The attitudes of parents toward the oral health of children and their reflection on the non-cavitated caries lesions

ObjectiveTo determine the extent of non-cavitated caries lesions in preschool children, and compare its relationship with socioeconomic status, oral and dental health practices, knowledge of caries prevention, and nutrition.Materials and methodsNinety-seven parents of 36–72 month-old children completed a questionnaire on the socioeconomic status of the family, parent's knowledge of caries prevention, the children's oral health practices, and nutrition. In the children, the cavitated dental caries were assessed according to World Health Organization (WHO) criteria and non-cavitated caries lesions on occlusal and smooth surfaces were evaluated by Universal Visual Scoring System (UniViSS). Statistical analysis was conducted using the SPSS software program. The relationships between variables were assessed using the chi-square test and logistic (ordinal) regression analysis.ResultsStatistically significant results were obtained relating to the parents' age, number of children, the time of first oral hygiene, frequency of tooth brushing, knowledge of caries prevention, drinks most often consumed by the children, and number of non-cavitated lesions. According to the regression model, the significant variables were caries activity (yes), drinks most often consumed by the children (milk–juice; juice–buttermilk), the frequency of tooth brushing (once a day, twice a day), observed changes in a child's teeth (change in color and breaks in teeth), the number of cavitated caries lesions and decayed, missing and filled teeth (dmft).ConclusionsThe primary factors contributing to non-cavitated caries lesions include the time of first oral hygiene and frequency of tooth brushing. The early diagnosis of non-cavitated caries is essential for preventive measures.     

Assessing the stage of caries lesion activity on the basis of clinical and microbiological examination

Abstract The dynamic nature of caries lesion progression may require that classification of caries lesions makes distinctions in activity status. The aim of the present review was to compile and discuss the literature which pertains to clinical assessment of caries lesion activity, and to examine whether recent developments in microbiological research may justify the use of microbiological methods for evaluation of caries activity. Clinical observations suggest that caries lesion progression can be arrested at any stage of lesion development, provided that clinically plaque-free conditions are obtained. However, there is no universal level of oral hygiene to be recommended. The diagnoses “active” and “inactive/arrested” caries have been validated by a range of histological and chemical methods which have supported a separation into distinct clinical categories. Simple microbiological methods have so far not been useful in differentiating between active and inactive caries lesions. Very few studies have evaluated the inter- and intra-examiner reliability of caries diagnostic criteria based on assessment of the activity state of lesions, but recent data indicate that active and inactive caries lesions can be diagnosed with a high degree of reliability. A decision-making tree for dental caries is presented by means of which it is possible to associate the assessment of caries lesion activity with an appropriate treatment modality. It is concluded that research into better methods of assessing caries lesion activity clinically should be stimulated.     

Non‐operative control of cavitated approximal caries lesions in primary molars: a prospective evaluation of cases

The effect of non‐operative caries control at cavity level is often questioned. This prospective study of cases aimed to evaluate the suitability of non‐operative treatment of active cavitated approximal caries lesions in primary molars by assessing clinical changes of lesions over time. Further, we evaluate children's and parents’ attitudes in response to non‐operative cavity treatment. Thirty‐nine children attending a community dental service, aged 5–11 years, joined the evaluation based on the following criteria: (i) the presence of at least one active cavitated caries lesion in the distal surface of first primary molar or mesial surface of the second primary molar extending up to two‐thirds into dentin assessed radiographically, (ii) the absence of spontaneous pain, (iii) the absence of pulpal or periapical pathology. After informed consent, one randomly selected lesion per child had overhanging enamel margins adjusted and was treated non‐operatively by the child/parent performing daily site‐specific oral hygiene with a fluoridated toothpaste, supplemented by professional topical fluoride treatment and dietary advice. Nine lesions/children dropped out. Fifteen lesions survived without pulpal or periapical pathology for an average of 26 m (range 9–44). Lesion failure was associated with poor compliance or lesions not suited for the method. Children and parents were highly satisfied with the treatment. Our study identifies key factors in the performance of non‐operative cavity treatment in a dental practice setting. It is concluded that non‐operative cavity treatment can be a helpful method to control caries lesion progression in primary teeth and may familiarise the child with dental treatment.     

