft debris were found uniformly throughout all groups. The need for dental health education is stressed, and the case for longitudinal socio-epidemiologic studies is discussed.     

A vicious cycle in the oral health status of schoolchildren in a primary school in rural Cambodia

Abstract Objective: To investigate the oral health status and the risk factors contributing to dental caries and gum disease of schoolchildren in Cambodia. Methods: A cross‐sectional survey was conducted in a primary school in the Puok District, Siem Reap Province of Cambodia. An oral examination and self‐reported questionnaire were used to evaluate oral health status of schoolchildren, ranging in age from 6–16. Of the 512 children that were enrolled in first through sixth grade at the primary school, 332 children (62.8%) participated. Results: Of the schoolchildren that were involved in this study, the prevalence of dental caries in permanent dentition was 53.5% and gum disease was present in 46.2%. Among the participants 80% had plaque, 68.6% suffered from tooth pain and only 44.2% of the schoolchildren owned their own toothbrush. There was an association between the schoolchildren that suffered from tooth pain and those that had dental caries (P < 0.03). Plaque was related to dental caries in permanent dentition (P < 0.003), calculus (P < 0.0001) and gum disease (P < 0.0001) and was linked to the schoolchildren who did not own a toothbrush (P < 0.03) and who suffered from tooth pain (P < 0.03). Conclusion: The following sequence of events may result in a vicious cycle in the oral healthcare of schoolchildren in rural Cambodia: the lack of a personal toothbrush leads to plaque buildup, which may increase the incidence of dental caries, which has been linked to tooth pain and gum disease. Ultimately, this poor oral healthcare impacts an individual’s quality of life and can lead to more serious health issues later in life.     

Dental caries in a group of schoolchildren in Kandy,Sri Lanka

This investigation was carried out in order to collect information regarding oral health in a group of schoolchildren in Kandy, Sri Lanka. 614 children of 6, 9, 12 and 15 years were selected by stratified random sampling and examined under field conditions.

The primary dentition showed a high rate of caries on all types of surfaces. Caries in the permanent dentition was mainly located to pits and fissures below the age of 12 years, after which smooth surface caries developed. The D-component was by far the largest component of the DMF-index in both the primary and the permanent dentition.

The results are discussed in the light of the existing dental care delivery system in Sri Lanka.     

Dental caries prevalence and treatment need among racial/ethnic minority schoolchildren

A study was undertaken to estimate dental caries prevalence and treatment need among racial/ethnic minority schoolchildren in the Bronx. Oral examinations were conducted on 148 second graders, 193 fourth graders and 299 sixth graders in three different schools. A single examiner trained to use the DMFS index according to National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria and procedures examined all the children between November 1999 and July 2000. The study revealed that 39% of the children exhibited dental caries experience in their permanent dentition (mean DMFS = 1.45), treatment need (D/DMFS = 28%); 26.4% of children in their primary dentition (mean dfs = 1.01) and treatment need (d/dfs = 18%). Hispanic children (mean DMFS = 1.71) had higher dental caries experience compared to African-Americans (mean DMFS = 1.14). This was found to be statistically significant (p = 0.004). Treatment need in Hispanics was (30%, 17%) and in African-Americans (30%, 18%) in permanent and primary dentition respectively. Treatment need was highest among sixth grade African-Americans in their permanent dentition and in second grade Hispanics in the primary dentition. The study showed a difference in dental caries prevalence, but the treatment need percentages did not differ between Hispanics and African-Americans in both dentition.     

Caries prevalence in different racial groups of schoolchildren in West Malaysia

ABSTRACT A dental health survey of 15,197 schoolchildren age 6–18 years was conducted in West Malaysia. The caries experience in the permanent teeth of the three racial groups, namely Malay, Chinese and Indian/Pakistani, showed a distinct variation. The prevalence was highest among the Chinese children, being about twice that of the Malay and Indian/Pakistani children. In the primary dentition, however, the caries experience in the three racial groups was comparable. An analysis of the factors contributing to the racial variation showed that dietary influence was not the only factor responsible. The possibility of a racial variation in caries susceptibility has been postulated. In the primary dentition the similar caries experience observed in the three groups of children was most probably due to the widespread occurrence of rampant caries which would heavily weight the dift score of the children in all three groups. The need to fluoridate the public water supply as an effective preventive measure is emphasized.     

A cohort study on prevalence of dental caries concerning primary schoolchildren in one village of Niigata Prefecture

To review the previous preventive measures against the incidence of dental caries in children, we started to examine the state of dental health in children at the age of 18 months. The annual dental examination continued up to 12 years of age (sixgraders). Enrolled in this study were a total of 225 children living in a Town T and born between 1980 and 1982. Meanwhile, we made surveys in order to gauge the degree to which the subjects and their parents have concern for oral health. The findings and their relationships to the caries incidence were analyzed using an epidemiological technique. The annual dental examinations revealed that in primary dentition the incidence of caries tends to increase in 3-year-olds while in permanent dentition the carious process extends in 4–6 graders. By kind of teeth, primary molars accounted for 52% of the affected deciduous teeth. First molars made up 72% of all the decayed permanent teeth. Using the two caries cumulative indexes developed by our department for recording the prevalence and severity of tooth decay in the deciduous dentition and in the permanent dentition, respectively, we found that there is a correlation between the incidence of caries in the deciduous dentition and that in the permanent teeth. The two formulae are based on the cumulative number of decayed teeth that appeared in the deciduous dentition and permanent dentition for a given period of time. In order to find whether there is any correlation between caries attack and attention paid to the risk factors, we divided the subjects into two groups by the number of decayed teeth per person. In the group made up of those with many carious teeth, it was noted that between-meal snacks are most likely to produce caries in deciduous teeth, while lifestyle affects permanentteth.

