Caries-risk assessment in early childhood using a caries activity test

BackgroundCaries-risk assessment based on the individual caries-risk is very important in the public health setting. The objective was to longitudinally assess the caries-risk of each group using cutoff points. Each groups were low, moderate, progressive border, improved border, moderately high, and high caries-risk groups which were determined based on the 18-month and 2-year-old current and 3.5-year-old predicted cutoff points.MethodsThis study was a two-year longitudinal study of 1,206 children born in 2000. The children were divided into six caries-risk groups using the current and 3.5-year-old predicted cutoff points at 18 months and 2 years of age. It was investigated as to which caries-risk assessment was better.ResultsThe 3.5-year-old predicted cutoff points calculated based on the 18-month and 2-year-old caries activities were more suitable for caries-risk assessment through analysis of significant differences of the mean numbers of dft in each groups.ConclusionIt was suggested that researchers and practitioners should try to keep caries-risk of children in the low or moderate caries-risk groups for caries prevention.     

Caries increment in the permanent dentition of Mexican children in relation to prior caries experience on permanent and primary dentitions

OBJECTIVE: To evaluate the likelihood of caries increment in schoolchildren, based on their prior caries experience. MATERIAL AND METHODS: We undertook a longitudinal study in 452 six-to-nine year olds between 1999 and 2001 in Mexico, with dental exams conducted by two standardized examiners (kappa>0.85). The dependent variable was the DMFT increment, dichotomized as without increment, and at least one unit of increment. Independent variables estimated caries experience at baseline. Data were analyzed using non-parametric tests and generalized linear models (log-binomial) to calculate relative risk (RR) adjusted for age and sex. RESULTS: The percentage of caries-free children diminished by 20.5% from 1999 to 2001. DMFT index increased two-fold, from 0.25+/-0.70 in 1999 to 0.77+/-1.30 in 2001 (p<0.001). The overall risk for this sample was 24%. The DMFT increment was higher (p<0.001) in children with DMFT>0 and dmft>0 in 1999 (RR=1.89, 95% CI=1.37-2.62; RR=2.71, 95% CI=1.94-3.76, respectively). The likelihood for DMFT increment from the 1999 levels was: (1) 2.78 times higher (95% CI=2.06-3.76) if schoolchildren had caries in any of the first permanent molars and (2) 1.62 times higher (95% CI=1.20-2.19) if schoolchildren were affected by high severity caries at baseline. CONCLUSIONS: Both caries prevalence and mean DMFT had significant increments in 18 months. Dental caries in the primary (dmft) and permanent (DMFT) dentitions at baseline are goods indicators of subsequent caries development in this group of children in a medium income country. This relationship became stronger when the occurrence of caries in the first permanent molars was included.     

DGA下龋病治疗对儿童口腔健康及生长发育的近期影响

目的 随访在全身麻醉下行龋病治疗的患儿,分析全麻下龋病治疗对儿童口腔健康及生长发育的近期影响。方法 收集2017年2月—2018年1月在上海交通大学医学院附属第九人民医院儿童口腔科进行全身麻醉下龋病治疗并符合研究标准的全部病例。经患儿家长知情同意,研究者在术前、术后随访时检查患儿口腔情况,记录身高、体重,检测龋活跃性。采用SPSS 25.0软件包对数据进行统计学分析。结果 治疗前患儿平均龋均值为14.02,夜奶喂养及过早人工喂养的患儿龋均值明显偏高。术后3个月时龋病复发率为25.67%,6个月时龋病复发率为50%。治疗后患儿龋活跃性发生明显改变,3次随访结果中,龋活性值在术后3个月时最低。全麻治疗后患儿用餐时间显著缩短,进食次数及摄入甜食的频率明显下降,刷牙时间明显延长。术后BMI处于正常范围的儿童数量显著增加。结论 全身麻醉下龋病治疗可在短期内显著降低患儿的龋活跃性,改善患儿的口腔健康行为和发育情况。但大部分患儿治疗后仍具有较高的龋复发风险。     

