Pattern and severity of early childhood caries

OBJECTIVES: The aim of this study was to investigate the association between selected social and behavioural variables and the pattern and severity of early childhood caries (ECC) within a community child population. METHODS: A cross-sectional sample of 2515 children aged 4-5 years were examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) indices and a self-administered questionnaire was used to obtain information regarding social, demographic, birth, infant feeding, oral and general health attitudes. Children with caries (847) were divided into anterior or posterior caries pattern groups and severe (dmfs score > or =6) or non-severe (dmfs score <6) caries groups. The data were analysed using a chi-square test and modelled using a logistic regression procedure. RESULTS: Significant variables associated with anterior ECC pattern were ethnicity other than Caucasian (OR = 2.1, 95% CI = 1.4-3.1), sipping from the bottle during the day (OR = 1.9, 95% CI = 1.3-2.7), male gender (OR = 1.6, 95% CI = 1.2-2.2) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2). Significant variables associated with severe ECC form were sipping from the bottle during the day (OR = 2, 95% CI = 1.4-2.8), maternal age at birth < or =24 years (OR = 1.8, 95% CI = 1.3-2.7), ethnicity other than Caucasian (OR = 1.6, 95% CI = 1.1-2.5) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2). CONCLUSIONS: Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4-5-year-old Australian children.     

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.     

Longitudinal Study of the Caries Susceptibility of Occlusal and Proximal Surfaces of First Permanent Molars

Ten- to 13-year-old children were examined annually for three years to determine the caries activity in the proximal and occlusal surfaces of first permanent molars. Almost every tooth with an unsound (carious or filled) proximal surface also had an unsound occlusal surface. Caries scores in proximal surfaces remained relatively constant and low. The percentage of teeth with occlusal caries or fillings increased throughout the study, even though the teeth had been erupted for seven to ten years by the end of the study. Within the age range studied, the time that teeth were in the mouth had little effect on the vulnerability of occlusal surfaces to caries attack.     

The University of North Carolina Caries Risk Assessment study: further developments in caries risk prediction.

Over 4000 first and fifth grade children from the areas surrounding Aiken, South Carolina, and Portland, Maine, participated in a 4-yr study to develop caries risk assessment models. The predictors used at baseline included detailed clinical examinations, salivary microbiological tests, and sociodemographic and dental behavior data. Mean 3-yr caries increments in South Carolina were twice those in Maine. For the four risk assessment models (two grade cohorts at two sites) specificity values averaged 0.83 and sensitivity values averaged 0.60. Clinical predictors such as prior DMFS, pit and fissure morphology, and predicted caries risk status were the major contributors to the models.     

Study design to reduce biases in estimating the percentage of carious lesions that do not progress within a time period

Abstract Much of the available information on the rate of caries progression comes from studies in which two examinations have been done and the percentage of lesions that do not progress from a carious state between the examinations recorded. Extrapolation from this type of study is subject to two offsetting biases. On the one hand, slow progressing lesions that have been in a state for a long time before the first examination may progress between examinations. When these are counted as lesions that progress within the time period between the two examinations, there will be an underestimation of non-progressing lesions. On the other hand, slow progressing lessions will be over-represented in the sample of lesions detected at the first examination. This will result in an overestimation of non-progressing lesions. We suggest a three examination protocol to minimize these biases.     

上海蓬莱地区龋病调查

目的为了查清蓬莱地区居民口腔健康状况，为制订预防计划提供基线资料，为口腔保健措施及口腔健康教育的监测与效果提供依据。方法采用分层，等比整群随机抽样的方法，所采用的诊断标准为第二次全国口腔健康流行病学调查的标准。结果患龋率分别为：５岁组６３．１％，１２岁组２８．６％，１５岁组３１．８％，１８岁组４３．６％，３５～４４岁组４１．３％，６５～７４岁组６１．８％。结论本次调查发现：①不同年龄组居民患龋率有明显差异。②本地区居民患龋率，龋均与第二次全国流行病学调查上海地区调查结果相比较低     

Carisolv技术治疗乳牙龋病的临床应用评价

目的:比较和评价Carisolv去龋技术和采用低速牙钻去龋治疗乳牙龋病的效果和患儿接受程度.方法:选择年龄6～10岁,双侧乳牙均患中龋的儿童100名,以自身半口为对照,分别用Carisolv和牙钻去龋,然后用复合体充填,记录去龋时间.采用问卷调查患儿对两种去龋方法的接受程度,1年后复查,观察修复体的情况.结果:Carisolv去龋时间(4.36±1.28)min长于低速牙钻去龋时间(2.60±0.84)min.82%的患儿认为Carisolv去龋疼痛轻于牙钻；多数患儿倾向使用Carisolv去龋.1年后复查表明Carisolv和牙钻去龋的修复体继发龋率、脱落率方面无显著性差异.结论:Carisolv去龋时患儿疼痛程度明显减轻,但去龋时间略长于牙钻去龋,多数患儿倾向于Carisolv去龋.Carisolv修复术后的继发龋率并未增加.     

