Validation of a Swiss method of caries prediction in Dutch children

OBJECTIVE: This study aimed to validate a caries prediction method, the Dentoprog-Method, which was developed on Swiss children. METHOD: A Dutch child population was used for validation. The diagnosis of caries, age of the children and the caries experience were slightly different from the population from which the Dentoprog-Method was developed. With the Dentoprog-Method, Dutch children were ranked in increasing order of high caries risk probability. The measure of prediction was expressed in sensitivity and specificity, which were calculated at 10% risk probability intervals for each class of "high" caries increment and for different forecast periods. ROC curves presenting sensitivity as a function of (100-specificity) were employed to summarize the obtained information. The area under the ROC curve was used as a measure of predictive accuracy. RESULTS: The area under the ROC curves for various caries increment classes of 7.5-year-old and 9.5-year-old Dutch children was in the range of the area under the ROC curves of Swiss children. CONCLUSION: This analysis indicated that the Dentoprog-Method when applied on a sample of Dutch children was robust enough to overcome small differences in caries diagnosis, age and caries experience.     

Caries prediction: a review of the literature

For over a decade researchers have been looking for the formula that will allow caries prediction. The purpose of this summary is to review recent multi-factorial prediction models for adults and children with the aim of identifying the most successful and consistent methods. Conclusions from this review include the following: Clinical variables, especially past caries experience, are confirmed as the most significant predictors of future caries development. The status of the most recently erupted/exposed surface is the most successful measure of past caries experience. Bacterial levels are included in the most accurate prediction models. Sociodemographic variables are most important to caries prediction models for young children and older adults.     

Comparative effectiveness of visual/tactile and simplified screening examinations in caries risk assessment

Central to the development of a model for identifying children at high risk to caries is a clinical evaluation to assess dental status and other conditions potentially useful in caries prediction. Traditionally, this evaluation has been based on a relatively lengthy visual/tactile examination conducted by a dentist. Replacing the dentist examination with a dental auxiliary conducted screening evaluation could lead to reduced time and costs. The 4-yr University of North Carolina Caries Risk Assessment Study involved approximately 5000 schoolchildren initially in Grades 1 and 5 living near Aiken, South Carolina, and Portland, Maine. The effectiveness of caries prediction models using visual/tactile examination data were compared with the same models using simplified screening evaluation data. Results showed sensitivity ranged from 0.57 to 0.61 for the visual/tactile and screening models by site and grade cohort. Specificity for the models ranged from 0.80 to 0.83. None of these differences in sensitivity and specificity between visual/tactile (dentist) and screening (hygienist) models was statistically significant. Findings show that for the prediction of children at high risk to dental caries the clinical evaluation may be conducted with no reduction of precision by using dental hygienist performed screening evaluations rather than dentist conducted visual/tactile examinations. While no cost data were collected, these results imply that costs to future prediction programs could be reduced by using screening evaluations.     

The value of salivary bacterial counts as a supplement to past caries experience as caries predictor in children

This study aimed to determine whether salivary mutans streptococci and lactobacilli counts could add any value to a combination of caries experience variables that was recently presented for the prediction of caries. Sixty-nine children at the age of 7.5 yr participated in this longitudinal study. Microbiological data were obtained at the ages of 7.5, 9.5 and 11.5 yr and caries data at the ages of 7.5. 9.5. 11.5, 13.5 and 15.5 yr. Spearman's correlation coefficients were computed, and forward multiple regression analyses were carried out using bacterial counts and caries experience parameters as explanatory variables and caries increment as a dependent variable. The explained variance (adjusted R2 value) was the measure used to assess the additional value of bacterial counts to the caries predictive potential of the combined parameters of the past caries experience. Correlation coefficients between bacterial counts and 4-yr caries increment were from 0.22 tip to 0.54. In all cases, the simultaneous streptococcus mutans-lactobacilli counts showed a statistically non-significant additional adjusted R2 value of <0.06. The results do not lend support to the concept that these salivary bacterial counts are useful additional caries predictors for the mixed dentition, when a combination of caries experience parameters is used.     

