大连开发区儿童第一恒磨牙窝沟形态及龋病患病状况调查

目的 了解大连开发区7~9岁儿童第一恒磨牙窝沟形态和龋病患病状况,探索第一恒磨牙窝沟形态与非成洞龋的关系。方法 采用多阶段、分层、整群抽样方法调查大连开发区7~9岁儿童第一恒磨牙的窝沟形态和龋病患病状况。窝沟形态包括深度和着色情况,龋病的检查参考ICDAS标准分为成洞龋和非成洞龋。结果 总调查样本量1 160人,第一恒磨牙成洞龋患病率为19.1%,龋均为0.31,城乡、男女、不同年龄组患龋率和龋均间的差异均无统计学意义。非成洞龋患病率42.1%,龋均0.86,农村儿童龋均显著高于城市儿童,女生龋均显著高于男生,不同年龄组之间龋均无统计学差异。44.7%的人第一恒磨牙有深窝沟,非成洞龋的患病率随着窝沟深度的增加而增加。结论 大连开发区7~9岁儿童第一恒磨牙的非成洞龋患病率和深窝沟率均较高,窝沟深度与非成洞龋之间存在相关性。     

Dental caries in the primary dentition: assessing prevalence of cavitated and noncavitated lesions

BACKGROUND: Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later caries experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. METHODS: As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2-3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n = 67) of these children. RESULTS: Interexaminer agreement for any d1 and any d2-3 lesions at the person level was 100 percent. At the tooth level for d1d2-3f, there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa = .24. For d2-3 it was 99.4 percent agreement and kappa = .81. Prevalence of untreated d2-3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2-3 or filled surfaces, while over 63 percent had no d1, d2-3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2-3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. CONCLUSION: Despite some concern with reliability of diagnosing d1 lesions, it appears that the d1d2-3 criteria are informative and useful in assessing the primary dentition.     

武汉市6～8岁儿童龋病及第一恒磨牙窝沟形态调查研究

目的调查武汉市6～8岁儿童龋病和第一恒磨牙窝沟形态情况,为儿童患龋风险评估和龋病预防政策的制定提供理论依据。方法选取武汉市区5所小学二年级学生,共检查1043名儿童,平均年龄7.6岁。由两名口腔医师检查龋病和第一恒磨牙窝沟形态。其中,龋指数采用改良世界卫生组织标准,使用单因素方差分析和t检验进行统计学分析。结果恒牙D3水平的患龋率为8.7%,乳牙d3水平的患龋率为68.7%。恒牙龋均和龋面均分别为0.11和0.14,乳牙龋均和龋面均分别为2.8和5.0。其中乳牙龋指数d3占d3mft的73.6%,而乳牙早期釉质龋牙数占乳牙d2水平牙数的36.4%。中窝沟和深窝沟第一恒磨牙的儿童占总受检人数的84.6%。结论武汉市6～8岁儿童的乳牙患龋率高,第一恒磨牙中度和深度窝沟比例较高,因此应对高患龋风险的儿童进行窝沟封闭等预防措施。     

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.     

The effect of fluoride gel on incipient carious lesions in a low-caries child population

OBJECTIVES: Secondary analyses were performed to study the cariostatic efficacy of semi-annual professional fluoride gel application on incipient carious lesions in low-caries children initially aged 9.5-11.5 years. METHODS: Double-blind randomized controlled clinical trial. RESULTS: The mean treatment effect of fluoride gel for enamel and dentinal caries lesions after 4 years' follow-up was 0.92 D(2,3)FS and 0.20 D(3)FS, respectively. When enamel lesions were included in the DFS count (i.e. D(2,3)FS), the preventive fraction (PF) showed borderline significance (23%; P = 0.05). No significant treatment effect of professionally applied fluoride gel was found for D(2,3)FS and D(3)FS scores of the second molars. The PF for D(2,3)FS of occlusal, approximal, buccal and lingual surfaces and for buccal and palatal pits and fissures differed not significantly. CONCLUSION: Professionally applied fluoride gel showed no statistically significant caries-inhibiting effect on both enamel and dentine lesions in the permanent dentition of low-caries children.     