Clinical diagnosis of precavitated carious lesions

Abstract During the 20th century, dental caries was usually diagnosed using tactile-visual criteria that detected the presence of cavitation rather than measured the disease process as a continuum that starts from the appearance of micro-porosity, as a result of demineralization, to the occurrence of cavitation. With increasing understanding of the dental caries process and the role of primary and secondary prevention in arresting it, sensitive and specific diagnostic systems are needed that could enable dentists to detect signs of early demineralization and possible progression of precavitated carious lesions before the occurrence of cavitation. In this review of the literature, published validity studies of diagnosis of precavitated lesions were reviewed. Overall, the current clinical diagnostic systems have low sensitivity and moderate specificity. Good reliability of diagnosing precavitated carious lesions could be obtained for diagnosing pits and fissures but for smooth tooth surfaces the reliability is poor. As our diagnostic capability of precavitated lesions improves, there is a need for a significant change in dental education, dental insurance, and dental practice to reward dentists for promoting oral health and preserving tooth structure. In this paper, a new model for classifying carious lesions based upon the type of intervention strategies is proposed to assist in this new approach of caries management.     

How to measure the effects of fluoride treatments in clinical trials? Assessment: modern versus traditional methods

In recent years there has been a pronounced change in the epidemiology and disease pattern of dental caries. In the current context, traditional methods of caries assessment, discriminating lesions at cavitation, are clinically inappropriate, and obsolete for research requiring detection of a very early phase of mineral loss. Modern prospective caries studies require sensitive methods permitting the measurement of small changes in tooth mineral content, and objective, quantitative measurements of such changes are now possible in a single caries lesion. For longitudinal studies there are noninvasive methods for assessment of new lesions as well as quantitative changes (progression or regression) in existing lesions. Among as yet unresolved issues are improved methods to assess the current activity of a lesion, methods for detection and quantification of secondary caries and root caries, calibration of methodologies between different research institutes, and methods capable of assessment of the whole continuum in the development of a caries lesion, from initial loss of mineral to cavitation.     

Longitudinal associations between children's dental caries and risk factors

Dental caries is a common disease in children of all ages. It is desirable to know whether children with primary, mixed, and permanent dentitions share risk factors for cavitated and non-cavitated caries. Objective: To assess the longitudinal associations between caries outcomes and modifiable risk factors. Methods: One hundred and fifty-six children in the Iowa Fluoride Study met inclusion criteria of three dental examinations and caries-related risk factor assessments preceding each examination. Surface-specific counts of new non-cavitated caries and cavitated caries at the primary (Exam 1: age 5), mixed (Exam 2: age 9) and permanent (Exam 3: age 13) dentition examinations were outcome variables. Explanatory variables were caries-related factors, including averaged beverage exposure frequencies, tooth brushing frequencies, and composite water fluoride levels collected from 3-5, 6-8, and 11-13 years, dentition category, socioeconomic status, and gender. Generalized linear mixed models (GLMMs) were used to explore the relationships between new non-cavitated or cavitated caries and caries-related variables. Results: Greater frequency of 100 percent juice exposure was significantly associated with fewer non-cavitated and cavitated caries surfaces. Greater tooth brushing frequency and high socioeconomic status (SES) were significantly associated with fewer new non-cavitated caries. Children had significantly more new cavitated caries surfaces at the mixed dentition examination than at the primary and permanent dentition examinations. Conclusions: There were common caries-related factors for more new non-cavitated caries across the three exams, including less frequent 100 percent juice exposure, lower tooth brushing frequency and lower SES. Less frequent 100 percent juice exposures might be associated with higher exposures to several other cariogenic beverages.     

Arrest of non‐cavitated dentinal occlusal caries by sealing pits and fissures: a 36‐month,randomised controlled clinical trial

Objective: This study aimed to evaluate the progression of sealed non‐cavitated dentinal occlusal caries in a randomised controlled clinical trial. Materials and methods: Sixty teeth with non‐cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. Results: Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12‐month follow‐up. At the 24‐ and 36‐month recall appointments, neither sealant loss nor caries progression were observed. Conclusion: The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.     