基于慢性疾病管理理念的重度低龄儿童龋管理方法

重度低龄儿童龋是威胁中国儿童口腔健康的主要疾病。目前中国龋病治疗的主要手段是充填修复,对重度低龄儿童龋患者,充填修复具有患儿难配合、新发龋多、经济及医疗负担重等局限之处。随着对龋病病因学和疾病过程的深入理解,学界提出了基于慢性疾病管理思路的龋病管理模式,通过对致龋因子和保护因子的干预来改善口腔环境,由单纯的去除龋坏组织转向控制龋病的疾病进程,由此来改善龋病的治疗效果。本文以龋病的慢性疾病管理方法及国外本专业学术组织发布的指南进行回顾综述,为中国重度低龄儿童龋防治提供参考。     

Caries risk assessment in Bosnian children using Cariogram computer model

AIM: To examine caries risk using the Cariogram model, interactive PC program for caries risk evaluation in 12-year-old children and to correlate caries risk in children of different socioeconomic backgrounds. MATERIAL AND METHODS: 109, Sarajevo 12-year-olds in three groups based on socioeconomic background. Baseline data on general health condition, diet frequency and use of fluoride were obtained. DMFT and plaque scores were calculated. Saliva analyses included lactobacillus and mutans streptococci levels in saliva, saliva secretion and buffer capacity. Scores were entered into the Cariogram model and risk was calculated for each child. RESULTS: Most 12-year-old children have a medium risk of caries, with a 59.4% chance of avoiding future caries. In an average caries risk profile of children from Sarajevo the dominant sector is diet, with 12.5% risk; bacteria sector (plaque and mutans streptococci level) 10.8% risk; susceptibility (fluoride, saliva secretion and buffering capacity) 9.7% risk; circumstances (caries experience and medical history) 7.4% risk. Caries risk profiles showed that there are differences in the socioeconomic status of children with significantly greater risk in children with poor living conditions who also have the most unfavourable caries risk profiles. CONCLUSIONS: The Cariogram model can successfully determine caries risk profiles for 12-year-old children of different socioeconomic status and can be used in developing preventive strategies for reducing caries risk in children.     

Salivary counts of lactobacilli and Streptococcus mutans in caries prediction

Abstract – The aim of the study was to evaluate whether a combination of tests of salivary counts of lactobacilli and S. mutans would be of more value in caries prediction than each test used by itself. The study was done on 179 children 8 and 13 yr old. The mean caries increments in these children were 1.5 and 3.7 new caries lesions per year, respectively. The results showed that these tests or a combination of them are not specific in selecting caries risk patients. A combination of the two tests, however, was more efficient in selecting these patients than each test used by itself.     

A systematic review of population-based dental caries studies among children in Saudi Arabia

ObjectiveDental caries critically impacts the health and development of children. Understanding caries experience is an important task for Saudi Arabian policymakers to identify intervention targets and improve oral health. The purpose of this review is to analyze current data to assess the nationwide prevalence and severity of caries in children, to identify gaps in baseline information, and to determine areas for future research.MethodsA search of published and unpublished studies in PubMed, Google, and local Saudi medical and dental journals was conducted for the three keywords “dental,” “caries,” and “Saudi Arabia.” The inclusion criteria required that the articles were population-based studies that assessed the prevalence of dental caries in healthy children attending regular schools using a cross-sectional study design of a random sample.Results/discussionThe review was comprised of one unpublished thesis and 27 published surveys of childhood caries in Saudi Arabia. The earliest study was published in 1988 and the most recent was published in 2010. There is a lack of representative data on the prevalence of dental caries among the whole Saudi Arabian population. The national prevalence of dental caries and its severity in children in Saudi Arabia was estimated to be approximately 80% for the primary dentition with a mean dmft of 5.0 and approximately 70% for children’s permanent dentition with a mean DMFT score of 3.5. The current estimates indicate that the World Health Organization (WHO) 2000 goals are still unmet for Saudi Arabian children.ConclusionChildhood dental caries is a serious dental public health problem that warrants the immediate attention of the government and the dental profession officials in Saudi Arabia. Baseline data on oral health and a good understanding of dental caries determinants are necessary for setting appropriate oral health goals. Without the ability to describe the current situation, it is not possible to identify whether progress is being made toward these goals. A roadmap with a clear starting point, destination, and pathway is a desperately needed tool to improve the oral health of Saudi Arabian children.     