Clinical randomized controlled trial of chemomechanical caries removal (Carisolv)

OBJECTIVES: The purpose of this study was to compare the chemomechanical caries-removal system (Carisolv) with high-speed excavation in cavitated occlusal caries of primary molars. Design and setting. The study was a randomized controlled, clinical trial in which the two techniques were compared in each subject. Participants were chosen from public schools, in Maracaibo County, Zulia State, Venezuela. SAMPLE AND METHODS: The sample consisted of 80 primary molars selected from 40 children (mean age 7.7+/-0.7 years). Each patient had at least two contralateral primary molars with cavitated occlusal caries and approximately equal-size access to lesions. The outcome variables were: clinically complete caries removal, size of the opening of the cavity, volume of carious tissue removed, pain during caries removal, anaesthesia requested by the patient, caries-removal time, and behaviour and preference of patients. RESULTS: All treated molars were clinically caries free whichever caries-removal procedure was used. When Carisolv' was used the final cavity entrance sizes were smaller (P<0.001) and the estimated volume of tissue removed was less (P<0.001). The time taken for caries removal was three times longer (7.51+/-1.83 min, P<0.001). Some pain was reported by seven (17.5%) participants when Carisolv was used, compared with 16 (40%) when high-speed excavation was used (P<0.05). Using the Carisolv method there was a higher proportion of patients with positive behaviour (P<0.01), and 71.0% (P<0.05) preferred this treatment. CONCLUSION: Carisolv is an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars; it is more conservative of dental tissue and appeared to be more comfortable for most patients, although the clinical time spent is longer than when using high-speed excavation.     

Oral hygiene as a risk indicator of enamel and dentin caries

Dental researchers have postulated that the risk factors for enamel and dentin caries may not be the same. A review of the literature ascertained that data to support this theory are lacking. Objectives: To evaluate the risk indicators of enamel and dentin caries of the permanent dentition in a study group who had limited access to fluorides and made limited use of dental services. Methods: The study was conducted in Goa, India. Data came from a cross-sectional survey of 1189 seventh grade children, which consisted of a clinical dental examination and a self-administered questionnaire to their parents. The cavitated and non-cavitated criteria were used to score for caries, and the Silness-Loe index for plaque. Results: The mean age of the children was 12.2 years. The percentage of children caries free in the permanent dentition was 22.2%, the mean± s for dmfs, enamel and dentin lesions were 4.20±5.10, 2.59±2.89 and 1.61±3.30 respectively, and the mean plaque score was 1.00±0.48. Results of regression analyses showed that the risk indicators of prevalence and severity of caries differed depending on lesion type. The only variable that was consistently a risk indicator of presence and severity of both dentin and enamel caries was poor oral hygiene. Mother's highest level of education and presence of fluorosis were also risk indicators of enamel and dentin caries. The presence of decayed primary teeth was a risk indicator of enamel caries; and fluorosis severity, use of fluoride toothpaste at the time of the survey, and toothbrushing frequency were risk indicators of dentin caries. The observed caries-oral hygiene association seen is explored further.     

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     

Relationship between caregiver's and child's caries prevalence among disadvantaged African Americans

Abstract – Objective: To assess the relationship between African‐American caregivers’ and children’s caries levels adjusting for sociodemographic factors. Methods: A representative sample of 1021 children (0–5 years) and their caregivers were recruited using a stratified two‐stage area probability sample of households in Detroit. The response rate was 73.7%. Caries was measured using the International Caries Detection and Assessment System. Caries was defined as D1S/d1s (noncavitated) or D2S/d2s (cavitated lesions) for both caregivers and children. Sociodemographic data included caregivers’ employment status, sex, age, income and education. Negative binomial regression techniques were used for the multivariable analyses because of the highly skewed distribution of caries among the children. Results: 48% of the children were male, 39% had employed caregivers, 46% had caregivers with less than a high school education and 44% had family incomes less than $10 000. A total of 47% of the children had at least one noncavitated lesion and 31% had a cavitated lesion. Younger children (ages 0–3 years) had lower caries rates with 24% having one or more noncavitated lesion,18% having a cavitated lesion and 31% with any lesion compared with 78%, 51% and 81%, respectively, among the 4‐ to 5‐year olds. Because of these differences in prevalence in the age groups, subsequent analyses were conducted separately for the two age groups. Multivariable analyses found that the number of cavitated surfaces among the caregivers was significantly related to the number of cavitated and noncavitated lesions among their children for both age groups. The prevalence of children’s caries increased with increasing caregivers’ caries score when demographic characteristics of caregivers were controlled. Younger children with family incomes of less than $10 000 had a significantly increased risk of higher caries prevalence compared with children in families with incomes greater than or equal to $20 000. Conclusions: Caregivers’ caries levels were modestly correlated with children’s caries. However, higher caries prevalence among caregivers significantly increased the risk of caries prevalence among their children. Thus, efforts aimed at improving caregiver’s oral health could result in reducing caries risk among their children, regardless of whether the mechanism was biologically or behaviorally based. Efforts also should be aimed directly at reducing caries risk among children by increasing fluoride exposure among children and improving access to preventive dental care. Finally, even the poorest of the poor experienced additional health disadvantages associated with income suggesting even small increases in family income raising families could have a significant effect on reducing caries risk among young children.     

Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages

BACKGROUND. With Dental Caries being the most common disease amongst children in the world today, there is a need to fully understand risk factors that may be related to caries prevalence and how they could be best addressed. AIM. The aim of this study was to evaluate soda, juice, sugared-beverage intake, brushing habits, and community water source availability as they relate to the prevalence of both noncavitated and cavitated caries lesions in small rural villages in Mexico. DESIGN. The International Caries Detection and Assessment System (ICDAS) was used in children from small, isolated, villages in Mexico. Risk factors were assessed via questionnaires. RESULTS. Caries prevalence in the villages was very high, ranging from 94.7% to 100% of the children studied. The mean number of surfaces with lesions per child (D1MFS + d1mfs) having scores ≥1 (noncavitated and cavitated) ranged from 15.4 ± 11.1 to 26.6 ± 15.2. Many of the children reported drinking beverages containing sugar. CONCLUSIONS. Drinking sugared beverages, poor oral hygiene habits, and lack of access to tap water were identified as risk factor for caries in this sample of residents of rural Mexico.     

Caries experience in a child population in a deprived area of Brazil,using ICDAS II

The aim of the present study was to assess the caries experience of children aged 6 to 7 years old in a socially deprived suburban area of Brazil’s Federal District, using the ICDAS II system and to investigate determinants of dental caries. The survey was carried out in six public schools by three calibrated examiners, on a sample of 835 children. ICDAS II codes had to be converted into dmf/DMF components at surface and tooth levels, resulting in unfamiliar caries variables, to enable some meaningful reporting of the findings. The prevalence of dental caries, including enamel and dentinal carious lesions, in primary teeth was 95.6% and in permanent teeth it was 63.7%. Mean values of d₂mf₂-t (enamel and dentinal lesions), d₃mf₃-t (dentine lesions), D₂MF₂-T and D₃MF₃-T indices were 6.9 ± 3.8, 3.2 ± 3.4, 1.7 ± 1.6 and 0.2 ± 0.5, respectively. Enamel carious lesions predominated in the dmf-t/s and DMF-T/S indices. Seven-year-old children had statistically significantly more enamel and dentine carious lesions in permanent teeth than 6-year-old children had. Using ICDAS II, the prevalence of dental caries in both dentitions was very high. In both dentitions, the decay component predominated, with hardly any restorations or extractions observed. The new ICDAS II system leads to overvaluation of the seriousness of dental caries experience and made reporting of outcomes cumbersome. Guidelines on analysing data and reporting results should be agreed upon before this system can be used in epidemiological surveys globally.     

Oral health in pre-school children living in Sweden. Part III--A longitudinal study. Risk analyses based on caries prevalence at 3 years of age and immigrant status.

A decreasing proportion of children require operative treatment each year and an increasing proportion of children will at recall require no operative care. This would provide resources to give individualised prevention to children at risk for developing new carious lesions. From 3 years of age, however, the prevalence of caries increases up to the age when the primary dentition exfoliates, even though the children attend regular dental service programmes yearly, and for some children dental caries remains a significant problem. The purpose of the present study was to describe the dental health of a group of 6-year-old children living in Sweden, with special reference to caries prevalence at 3 years of age and to immigrant status. At 6 years of age, 45% of the children were free of initial and manifest carious lesions in the primary cuspids and molars. The mean caries increment between 3 and 6 years was 0.9 tooth surfaces for children who were caries free at 3 years of age compared to 4.5 tooth surfaces for children with manifest carious lesions at the same age. The mean caries increment from 3 to 6 years was 1.3 in the non-immigrant group and 3.6 in the immigrant group. For the majority of the children in this study, current preventive dental care seems sufficient. However, for about one-third of the children (children with carious lesions at 3 years of age and/or immigrant status), current caries preventive programme used in the Public Dental Service are inadequate.     