Caries assessment spectrum treatment: the severity score

Objectives: To appraise the feasibility of the caries assessment spectrum and treatment (CAST) severity score according to the formula (F) recommended in the CAST manual. Methods: Data from an epidemiological survey of 680 schoolchildren (mean age ± standard deviation: 7.45 ± 0.91 years), living in a low-income area in Brasília, were used. The CAST instrument was used for assessing enamel carious lesions (CAST code = 3), dentine carious lesions (CAST codes = 4–7) and tooth loss from caries (CAST code = 8). Results: The prevalence of carious lesions including enamel and dentine in both deciduous and permanent dentitions was 49.41% and 69.12%, respectively. Calculating the CAST severity score per child using F was unsatisfactory because of the undiscriminating weight given for each CAST code. Modification of weights according to the accepted levels of disease severity for individual CAST codes resulted in a new formula (F1), in which the weight given to cavitated dentine lesions was quadrupled in relation to that given to enamel carious lesions; this was different from F, in which the weight given to such lesions was twofold. F1 was able to categorise satisfactorily the study children into one of three levels of dental caries severity: mild (34.1%); moderate (29.5%); or severe (36.4%). Conclusion: According to the outcomes of the present appraisal, it was concluded that the numerical score provided by the CAST severity scores allows an overview of the severity of caries disease and the classification of individuals into mild, moderate or severe levels of dental caries when the new formula (F1) is used.Key words: Dental caries, epidemiological index, prevalence, caries assessment spectrum treatment, caries epidemiology     

The Caries Management System: an evidence‐based preventive strategy for dental practitioners. Application for children and adolescents

The application of the Caries Management System (CMS) for children and adolescents follows the rationale underlying the application of the CMS for adults. Briefly, the CMS is a 10‐step, risk‐based, non‐invasive strategy to arrest and remineralize early lesions and to enhance caries primary prevention. The method for assessing each patient’s diet, plaque distribution, and signs of caries as shown in bitewing radiograph images, follows the protocols for adults. Protocols presented here relating to caries risk assessment, lesion diagnosis and management, and patient recall are specific for children and adolescents. Fundamentally, non‐cavitated lesions in primary and especially permanent teeth are managed: (1) professionally by preservative non‐invasive means, including fluoride varnish and sealants; and (2) daily home toothbrushing using fluoride toothpaste where the aim is to arrest lesion progression so that restorations will not be necessary. Monitoring of lesions through the review of clinical signs and bitewing images is the means for assessing caries activity. For those who fail to respond to advice to reduce cariogenic exposures and continue to develop new lesions at a steady or increased rate, a more intensified programme is required; their higher risk status is confirmed and treatment follows the corresponding protocol.     

Prevalence of non-cavitated and cavitated carious lesions in a random sample of 7-9-year-old schoolchildren in Montreal, Quebec

This report describes the prevalence of non-cavitated and cavitated carious lesions in 911 randomly selected children in grades one through three on the Island of Montreal, Quebec, Canada. The criteria for diagnosis were developed for a longitudinal epidemiological study of restorative treatment decisions by dentists practising under a provincial dental insurance program for children. The intra- and inter-examiner reliability correlation coefficients of the two examiners were excellent (Kappa > or = 0.80). The most frequent carious lesion found in the examined children were non-cavitated carious lesions (incipient) within 1.5 of the gingival line on smooth tooth surfaces, and stained or non-cavitated carious lesions on pits and fissures. Out of 911 children in the study, 19.6% had sealants. Children whose parents completed a university education had a significantly lower prevalence of non-cavitated and cavitated carious lesions and fillings, and a significantly higher mean number of sealants than children whose parents had only primary school education. Education status of the parents was a significant risk marker of children with high caries experience and these children had a significantly higher mean number of non-cavitated carious lesions. This study has found that non-cavitated carious lesions are significantly more prevalent than cavitated carious lesions in children.     