儿童龋病管理

龋病是临床上最为常见的儿童口腔疾病,儿童龋病在我国具有患病率高、治疗率低的特点。近年来,随着对龋病认识的日趋深化以及材料和技术的不断进步,儿童口腔医学不仅仅关注儿童龋病的治疗,开始更多地强调对其进行早期预防、诊断和干预,微创理念亦贯穿儿童龋病预防和诊疗的全过程。文章从对龋病发生发展的再认识出发,就儿童龋病风险评估和管理以及如何治疗儿童龋损做一介绍。     

Exploration of prediction models for caries risk assessment of the geriatric population

The purpose of this study was to demonstrate a method for establishing a model designed to predict the caries risk of elderly individuals. Twenty-three patients over the age of 65 and living in a semi-independent retirement center were examined; several variables were collected and analyzed for their ability to predict the development of new carious lesions. The analysis was performed using logistic regression where the proportion of new decay was used as the dependent variable. The model for prediction of combined coronal and root caries included the variables flow rate, gender, and root caries index. The proposed method has the advantages of easily collected data, individualized criteria, and the ability to order patients as to the relative risk of developing decay.     

Increasing the sensitivity of caries clinical trials by applying logistic modelling to specific teeth

An alternative statistical approach is proposed for analysing data from longitudinal clinical trials. Caries increments on those teeth which are known to be particularly susceptible to caries for the population under study are represented by a linear logistic probability model. Expression of the caries increments in the form of a probability model should lead to a better understanding of the relative importance of the various factors which contribute to the caries increment in the population under study. When this model was applied to caries increments on the permanent second molars of children aged 11-13 yr at the baseline of two 3-yr trials, the sensitivity of statistical analysis was up to five times greater than that obtained with traditional statistical methods.     

儿童龋病管理

 龋病是临床上最为常见的儿童口腔疾病，儿童龋病在我国具有患病率高、治疗率低的特点。近年来，随着对龋病认识的日趋深化以及材料和技术的不断进步，儿童口腔医学不仅仅关注儿童龋病的治疗，开始更多地强调对其进行早期预防、诊断和干预，微创理念亦贯穿儿童龋病预防和诊疗的全过程。文章从对龋病发生发展的再认识出发，就儿童龋病风险评估和管理以及如何治疗儿童龋损做一介绍。     

Caries experience of Danish children evaluated by the Child Dental Health recording system

The purpose of this report is to describe certain features of the child dental health care in Denmark. The caries picture and the caries distribution pattern in Danish children aged 2--15 years are demonstrated and some regional variations are analyzed. The study is based on epidemiologic data collected in the school year 1977--78 from about 500 000 children being treated in accordance with the Child Dental Care Act. The data collection is being effectuated annually under a child dental health recording system, and the aim and function of this system is discussed. The mean defs- and DMFS-indices are illustrated for individual age groups reflecting the natural history of dental caries. Certain trends in relation to different geographical distributions of caries and in relation to different cohorts of children from 1972 to 1977 are discussed. The analysis of the caries picture is extended by means of the distribution pattern according to caries severity zones. Finally, the use of caries epidemiologic data for planning and resource allocation purposes is illustrated and some policy implications for the development of the child dental health services in Denmark are discussed.     