北京市海淀区3岁儿童龋病患病状况及龋病活跃性检测的研究

目的 通过了解北京市2所大学附属幼教机构学龄前儿童的口腔健康状况、龋病活跃性,了解儿童患龋情况与龋病活跃性之间的关系,探讨龋病活跃性检测筛查龋易感儿童及反映龋活跃性检测试剂的灵敏性和特异性,评价其对患龋预测的有效性和可行性.方法 对3岁年龄组儿童进行连续1年的口腔检查和龋活跃性检测,分析儿童患龋情况的变化与龋病活跃性之间的关系.结果 3岁儿童的患龋率为44.80%,龋均dft为2.04,龋面均dfs为2.79,儿童龋活跃性检测结果的各个分值与儿童患龋程度呈高度正相关关系(P<0.001).1年后随访,龋高危组儿童的新龋发生率显著高于龋低危组,经统计学检验其差异具有显著性意义(P<0.001).Cariostat法进行龋活跃性检测的敏感度可达95.1%,特异度达50.2%.结论 龋活跃性检测能够准确的反映儿童龋患现状,预测儿童患龋的趋势,为儿童制定个性化的预防保健计划.     

A longitudinal study of early childhood caries risk,dental caries,and life style

The objectives of this longitudinal study were to assess children's caries risk and mean number of decayed teeth and determine their life style factors that influence their caries activity. A total of 283 children were selected based on the following criteria: they had 1.5, 2.5, and 3.5-year-old oral examinations, participated in Cariostat microbial sampling and the mother of a child filled out the questionnaires. Caries experiences of children were 2.1% for the 1.5-year-old, 8.1% for the 2.5-year-old, and 14.8% for 3.5-year-old period, respectively. Caries risk at the 1.5-year-old period showed significant differences (P<0.001) for mean number of decayed teeth when children were at the 2.5-, and 3.5-year-old period. A significant difference (P<0.01) was also seen for caries risk at the 2.5-year-old period. Regarding children's lifestyle factors at the 1.5-year-old period, pre-chewing food and breastfeeding produced significant caries susceptibility in both 2.5- and 3.5-year-old period. Additionally, children's life styles were analyzed to have an impact on caries only at the 2.5-year-old period. For children's life style at the 2.5-year-old period, increased frequency of snack, irregular snack time, and brushing without assistance by the mother put 3.5-year-old children at high risk of developing caries. A caries activity test could predict 2.5-, and 3.5-year-old children's caries risk based on the 1.5-year-old test result. Some children's life styles at an early age showed a higher risk of developing caries at a later age.     

Associations between caries activity,salivary buffer tests and caries increment in Mongolian children

The aim of the study was to evaluate caries increment in combination with a caries activity test (CAT21 Test) and a salivary buffer test (CAT21 Buf Test)—to predict future caries activity in Mongolian preschool children living in Ulaanbaatar City. The effectiveness of combining both tests and deft (decayed, extracted, filled teeth) means was also investigated. The caries prevalence in subjects was 94%, and deft mean value was 6.8. The caries increment after one year was 2.3 teeth. From the distribution of CAT21 Test scores a low risk was found in 38.6% and high risk in 61.4% of the examined children. From the CAT21 Buf Test scores, the high risk (lower buffer capacity) was found in 79.8% of the examined children. When the combination CAT21 Test and CAT21 Buf Test scores were divided into four groups (low-low/lowhigh/ high-low/high-high), the mean def-teeth showed a significant difference among the four groups (ANOVA P < 0.001). One year after the caries increment was evaluated in combination with the CAT21 Test scores and CAT21 Buf Test scores, the low-low risk group showed the lowest mean def-teeth. On the other hand, the high-high risk group showed the highest mean def-tooth (ANOVA P < 0.05). Based on these results, the CAT21 Test and CAT21 Buf Test are useful for clinical application of preschool children in predicting future caries activity. Furthermore, when the CAT21 Test and the CAT21 Buf Test were combined, a higher correlation was shown with the caries status.     

Validity of caries risk assessment programmes in preschool children

Objectives

Various programmes have been developed for caries risk assessment (CRA). Nevertheless, scientific evidence on their validity is lacking. This study aimed to compare the validity of 4 CRA programmes (CAT, CAMBRA, Cariogram, and NUS-CRA) in predicting early childhood caries.