Assessment of different methods for diagnosing dental caries in epidemiological surveys

AIMS: The aims of the study were: (i) to assess different clinical diagnostic methods of dental caries during epidemiological surveys; (ii) to determine which combinations of methods and diagnostic adjuncts show the best performances in epidemiological surveys when compared with examinations performed in a traditional dental setting (standard); (iii) to evaluate the influence of including noncavitated (NC) lesions in dental caries estimation. METHODS: Forty 12-year-old children were divided into low and moderate caries prevalence groups. The individuals were submitted to 12 epidemiological examinations (in an outdoor setting), which combined three methods (blade, mirror and mirror + CPI (Community Periodontal Index) dental probe) with or without diagnostic adjuncts (previous dental brushing and dental drying). The last examination was performed in a traditional dental setting (standard examination). The unit of measure was the DMFS (decayed, missing and filled surfaces) index according to WHO criteria. The variance analysis, Dunnet's and Tukey's tests were applied. RESULTS: For the DMFS analysis, the visual/tactile method, with or without diagnostic adjuncts, was the best method for both groups, presenting a performance higher than 90% when compared with the standard examination, except for the examinations without previous dental brushing for the low caries prevalence group. Previous dental brushing was more relevant than dental drying (P = 0.0054). All of the epidemiological examinations underestimated the NC diagnosis even with the association of diagnostic adjuncts when compared with the standard examination. CONCLUSION: The visual-tactile (for both groups) and the visual (mirror) methods plus dental brushing (for the moderate group) are appropriate for diagnosing cavitated lesions, but not NC lesions.     

Is dental caries experience increased in HIV-infected children and adolescents? A meta-analysis

Abstract

Objective. To undertake a systematic review to assess if HIV-infected children and adolescents have an increased dental caries experience. Methods. A search of MEDLINE, BIREME, EMBASE, GOOGLE SCHOLAR, SIGLE (Grey Literature) and reference lists of included studies was carried out. To be eligible the studies had to present HIV-infected and non-infected children/adolescents between 0–18 years old. To assess the methodological quality, the studies were categorized in scores from ‘A’ to ‘C’. To perform a meta-analysis a random effect model was used with 95% confidence intervals and two distinct sub-group analyses were carried out in terms of caries progression: data for cavitated and non-cavitated lesions (sub-group 1) and data only for cavitated lesions (sub-group 2). Results. Five studies fulfilled the selection criteria. Four studies (two ranked A and two B in the quality assessment) revealed higher caries scores in primary teeth in the HIV-infected patients with mean dmft/dmfs scores of 3.8–4.1/7.8–11.0 compared to the control group 1.5–2.4/3.4–5.1. No differences in caries index were found for permanent dentition. The meta-analysis excluded caries data of permanent teeth and showed a significant association between caries experience in primary dentition and HIV infection considering cavitated and non-cavitated lesions (OR = 2.33, 95% CI = 1.48–3.68) or only cavitated lesions (OR = 2.98, 95% CI = 1.59–5.59). Conclusion. Evidence exists that suggests HIV-infected children/adolescents have an increased caries experience in primary dentition.     

Increment of dental caries among Finnish dental students during a period of 2 years

The purpose of the study was to estimate the increment of dental caries among dental students in Helsinki, who acquired good knowledge of caries prevention during their studies. The group (59 students) was examined twice with an interval of 20.2 +/- 4.1 months. Clinical findings, augmented with bitewing radiographs and an orthopantomogram, were recorded separately for each tooth surface, and individual DMFS and DS index scores were computed. In addition, the students were interviewed with regard to oral hygiene, topical fluoride application, and dietary habits. The mean DMFS and DS index scores at the first examination were 45.0 and 9.1, respectively. At the second examination, DMFS was 46.4 and the number of new decayed surfaces per student 0.54/year. Both the latter values indicated that caries progression was slow. The increment of dental caries among the dental students was much smaller than that observed earlier among other groups of university students in Finland. Further evidence that caries progression among the dental students was slow was provided by the finding that of the 318 incipient caries lesions recorded at the first examination, no more than 11 had developed into clinical caries by 20 months.     