上海市闵行区2010-2014学年3～15岁儿童口腔健康状况调查

目的调查闵行区2010—2014学年不同年龄儿童的患龋率及龋均情况,分析5年来儿童易患龋年龄段及易患龋牙位情况。方法闵行区2010年9月—2015年8月公立中小幼机构3~15岁儿童进行口腔检查,获得其基线资料,建立个人口腔健康档案。应用SPSS 20.0软件包进行结果分析。结果从10至14学年,幼儿园学生、小学生5年来患龋率和龋均并无趋势可言(P>0.05),已趋于平稳,闵行区幼儿园学生患龋率在50%左右,小学生患龋率在60%左右;而中学生患龋率及龋均逐年下降,2014学年中学生患龋率下降至28.57%,龋均1.14,均明显低于幼儿园学生和小学生(P<0.01);就每个年级而言,3~8岁儿童随年龄增加患龋率和龋均升高,9~12岁儿童患龋率和龋均随年龄增加下降,13~15岁儿童随年龄增加患龋率下降,而龋均逐渐缓慢升高。结论幼儿园和小学学生的龋病预防和干预是关键,8岁前儿童主要预防乳牙龋,8岁以后第一磨牙的预防及早期干预尤为重要。     

Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study

Abstract

Objective: To explore caries development in children from 5 to 12?years of age, and to study whether enamel caries and dentine caries at 5?years of age could predict caries prevalence at 12?years of age, controlled for child characteristics.

Methods: The study included 3282 children examined at 5 and 12?years of age. Data were collected by clinical examination and questionnaire. Enamel and dentine caries were registered at surface level. Data were tested by t-test and analysed by bi- and multivariate logistic regression. The study was ethically approved.

Results: In 5-year-olds, 15% of the children had dentine caries experience and 21% had enamel caries. In 12-year-olds, 32% had dentine caries experience and 47% had enamel caries. Children with dentine caries experience at 5?years of age had at 12?years of age developed more surfaces with enamel caries (mean 2.8, SD 4.2) and dentine caries experience (mean 1.8, SD 2.5) than other children (p?<?.05). Dentine caries experience at 12?years of age was associated with having only enamel caries (OR 1.6, CI 1.2–2.0) and dentine caries experience (OR 3.2, CI 2.6–3.9) at 5?years of age. Family status and parental education were related to caries development.

Conclusion: Children with caries in primary teeth continued to be caries risk children during the mixed dentition period. In addition to dentine caries experience, enamel caries in primary teeth was a predictor for caries development in young permanent teeth and may be used to improve the caries risk assessment.     

Correlation between caries experience in primary and permanent dentition in birth-cohorts 1950–70

Abstract – Caries experience in the primary molars and canines at 8 yr of age and in the permanent dentition at 16 was correlated in every fourth birth-cohort between 1950 and 1970 in a Danish community. Correlations between 0.44 and 0.56 were found. Cross-tabulation of the data also revealed close association, but prediction of individual high caries risk children based solely on screening for caries experience in the primary dentition is hardly cost-effective.     

Cariogram--a multifactorial risk assessment model for a multifactorial disease

This paper reviews some common methods for the assessment of caries risk. It also describes a new way of illustrating the caries risk profile of an individual, the Cariogram. Past caries experience and socioeconomic factors are often used for prediction of caries. As prediction models, the methods are simple, inexpensive and fast. However, they are not risk models, as they do not specify which particular risk factors are operating. Various biological factors can be used for risk assessment. Common ones are bacteria, diet and host factors. Taken separately, these biological factors often have limited predictive values. Socioeconomic factors often have a heavy impact on the biological factors as they can explain why an individual, for example, has a cariogenic diet or neglects oral hygiene. The biological factors are the immediate cause of the cavities. Caries experience is an illustration of how the host copes up with the biological activity. To facilitate the interpretation of biological data, the Cariogram was developed. It is a computer program showing a graphical picture that illustrates a possible overall caries risk scenario. The program contains an algorithm that presents a 'weighted' analysis of the input data, mainly biological factors. It expresses as to what extent different etiological factors of caries affect caries risk. The Cariogram identifies the caries risk factors for the individual and provides examples of preventive and treatment strategies to the clinician.     