Methods

A total of 544 children aged 3 years underwent oral examination and biological tests (saliva flow rate, salivary buffering capacity and abundance of cariogenic bacteria mutans Streptococci and Lactobacilli). Their parents completed a questionnaire. Children's caries risk was predicted using the 4 study programmes without biological tests (screening mode) and with biological tests (comprehensive mode). After 12 months, caries increment in 485 (89%) children was recorded and compared with the baseline risk predictions.

Results

Reasoning-based programmes (CAT and CAMBRA screening) had high sensitivity (≥93.8%) but low specificity (≤43.6%) in predicting caries in children. CAMBRA comprehensive assessment reached a better balance (sensitivity/specificity of 83.7%/62.9%). Algorithm-based programmes (Cariogram and NUS-CRA) generated better predictions. The sensitivity/specificity of NUS-CRA screening and comprehensive models were 73.6%/84.7% and 78.1%/85.3%, respectively, higher than those of the Cariogram screening (62.9%/77.9%) and comprehensive assessment (64.6%/78.5%). NUS-CRA comprehensive model met the criteria for a useful CRA tool (sensitivity + specificity ≥ 160%), while its screening model approached that target.

Conclusions

Our results supported algorithm-based approach of caries risk modelling and the usefulness of NUS-CRA in identifying children susceptible to caries.

Clinical significance

This prospective study provided evidence for practitioners to select tools for assessing children's caries risk, so that prevention measures can be tailored and treatment plan can be optimised.     

上海市浦东新区低龄儿童龋危险因素分析

目的：建立幼儿园儿童的前瞻性队列,纵向研究低龄儿童龋的发病原因。方法：采用整群随机抽样方法,在上海市浦东新区城郊各抽取1所幼儿园,共240名小班儿童加入本研究。采用SPSS 21.0软件包中的χ²检验、方差分析、二项logistic回归模型和一般线性回归模型,对该队列儿童基线及随访1年后的龋患情况进行分析。结果：该队列研究前2年随访率为88.3%,基线和随访第1年儿童患龋率分别为58.3%,69.8%,龋均分别为3.1±4.2、4.5±4.9,56.1%的儿童发生新龋。Logistic回归分析显示,居住在郊区（P=0.010）和吃糖果频率较高（P=0.036）的儿童,新发龋率较高。一般线性回归方程结果显示,郊区儿童（P<0.001）,未使用含氟牙膏（P=0.003）以及吃糖果频率较高（P=0.002）的儿童,新发龋均较高。结论：居住在郊区、未使用含氟牙膏以及进食糖果频率较高,是学龄前儿童新发龋的重要危险因素。     

Risk behaviors and their association with presence of S.mutans or S.sobrinus and caries activity in 18-month-old Japanese children

The purpose of this study was to investigate risk behaviors associated with the presence of S. mutans or S. sobrinus and caries activity. The subjects were 448 mother-child pairs who underwent dental health examinations between February 2004 and November 2004 when the children were 18 months old. Caries activity was assessed by the Cariostat test. The presence of S. mutans and S. sobrinus was detected using PCR techniques. Questionnaires regarding risk behaviors were completed by the mothers. A statistically significant correlation was found for the detection of S. mutans and/or S. sobrinus in children and mothers (P < 0.01). High-risk mothers were more likely to have high-risk children (P < 0.001). In children in whom bacteria were detected, breast-feeding was ranked as the most important risk factor (P < 0.01), followed by eating snacks while playing (P < 0.01), getting snacks from neighbors (P < 0.05), being cared for by grandparents (P < 0.05) and pre-chewing of children's food by mothers (P < 0.05). In children with high caries risk, breast-feeding and pre-chewing were the most important risk factors (P < 0.01), followed by taking meals at irregular intervals and mothers not attending maternity classes (P < 0.05).     