Dental caries and associated factors in Mexican schoolchildren aged 6-13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6-13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85+/-2.73 and 1.44+/-2.05, respectively (DMFT = 3.11+/-2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR = 0.95) with caries in primary dentition. Caries experience in the primary dentition (OR = 6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.     

Dental caries status of children with bronchial asthma

The purpose of the present study was to determine the dental caries status in children with bronchial asthma and to examine the correlation with the severity of asthma and the form of medication being taken. Two hundred and five asthmatic children of both sexes from three to eighteen years old participated in this study. Children were divided into groups: primary, mixed and permanent dentitions. They were also grouped depending on the severity of asthma into mild, moderate and severe asthma and depending on the form of medication being used into inhaler, syrup, tablet and combination group. In the primary dentition group, the asthmatic children had a mean deft of 5.02 +/- 3.05 and a caries prevalence of 75.75%, in the mixed dentition group, the mean deft was 3.45 +/- 2.89 and mean DMFT was 4.83 +/- 3.66 with a caries prevalence of 78.31%. In the permanent dentition the mean DMFT was 5.17 +/- 4.54 and a caries prevalence of 83.15%. Asthmatic children had a high caries prevalence and it increased with the severity of bronchial asthma. The caries prevalence was highest in those taking medication in the form of syrup.     

Caries progression in 12-to 16-year-old schoolchildren in fluoridated and fluoride-deficient areas in Brazil

Abstract Water fluoridation may reduce the rate of caries initiation, but relatively little is known of its effect on rates of caries progression through the enamel and the dentin. Objective: This longitudinal study was designed to compare rates of caries progression in fluoridated and fluoride-deficient areas. Methods: Approximal caries progression was evaluated on two standardized sets of bitewing radiographs taken at a 12-month interval of 290 12- to 16-year-old Brazilian schoolchildren. Pitts' scoring system was used to measure caries progression on conventional bitewing images. Caries progression data on the occlusal, free-smooth, and approximal surfaces of the anterior teeth were collected via clinical visual examinations. Results: The mean rate of approximal caries progression in schoolchildren living in fluoridated areas (0.54) was found to be 62% lower than that in children from fluoride-deficient areas (1.41). When progression rates were adjusted for the initial number of decayed surfaces per subject, differences were statistically significant for lesions located at the inner half of the enamel at baseline (11% in the fluoridated areas vs. 16.5% in the fluoride-deficient areas). Multivariate logistic regression analysis revealed that residence in a fluoride-deficient area remained a significant risk factor for caries progression after controlling for caries prevalence (D₁FS), number of cavitated carious lesions, whether tooth type was molar or premolar, and tooth brushing frequency. Conclusions: These results suggest that water fluoridation reduces the rates of caries progression through the enamel and dentin, but the effect was more pronounced for lesions in the inner enamel than for those in the dentin.     

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

Restorative Treatments Received by Children Covered by a Universal, Publicly Financed, Dental Insurance Plan

Objectives : This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. Methods : A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. Results : The presence of a carious cavity was a strong risk marker for placement of new restorations (odds ratios ≥4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3–6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. Conclusion : The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.     

Dental caries status of young children in a suburban community of Mexico City

One hundred and thirty-four children, 6 to 7 yr of age from a public school in Tepepan, Mexico were examined for the prevalence and severity of dental caries. Average deft score was 6.08 and defs was 12.15. Average DMFT and DMFS scores were .57 and .99 respectively. It was observed that 66% of primary teeth with carious lesions required one surface restoration and 11% three or more surface restorations. In the permanent dentition 99% of the affected teeth required one surface restoration. A comparison of the results with those of the Mexico City public school children survey (1980) showed that the Tepepan children had a similar caries level in primary teeth and a lower caries level in permanent teeth. Although the Tepepan group showed fewer carious lesions, their caries index and unmet restorative index are still high, especially for primary dentition, so an intensive educational, preventive and restorative program is required.