澳门幼儿乳牙龋病及龋病活跃性的分析研究

目的：了解澳门地区幼儿乳牙患龋状况及其龋病活跃性,并作两者间关系分析,填补该地区资料的空白。方法：对澳门生活环境、经济条件等有较大差异的两所幼儿园2～4岁930名幼儿作龋蚀程度检查和记录;其中910名幼儿并作龋病活跃性检测SCAT,依据牙菌斑产酸能力强度分度。统计分析患龋率,龋均dft、龋蚀严重度指数CSI和SCAT。结果：①2～4岁930名幼儿乳牙患龋率为42.5%、dft1.93、CSI6.35,性别间无显著性差异（P〉0.05）。②患龋率、dft、CSI在年龄组间均有显著性差异。③两幼儿园间,患龋率、dft、CSI均有明显差异。④910名幼儿SCAT0度和1度占68.68%,2度和3度占31.32%。⑤两幼儿园间SCAT各度的分布有明显差异。⑥SCAT各度间,患龋率、dft、CSI均有明显差异,dft、CSI与SCAT相关性有显著意义。结论：①澳门幼儿患龋状况不容忽视。应抓紧低年龄幼儿的龋病防治工作。②儿童所处的不同生活条件可影响患龋状况,普及科普知识、维护口腔卫生、开展定期防治等的推广尤有必要。③SCAT能反映患龋状况的敏感度,在筛选幼儿龋病高危群体、有的放矢开展龋病防治计划工作中,既能节省人力、财力、又能提高效率。     

南京市低龄儿童龋风险的影响因素研究

目的 分析低龄儿童龋风险的影响因素,完善低龄儿童龋风险评估模型,以便辅助诊断低龄儿童龋,提供有效的预防及治疗建议。方法 收集来自南京医科大学附属口腔医院儿童牙病预防科临床就诊患者的基线资料,使用CPI探针检查全口牙齿状况,对儿童家长进行问卷调查。所有儿童采集静脉血5 mL。采用单因素及多因素Logistic回归进行相关因素分析。结果 本研究纳入199例龋高风险儿童,多因素logistic回归分析结果显示,血液中总蛋白比值比（Odds ratio,OR）=1.092,95%可信区间（Confidence interval,CI)：1.034~1.155、血清钾（OR=2.175,95%CI：1.056~4.48）、二氧化碳（OR=1.32,95%CI：1.194~1.459）及磷酸肌酸激酶水平（OR=1.007,95%CI：1.001~1.014）与低龄儿童龋风险相关。结论 龋高风险儿童血检生化指标中总蛋白、血清钾、二氧化碳及磷酸肌酸激酶水平均高于无龋儿童,提示这些指标均可能是低龄儿童龋风险的影响因素。     

Multiple imputation of dental caries data using a zero-inflated Poisson regression model

Excess zeros exhibited by dental caries data require special attention when multiple imputation is applied to such data. Objective: The objective of this study was to demonstrate a simple technique using a zero‐inflated Poisson (ZIP) regression model, to perform multiple imputation for missing caries data. Methods: The technique is demonstrated using data (n = 24,403) from a medical office‐based preventive dental program in North Carolina, where 27.2 percent of children (n = 6,637) were missing information on physician‐identified count of carious teeth. We first estimate a ZIP regression model using the nonmissing caries data (n = 17,766). The coefficients from the ZIP model are then used to predict the missing caries data. Results: This technique results in imputed caries counts that are similar to the nonmissing caries data in their distribution, especially with respect to the excess zeros in the nonmissing caries data. Conclusion: This technique can be easily applied to impute missing dental caries data.