龋病再认识

随着对龋病研究的不断深化,龋病的病因、分类以及治疗计划的观念发生改变。通过对患者进行龋病危险性评估,分析并控制龋病发生的危险因素,制定基于龋危险性评估的个性化龋病管理和治疗计划,有针对性地实施无创、微创、有创的循序渐进式龋病防治技术,已成为现代龋病防治的趋势。     

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.     

The University of North Carolina Caries Risk Assessment Study. II. Baseline Caries Prevalence

Baseline clinical dental examinations were conducted on 5,233 children in grades 1 or 5 from the areas surrounding Aiken, SC, and Portland, ME, as part of a longitudinal study being conducted to predict children at high risk to dental caries. Mean caries levels in the Aiken area were nearly twice those of the Portland area. Black children experienced slightly more disease than whites. In addition to lower levels of caries experience, Portland children also had more treatment needs met, as indicated by higher filled ratio scores.     

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??Objective    Through the analysis of epidemic situation of dental caries in preschool children aged 3-5 years in Baotou city??to discuss the relationship between caries situation and the degree of dental caries activity. Methods    Totally 379 children??male 196??female 183??were selected in 5 kindergartens for dental caries examination with random choice. The dental caries rate??decayed or filled teeth??dft??and caries severity index??CSI??were calculated. Caries activity??CAT?? was measured by caries activity test. Results    The caries rates??dental filling teeth??dft??and caries severity index??CSI??respectively were 56.20%??3.82 and 10.11 in 3-5 years old children in Baotou city. There was no statistically significant difference between male and female??P > 0.05??. The incidence of caries??dft and CSI had no statistically significant difference in all age groups??P < 0.05??. There was no difference in dft and CSI when CAT were at the degree from 0 to 1and from 2 to 3 when each two groups were compared??P > 0.05??. Others had statistically significant difference??P < 0.05??. CAT was positively correlated with dft and CSI at each degree??r = 0.394 and 0.363??P < 0.05??. Conclusion    Caries activity test can reflect the degree of decay effectively and accurately. It is important to screen for high-risk caries patients in children. Reasonable prevention and treatment measures should be developed in response to the caries situation in school-aged children in Baotou city??in order to lay a solid foundation for preventing caries in children.     

Caries risk assessment: methods available to clinicians for caries detection

It is hypothesized that occlusal lesions are initiated on the fissure walls and can therefore be obscured by sound superficial tissue. Additionally, there is evidence that one effect of regular use of fluorides is greater opacity of enamel, which may obscure underlying lesions in dentin, the so-called 'hidden lesions'. Dental radiographs are inadequate for detecting decay in the occlusal surfaces until the lesion is well advanced through the enamel and into the dentin. The clinician relies on visual observation of texture and discoloration, clinical judgment based upon experience, and on tactile sense by probing with an explorer. An objective detection method to complement the traditional visual assessment is used by the clinician for arriving at clinical decisions on the management of the carious lesion: whether invasive therapy or a more conservative, noninvasive approach. Objective and reliable longitudinal monitoring of the lesion's response to preventive measures allow the selection of an appropriate therapy before the lesion progresses to the stage where invasive treatment is required. This paper discusses the problem of the lack of appropriate clinical methods for the detection and quantification of carious lesions. A few commercially available methods are described (the quantitative light-induced fluorescence method, the DIAGNOdent device, and electrical caries monitor) and some new techniques mentioned.     