The effect of a preventive program, including the application of low-concentration fluoride varnish, on caries control in high-risk children

The aim of this 2-year prospective randomized clinical study was to evaluate the efficacy of a prevention program for schoolchildren with high caries risk. A sample of 419 subjects was divided into a test (T, n=259) and control group (C, n=160). Four times a year, the test group received professional tooth-cleaning and application of a 0.1% fluoride varnish as well as motivation and instruction in oral hygiene. The control group received only oral hygiene instruction and took part in supervised tooth-brushing once a year. At baseline and after 2 years, the D₃,₄MFS and the incipient lesions (D_1,2) were recorded. After 2 years, 318 subjects (T=187, C=131) were included in the data analysis. The baseline D_1,2 was 6.18 (T) and 5.50 (C), the D₃,₄MFS 2.13 (T) and 2.08 (C), respectively. No statistically significant difference was found for the baseline values. At the final examination, the D_1,2 increment was 3.96 in the test and 6.53 in the control group, showing a statistically significant difference (P<0.001). No such difference was found for the D₃,₄MFS increment (T: 2.22; C: 2.61). The results indicate that it might not be possible to prevent cavities in high caries risk children by means of the described program. Received: 24 August 2000 / Accepted: 18 September 2000     

纵向研究0-2岁婴幼儿变异链球菌群与早期婴幼儿龋的关系

目的探讨8～32个月婴幼儿牙菌斑中变异链球菌群的定植情况,并分析其早期定植与龋病关系。方法收集广州市花都区新华镇225名8月龄婴幼儿,每半年复查一次,持续两年,至婴幼儿32月龄。复查内容包括龋病检查和前牙牙菌斑样本收集。WHO诊断标准用于龋病诊断,选择性培养基及生化实验用于变异链球菌群的分离鉴定。统计方法采用χ2检验或Fisher确切概率法。结果 8月、14月、20月、26月和32月龄变异链球菌群定植率分别为6.7%、31.2%、50.3%、61.0%和75.5%。其中,8月龄组有2名幼儿检出变异链球菌群未见乳牙萌出。变异链球菌群首次检出的平均年龄为（19.6±6.9）个月。婴幼儿乳牙变异链球菌群早期定植患龋率高于晚期定植,32月龄组差异有统计学意义（P=0.018）。结论变异链球菌群能在未萌牙口腔中检出,其定植率随年龄的增长而增加。变异链球菌群在前牙面的早期定植促进乳牙龋病的发生。     

Quarter of a century of change: caries experience in Australian children, 1977–2002

Background:  The establishment of the evaluation programme of the Australian School Dental Scheme has led to continuous surveillance of child oral health extending from 1977 to the present day. The aims of this study were to examine the state of child oral health in Australia in 2002 and to explore longer term trends across the quarter of a century of recorded surveillance activity.
Methods:  Caries data were obtained for children who were enrolled in the School Dental Services of each state and territory for the years 1977–2002. Data collection derived from routine examinations within the School Dental Service with oral examinations carried out by dentists and dental therapists.
Results:  There were considerable declines in caries experience between 1977 and the mid to late 1990s, with mean decayed, missing and filled deciduous teeth (dmft) for 6-year-old children decreasing from over 3 in 1977 to approximately 1.6 in 1996, and permanent 12-year-old decayed, missing and filled teeth (DMFT) decreasing from 4.8 in 1977 to 0.89 in 1998. However, since the mid to late 1990s, deciduous 6-year-old dmft has increased by 24 per cent and 12-year-old DMFT has increased by almost 15 per cent. Reductions in caries experience of those children with the most disease have also ceased, and between 1999 and 2002 an increase in the Significant Caries Index occurred.
Conclusions:  Improvements in the oral health of Australian children halted during the mid 1990s, after which caries experience has increased. It is important that we understand the changes taking place and their causes, so that action can be taken to halt any further possible declines in child oral health.     