     

An assessment of adverse effects of antiretroviral therapy on the development of HIV positive children by observation of dental mineralization chronology

J Oral Pathol Med (2010) 39 : 35–40
Background:  The difference between dental age (DA) and chronological age (CA) indicates an advance or delay in comparison with the normal standard. Considering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observing the timing of dental mineralization.
Methods:  A retrospective examination was made of the medical records and dental panoramic radiographs of 50 HIV-positive pediatric patients, aged 37–168 months of age. Through these radiographs, their DA was estimated and compared with their CA.
Results:  The mean DA was significantly lower than the mean CA in the entire studied sample ( P  < 0.01). There was a statistical difference between children who received antiretroviral drugs and those who used no drugs ( P  = 0.02), i.e. the non-treated individuals presented practically no difference between CA and DA, while the treated patients showed a difference of 10.67 months.
Conclusion:  We conclude that the DA of HIV infected children was delayed when compared to the CA, and there was a positive association between the use of antiretroviral therapy and a delay in the chronology of dental mineralization in the sample.     

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

Background.  In Mexico, there is a high prevalence of dental caries and large groups of children still show extensive untreated dental damage.
Aim.  This study aims to evaluate, in a cohort of 6-year-old Mexican children, the relationship between caries increment at 4 years and the following caries risk markers: fissure morphology, caries experience, salivary flow rate, Snyder test results, and mutans and lactobacilli counts.
Design.  To predict new caries lesions in 110 schoolchildren, clinical, salivary, and bacteriological caries risk markers were used, including fissure morphology, caries experience, salivary flow rate, Snyder test, and Streptococcus mutans and lactobacilli counts. To determine the validity of these markers, the baseline data were compared with the caries increment after 4 years.
Results.  The risk model's capacity to predict caries was moderate (specificity 79.6% and sensitivity 78.6%). Caries experience ( P  = 0.0001), Snyder test ( P  = 0.002), and fissure morphology ( P  = 0.024) had the strongest association with caries increment. Salivary flow rate, lactobacilli, and S. mutans counts did not contribute significantly to the prediction of caries lesions in these children.
Conclusion.  In addition to the initial caries experience, tooth morphology and Snyder test proved to be useful predictors for caries. These three risk markers may be particularly useful in targeting caries prevention efforts in developing countries.     

Oral health status among schoolchildren in Romania, 1992

Abstract – In Romania, systematic information on the occurrence of oral diseases in children is scarce. The purpose of the present study was to describe the prevalence and the pattern of dental caries in schoolchildren, and to use the data to provide a baseline for planning and evaluation of oral health care. A national sample of children at grade I ( n = 729) and grade 6 ( n = 660) was chosen consistent with the WHO pathfinder principle. Clinical examinations were carried out according to the recording system for the Danish Municipal Dental Service and the following results were obtained. In children of grade 1 (7-yr-olds) the prevalence proportion of caries in primary teeth was 86% and in permanent teeth 39%. The mean caries indices were 11.4 dels and 1.3 DMFS. At grade 6 (12-yr-olds) the prevalence proportion of caries in primary teeth was 17% and in permanent teeth 90%. The mean caries experience was 0.8 defs and 6.5 DMFS, and a mean of 4.1 DMFT was observed. In both groups, the D-component of the caries index was dominant. The children were also classified by caries severity zone. At grade 1, 61% had a very severe pattern of caries in the primary teeth, i.e. caries in pits/fissures, proximal surfaces, smooth surfaces, and incisors. Forty-three percent of the children at grade 6 showed this pattern in permanent teeth. In Romanian schoolchildren the present level and pattern of dental caries are most severe and the implementation of oral health promotion and prevention at the community level is urgently needed.     

Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children

Aim.  The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children.
Design.  Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted.
Results.  Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin.
Conclusion.  Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.     

Dental caries among urban schoolchildren in Madagascar

Abstract An epidemiological survey of prevalence and severity of dental caries was carried out in an urban population of children in Madagascar. The study population comprised 1257 children in the age groups 4–5 yr to 14–15 yr equally distributed by sex. The children were examined according to the recording system for the Danish Child Dental Services. The caries experience in the primary dentition as well as in the permanent dentition was high. For example, among 6-yr-olds a mean number of 11.8 defs and 5.2 deft was observed and 82% of the children were affected by caries in primary teeth. In particular, primary molars in the mandibular and incisors in the maxilla were affected and approximate caries was frequent. Among 12-yr-olds mean DMFS was 4.0 and DM FT 2.4 and 75% of the children had caries in permanent teeth. In permanent teeth caries was located predominantly to mandibular molars and occlusal surfaces. In both dentitions almost all decay was untreated, indicating lack of dental treatment available due to the shortage of dental manpower. The establishment of a child dental service system is a matter of urgency. Dental health education and primary health care should be organized.     

Dental caries and dental treatment in the primary dentition in an industrialized South African community

This paper reports an examination of dental caries in the primary dentition of 2-5-yr-old white children in an industrialized South African city, in 1981 and 1983. There was a decrease in dental caries prevalence over the 2-yr period accompanied by an increase in dental treatment in 3-5-yr-olds. Treatment, however, remains low. Socioeconomic status had a varying effect on the trends, but in general there was a greater reduction in dental caries in the lower socioeconomic areas.