A Quantitave Analysis of the Numerical Density and the Distributional Pattern of Prisms and Ameloblasts in Dental Enamel and Tooth Germs: II. Serial Etching of Dental Enamel

Abstract

Objective. As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbrushing with fluoridated toothpastes or gels and involving institutions noted as having the highest caries levels. Materials and methods. The caries data (d₃mft/D₃MFT) was extracted from the results of the compulsory school entry examinations in Greifswald/Germany (2003/2004–2012/2013) involving ～ 280 6–7-year-olds each year. Data from schools that include children with the highest caries levels and coming from low-SES families were analyzed independently and used for comparisons. Additionally, caries trends from Greifswald were compared to data from representative national surveys (2004–2009). Results. Data from 2871 children were available for analysis. The baseline d₃mft value (2003/2004) was 3.2 ± 3.8; the d₃-component corresponded to 70% of the index. The latest caries data (2012/2013) showed a strong reduction (43.8%) in caries prevalence (d₃mft = 1.8 ± 2.5). Similarly, the SiC-Index declined significantly from 2003/2004 (7.9 ± 2.3) to 2012/2013 (4.8 ± 2.3; p < 0.001). Nevertheless, in all analyzed years the d₃mft values and the SiC-Index were significantly higher in the institutions that included children coming from lower-SES families (p < 0.05). The amount of caries reduction between 2004 and 2009 corresponded to 38% in Greifswald as compared to 13% in Germany. Conclusions. This strategy involving a combination of regular toothbrushing and fluoride application has achieved an overall substantial caries reduction, thereby indicating that caries-control strategies for heterogeneous risk groups can be highly successful as setting approach. However, activities targeting high risk groups still need to be strengthened.     

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。     

Community risk indicators for dental caries in schoolchildren: an ecologic study

Abstract A statewide survey of NC schoolchildren found wide variation in dental caries prevalence among sampled classrooms. This study examined factors associated with this variation using classrooms as a surrogate for the larger community, in order to identify community risk indicators (CRI). In all, 172 classrooms (3400 students) in Grades K-6 were available for analysis. Initially, 56 sociodemographic, environmental, health system, and clinical factors were evaluated for their association with caries prevalence (K-3: average dfs-f DMF'S; 4–6: average DMFS) using univariate and bivariate analyses. Of these, 21 factors met our criteria for evaluation using WLS multivariate regression. For Grades K-3 (w=108), population density, parental education, and coastal residence were negatively associated with caries scores, while age, and medical and dental Medicaid expenditures were positive. For Grades 4–6 (n=64), age and fs:dfs ratio were positively associated with caries scores, while population density, population: dentist ratio, and years of natural fluoride exposure were negative. CRIs for both models, when compared to individual models, explained a substantial portion of the variation in caries prevalence, 31% for Grades K-3 and 51% for Grades 4–6. Results suggest that a risk assessment model based on community rather than individual variables is feasible and further refinement may reveal factors useful in identifying high risk communities.     

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.     

Reasons for the caries decline: what do the experts believe?

The aim of this paper was to describe what experts of today believe are the main reasons explaining the caries decline seen in many westernized countries over the past 3 decades. We have collected the views of a number of international experts, trying to answer the specific question “What are the main reasons why 20-25-year-old persons have less caries nowadays, compared to 30 years ago?”. A questionnaire was mailed to 55 experts with a number of thinkable explanations to be scored according to a predetermined scale. The 25 items were divided into main groups under the heading of diet, fluorides. plaque, saliva, dentist/dental materials and other factors. The experts were asked to think of a specific country or area, and also to specify whether the chosen area had water fluoridation or not. The main finding of our study, based on a 95% response rate, was that there is a very large variation in how the experts graded the impact of various possible factors. For the use of fluoride toothpaste, there was a clear agreement of a definite positive effect.     

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。     

Coronal and Root Decay Experience in Older Adults in Ontario, Canada

This paper describes the coronal and root caries experience of subjects aged 50 years and older living in four communities in Ontario, Canada. The data were obtained as part of a comprehensive epidemiologic study of the oral health and treatment needs of this population. Caries experience was defined as the number of decayed and filled coronal and root surfaces per subject. Of 907 subjects interviewed and clinically examined, 78.3 percent were dentate and retained a mean of 18.9 teeth. The mean number of coronal decayed and filled surf aces was 23.9; 95.6 percent of subjects had at least one coronal DFS. The mean number of decayed and filled root surfaces was 3.6; 70.9 percent had at least one root DFS. The percent D/DFS was 3.5 for coronal and 20.0 for root caries. In linear regression analysis the number of teeth, making regular preventive visits, being born in Canada, and educational status emerged as predictors of coronal DFS. Predictors of root DFS were the number of surf aces with recession, the number of coronal DFS, the number of teeth, age, sex, and smoking status. These variables accounted for 42 percent and 35 percent of the variance in the number of coronal and root DFS, respectively.