Use of the Kaplan-Meier estimate to reduce biases in estimating the rate of caries progression

Abstract An important determinant of how often to perform dental radiography is how rapidly dental caries progress. Estimates of the rate of progression of dental caries have been biased by the elimination of filled lesions and non-progressing lesions (i.e. censored data) from the analysis. We illustrate the use of the Kaplan-Meier estimate to incorporate information from these cases and demonstrate the effect of using this information on estimates of the rate of progression of approximal caries.     

Onset, development and arrest of dental caries in Brazilian pre-school children

The aim of this study was to describe the onset, development and arrest of dental caries in Brazilian 1- to 5-year-old children with limited access to dental care. The sample represented 40% of all children in these age groups attending public nursery school in the Federal District of Brazil. A total of 1465 children who benefited from fluoridated water soon after birth were examined for caries. For all teeth and tooth surfaces, the examination recorded whether they were sound, showing active or arrested lesions (non-cavitated or cavitated), filled or indicated for extraction. The onset of dental caries was identified at an early age; 89% of children were free of caries at the age of 1 year, decreasing to 28% at the age of 5 years. Non-cavitated lesions (active and arrested) accounted for 71% (<2 years), 58% (3 years), 47% (4 years) and 40% (5 years) of the total number of surfaces showing caries experience. The corresponding values for cavities were 28%, 38%, 47% and 47%, respectively. Maxillary incisors and molars disclosed the highest caries experience in all ages. For children older than 1 year, both mean deft and defs scores not including non-cavitated lesions were significantly different from those for which non-cavitated lesions were taken into account (t-test, P<0.0001). At the age of 5 years, defs scores were 5.5 and 8.8, respectively. This study documented that the onset and development of dental disease started at an early age in the population studied, leading to a considerable need for dental care. Received: 10 March 1998 / Accepted: 25 May 1998     

Systems for grading approximal carious lesions and overlaps diagnosed from bitewing radiographs Proposals for future standardization

The diagnosis of dental caries from bitewing radiographs has become an important and integral part of many clinical caries trials, particularly in longitudinal studies. Although many seemingly similar systems for grading the degrees of approximal lesions have been used, the diagnostic criteria employed often differ in a number of significant areas. A variety of different conventions have evolved for the treatment of: 1) overlapping surfaces, 2) lesions in the region of the ADJ, 3) subdivision of the radiographic enamel cap and 4) score transitions and caries progression systems. Direct intertrial comparisons may be invalidated by the use of incompatible grading systems. Whilst one rigid grading system will not be suitable for all clinical trials, the use of the appropriate scoring codes and criteria from a standard system may greatly facilitate the comparison and interpretation of results. A comprehensive standard system for the grading and scoring of radiographic diagnoses (compatible with the existing WHO recommendations for the grading of clinically diagnosed lesions) is proposed.     

Early Childhood Caries in Victorian Preschoolers: A Cross-Sectional Study

AimThe objective of this work was to determine the prevalence of early childhood caries (ECC) in children attending preschools that are enrolled in the Smiles 4 Miles health promotion program in Victoria and determine the sociodemographic variables associated with ECC.Materials and methodsA cross-sectional sample of 1,845 3- to 5-year-old children attending 61 preschools was selected by stratified cluster sampling. Dental caries was classified as non-cavitated/early lesions (d^1-2), cavitated (d^3-6) lesions, and cavitated/non-cavitated (d^1-6) lesions using the International Caries Detection and Assessment System. A self-administered parental questionnaire captured sociodemographic and behavioural data. Multivariate logistic regression and Poisson mixed model analysis was used to examine associations amongst sociodemographic variables, child oral health behaviours, and decayed tooth surfaces.ResultsIn all, 56.6% (n = 1,044) of the children had ECC; more than one-third (36.6%) presented exclusively non-cavitated/early lesions, 5.7% solely cavitated lesions, and 14.2% both. Children from socioeconomically disadvantaged backgrounds had higher levels of dental caries. Parental pensioner/health care card status (incidence rate ratio [IRR] = 1.76, 95% CI, 1.57-1.97), non-English-speaking background (IRR = 2.09, 95% CI, 1.80-2.43), and Indigenous status (IRR = 1.91, 95% CI, 1.50-2.43) were associated with higher rates of cavitated lesions. Children who consumed soft drinks once or more per week had 1.66 times more cavitated lesions (95% CI, 1.48-1.86) compared to children who never/rarely consumed soft drinks. Soft drink consumption of once or more per week was associated with parental health care/pensioner card status (odds ratio [OR] = 1.73, 95% CI, 1.36-2.18), non-English-speaking background (OR = 1.58, 95% CI, 1.11-2.27), and Indigenous status (OR = 1.92, 95% CI, 1.04-3.52).ConclusionsHigher levels of more severe caries rates in children from socioeconomically disadvantaged background highlight an opportunity for early preventive interventions targeting these groups.     