An in vivo investigation of associations between saliva properties, caries prevalence and potential lesion activity in an adult UK population

OBJECTIVE: To investigate associations between prevalence and activity of intra-oral incipient, carious lesions and salivary properties tested using the Saliva Check kit (GC Corp., Belgium). METHODS: With ethical approval, 58 subjects with >16 teeth underwent clinical/radiographic examination. Conventional decayed, missing, filled teeth/decayed, missing, filled surfaces (DMFT/DMFS) indices and a more recently developed visual index described by International Caries Detection and Assessment System (ICDAS) were used to ascertain caries prevalence. Potential lesion activity was scored using an Ekstrand visual index. Saliva properties tested included hydration, resting pH, stimulated flow and buffering capacity. Spearman's rank correlation was used to analyse data. RESULTS: No saliva parameters correlated significantly with DMFT/DMFS caries prevalence scores (D3 threshold). The resting pH correlated negatively and significantly with the total number of lesions (r=-0.267, p=0.043), with ICDAS scores >1 (r=-0.333, p=0.011) and with mild lesions (r=-0.263, p=0.046). A negative correlation was found between saliva buffering capacity and the potential activity of moderate lesions (ICDAS 3 and 4; r=-0.227, p=0.035). CONCLUSIONS: There appeared to be a correlation between the resting pH of saliva and the prevalence of early lesions as well as the saliva buffering capacity and the potential lesion activity of moderate lesions. A difference was shown between lesion prevalence calculated using traditional DMFT(S) D3 versus the ICDAS D1 thresholding.     

北京市1～4岁儿童龋流行情况调查及其危险因素的初步研究

目的 调查婴幼儿龋流行情况及其相关因素的分析以利于早期防治。方法 对北京市海淀、丰台8所幼儿园408名1～4岁儿童，女195名，男213名，通过口腔检查龋齿及详细问卷调查，最后分别作统计分析及Logistic回归分析。结果 本研究婴幼儿龋患病率为40．19％，男性45．07％，女性34．87％，两性间有显著差异。各年龄组间患病率也有显著性差异。婴幼儿龋和乳磨牙龋的发生密切相关，Logistic回归分析结果显示，婴幼儿龋发生的危险因素依次为睡前哺乳，年龄，母亲受教育的程度，每天吃甜食及含糖饮料的次数，哺乳持续时间，刷牙的频率，均有相关性。针对婴幼儿龋的危险因素予以早期防治。结论 强调对双亲早期教育，尽早地去看口腔医生及局部用氟极为重要。     

A study on non-nutritive sucking habits in young Japanese children —Relationships among incidence,duration, malocclusion and nursing behavior—

PurposeThe purpose of the present study was to investigate the non-nutritive sucking habits of 18-month-old and 42-month-old children in order to determine the best method of advice to stop sucking habits.MethodWe examined the present situation of oral habits, the time of commencement and the time of discontinuation of the habits, the condition of occlusion, and the nursing behavior during the first 3 months from birth in the subjects.ResultsThe incidences of finger sucking and pacifier sucking habits in the 18-month-old children were 25.6% and 16.9%, respectively, and the incidences of the habits in the 42-month-old children were 27.2% and 16.8%, respectively. Most cases of the finger sucking habit continued until after 3 years of age, but the pacifier sucking habit was discontinued before 42 months of age. Open bite or maxillary protrusion was found in 70.7% of the 42-month-old children with persistent non-nutritive sucking habits but in only 6.8% of the 42-month-old participating children who had broken their sucking habits. We examined the correlation between non-nutritive sucking habits and nursing behavior. The incidence of oral habits was significantly higher in bottle-fed children than in breast-fed children. Pacifier sucking was more prevalent in children with a short breast feeding duration than in children with a normal feeding duration.ConclusionThe incidence of finger sucking is higher than that of pacifier sucking in Japan. Malocclusion caused by a sucking habit is more frequent in pacifier suckers than in finger suckers. The incidence of oral habits is higher in bottle-fed children than in breast-fed children.     

窝沟封闭加局部用氟对龋高危儿童防龋效果观察

目的探讨窝沟封闭术联合局部应用含氟涂料对龋高危儿童龋齿的预防效果。方法选择6~8岁,乳牙龋牙数不低于4颗且至少有1颗深龋或需牙髓治疗的龋高危儿童51例为研究对象,双侧同颌第一恒磨牙作为受试牙,共146颗。采用自身半口对照方法,随机选择一侧受试牙应用窝沟封闭术,另一侧应用窝沟封闭术联合含氟涂料涂布,分别设为对照组和试验组。定期复查封闭剂保留情况和患龋情况。结果 12、18个月时,试验组龋齿发生率显著低于对照组（P〈0.05）,龋坏主要发生在封闭剂脱落的窝沟内。结论相比单一的龋病预防模式,联合应用窝沟封闭和含氟涂料,能更有效地降低龋高危儿童龋病发生率,减少龋病对儿童牙齿的破坏,值得临床推广应用。     

上海市2岁幼儿龋病现状和危险因素的初步分析

目的调查分析上海市2岁幼儿龋病患病现状及其危险因素,为上海市幼儿龋病的早期防治提供依据。方法采用多阶段随机抽样方法抽取上海市576名2岁幼儿进行龋病检查和相关饮食喂养习惯的问卷调查,并对结果进行统计学分析。结果上海市576名2岁幼儿乳牙患龋率为18.40%,龋均为0.61,龋面均为0.84。高频率摄取甜食和非定时喂养是幼儿龋病发生的重要危险因素。结论对家长进行早期口腔健康教育,养成合理的饮食喂养习惯是预防幼儿龋病的重要措施。     

两种正畸酸蚀粘接法对儿童致龋活跃性的影响

目的:通过比较传统酸蚀后粘接与自酸蚀粘接正畸固定矫治器后龋活跃性的变化,了解矫治过程中不同酸蚀粘接法与龋活跃性的关系及其诱龋活跃性的差异.方法:随机选择30例11～14岁正畸儿童,安装方丝弓固定矫正器,左侧上下牙列采用传统酸蚀粘接法,右侧牙列采用自酸蚀粘接法,通过CAT龋病活跃性检测法比较正畸前及正畸后1周、1个月、3个月和6个月的龋病活跃性度数.结果:矫治前龋活跃性度数与矫治后3个月和6个月具有显著性差异(p＜0.05);与矫治后1周和1个月无显著性差异(p＞0.05).结论:两种粘接法致龋活跃性明显不同,传统法致龋活跃性高于自酸蚀法.     

东莞市12岁儿童龋病现状及其行为影响因素分析

目的:研究东莞市城乡12岁儿童恒牙龋病现状及其行为影响因素,分析两者之间的关系,为东莞市儿童口腔卫生保健工作提供科学依据。方法:采用多阶段、分层、整群、随机抽样的方法,抽取东莞市12岁城乡常住人口604人,检查全口恒牙龋病的患病状况并用问卷调查的方式收集全部受检儿童口腔健康行为等相关因素。结果:东莞市12岁儿童患龋率和龋均分别是40.89%和1.47。Logistic回归分析显示:口腔保健知识掌握越多的儿童其患龋率越低,食用水果的频率越高,儿童患龋率也相应增加。结论:东莞市12岁儿童患龋水平较高,口腔卫生行为较差,口腔保健知识掌握情况是致龋最为重要的影响因素,食用水果的频率是危险因素。     

Association of passive smoking with caries and related salivary biomarkers in young children

OBJECTIVE: To investigate the association between passive smoking, as determined by salivary cotinine level, and caries, salivary pH, buffering capacity, flow rate and microbiological counts in young children. DESIGN: Ninety passive smokers (PS) with a mean age of 5.02 years and 90 healthy age-matched controls were included in this study. Family income, smoking habits of household members, parental education levels, child's tooth-brushing habit and child's daily dietary sugar exposure were recorded by questionnaire. Three categories were formed with respect to the number of cigarettes smoked. A dmft score was calculated according to the criteria recommended by the World Health Organization. The children were also investigated for stimulated salivary cotinine level, pH, flow rate, buffering capacity and salivary Streptococcus mutans and lactobacilli colonisation. RESULTS: There were no significant differences in tooth-brushing habit, sugar exposure, family income and parental education levels between the two groups (P>0.05). The mean cotinine level of the PS subjects was 1.58+/-4.3ng/ml. The dmft scores, and salivary S. mutans and lactobacilli colonisation in PS children were significantly higher than in the control subjects (P<0.05). Statistically significant decreases in salivary pH, flow rate and buffering capacity were found in the PS subjects (P<0.05). CONCLUSION: PS children are at increased risk of caries compared with control subjects.