Longitudinal study of dental caries development in Dutch children aged 8-12 years

In many Western societies caries experience in children has decreased substantially in areas both with and without organized preventive programs or water fluoridation. In the majority of studies reporting declining caries activity, cross-sectional data of the same age groups are compared. The purpose of the present study is to provide longitudinal data on the progress of dental caries in permanent first molars. 252 caries-active children, initially 8-yr old, were followed up from 1979 to 1983. At all three examinations lower socioeconomic (SES) children had a significantly higher caries experience than children the same age in middle and high SES classes. The D2MF-S counts did not change between age 8 and 10, but increased steeply between 10 and 12 yr of age. The D3MF-S counts, on the other hand, rose steadily in all SES classes. The phenomenon was caused by the progression of enamel lesions to dentinal lesions or fillings, leading to a concomitant decrease in the curves of incipient caries lesions (D2). The rise from age 10 to 12 is attributable to new developing enamel lesions. With regard to predilection sites, at all ages and in every SES class, the highest proportion of both indices was due to lesions in occlusal surfaces, followed by buccal and lingual pits and fissures. The approximal sites were the least affected.     

A longitudinal study of occlusal caries among schoolchildren in Dar es Salaam, Tanzania

OBJECTIVES: To describe the clinical caries status and the radiographic progression of occlusal caries lesions in permanent first and second molars among primary schoolchildren in Dar es Salaam over a 3-year period. METHODS: Clinical and radiographic diagnosis of caries in first and second permanent molars in 223 children aged 8-16 years were carried out annually from 1994 to 1997. The drop-out rates from the baseline in 1994 to the follow-up examinations in 1995, 1996 and 1997 were 16.6%, 22.0% and 35.4%, respectively. Twenty-one percent of the dropouts were picked up during the study. RESULTS: Less that 5% of all occlusal surfaces that were sound at the beginning of the study developed new clinical caries lesions over the 3-year study period. The highest rate of new lesions was found in second molars. The mandibular second molars were most frequently affected by new caries lesions followed by the mandibular first molars. Progression of lesions was generally slow. After 1, 2 and 3 years, 30.0%, 47.9% and 52.8% of lesions in occlusal surfaces of first molars had progressed, compared to 47.9%, 71.3% and 100.0% of lesions in second molars. CONCLUSIONS: Dental caries prevalence was low. New occlusal lesions were more likely to appear in mandibular second molars. Carious lesions were progressing slowly, especially in the first molars. Fissure abrasion may play a role in minimizing the risk of developing new occlusal lesions as well as progression of existing lesions.     

ECSI - A new index for evaluating caries progression

abstract ECSI (Extrapolated Carious Surface Increment Index) is a caries progression index which takes into account the enlargement of existing lesions as well as the initiation of new ones. It differs in principle from previously described progression indices in that it is de-fined as an interval scale which allows expression of the increment as a single figure. It is also unique in that it relates fillings and extractions to their preceding caries state. Detailed analysis of data from caries clinical trials shows that different populations which are apparently similar as judged on the basis of conventional DMF indices can in fact be shown to be grossly different as a result of different denial treatment patterns. Furthermore, the fundamental assumption of the DMFS index that an extracted tooth is equivalent to four or five-carious surfaces is demonstrably false; the true figure obtained from the data studied is nearer 2.25. These shortcomings have been corrected in the ECSI logic.