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.     

The University of North Carolina Caries Risk Assessment Study I: Rationale and Content

This article presents the rationale and content of a current study that seeks to improve methods to identify children at high risk to dental caries. It summarizes the results of the development of a 12-factor, preliminary caries prediction model based on data derived from the National Preventive Demonstration Program. Despite data limitations, the model produced a sensitivity of .5 and specificity of .8 for four-year caries increment prediction in first- and fifth-grade children. Data on a number of additional potential predictors are being collected in two sites to expand and improve the existing model. These factors are identified.     

University of North Carolina Caries Risk Assessment Study. III. Multiple Factors in Caries Prevalence

The baseline caries experienced of approximately 5,000 children in South Carolina and Maine was used as the dependent variable in caries risk assessment analyses. Clinical, microbiologic, and demographic factors served as independent variables in a multivariate relationship to caries through regression and discriminant function analyses. Four factors--number of dental visits by the child in the past year, presence of white spot lesions, and both the urgency of need for restorative care and the future caries increment predicted by the examiner--associated significantly and consistently with caries prevalence in primary and permanent teeth of first and fifth graders at both study sites. Several factors associated significantly with caries prevalence at only one site or grade within a site, suggesting that wide applicability of a specific caries risk assessment model may be limited. In these analyses, sensitivity ranged from .60 to .72 and specificity varied from .86 to .91 in the four grade-site groups. The ultimate goal of this longitudinal study is to identify highly caries-prone children in time to prevent the occurrence of a future caries increment. Although the lack of consistent association of many variables, including microbiologic factors, with baseline caries prevalence was unexpected, it is expected that some of these variables will contribute predictive power in the prospective study.     

University of North Carolina Caries Risk Assessment Study: comparisons of High Risk Prediction, Any Risk Prediction, and Any Risk Biologic models

The purpose of this analysis is to compare three different statistical models for predicting children likely to be at risk of developing dental caries over a 3-yr period. Data are based on 4117 children who participated in the University of North Carolina Caries Risk Assessment Study, a longitudinal study conducted in the Aiken, South Carolina, and Portland, Maine areas. The three models differed with respect to either the types of variables included or the definition of disease outcome. The two "Prediction" models included both risk factor variables thought to cause dental caries and indicator variables that are associated with dental caries, but are not thought to be causal for the disease. The "Etiologic" model included only etiologic factors as variables. A dichotomous outcome measure--none or any 3-yr increment, was used in the "Any Risk Etiologic model" and the "Any Risk Prediction Model". Another outcome, based on a gradient measure of disease, was used in the "High Risk Prediction Model". The variables that are significant in these models vary across grades and sites, but are more consistent among the Etiologic model than the Predictor models. However, among the three sets of models, the Any Risk Prediction Models have the highest sensitivity and positive predictive values, whereas the High Risk Prediction Models have the highest specificity and negative predictive values. Considerations in determining model preference are discussed.     

Eighteen-month Coronal Caries Incidence in North Carolina Older Adults

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.     

The University of North Carolina caries risk assessment study: caries increments of misclassified children

The University of North Carolina caries risk assessment was conducted between 1986 and 1989 with 5000 children initially in grades 1 and 5 from low fluoride sites in South Carolina and Maine. Clinical, microbiologic, behavioral, and demographic factors served as independent variables used in logistic multiple regression models to determine the predicted caries risk classification of each child. The 3-yr DMFS increment of each child was the dependent variable, and the 20-25% of those in each cohort with the highest increment were considered the high risk group. Sensitivity and specificity values averaged 0.60 and 0.83 respectively, indicating the misclassification of substantial numbers of children. This paper reports analysis of the DMFS increments of the misclassified children. The majority of children had DMFS increments within one or two surfaces of the classification cut points. Many false negative children had increments composed entirely of filled surfaces, often of minimal extent and without evidence of previous decay. Many false positive children had increments composed of decayed surfaces and would have benefitted from being identified as high risk and assigned to a preventive program. Other false positive children had sealants placed after the baseline examination that undoubtedly reduced their true increment. It is concluded that the consequences of misclassification are not serious for most children in this study.     

四川省青少年儿童恒牙龋病抽样调查报告

目的:为了解四川省青少年人群口腔健康状况,制定龋病防治规划提供参考依据。方法:根据WHO《口腔健康调查方法》,参照“全国第二次口腔流行病学调查方法”,在四川省三市、三县,随机抽样共选取36 个调查点,3 个年龄组各调查2132 人,男女比为1∶1 ,共调查6396 人。结果:四川省青少年儿童随年龄增加龋患率增加,女性患龋率较男性高( P < 0105) 。12、15、18 岁组青少年儿童龋病患病率分别为28147 %、36140 %、39154 %;DMFT 分别为0152、0181、0199。龋患牙充填率低,需治龋牙60 %以上是单面洞。结论:四川省青少年儿童龋病患病率相对较低,但龋病仍广泛存在;龋充填率低,主要是单面洞需要治疗。     

Root Caries Prevalence in Black and White North Carolina Adults over Age 65

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.     

Caries prediction – state of the art

Abstract This paper considers the question of whether, by using the currently available measures for assessing caries risk, one can identify with sufficient accuracy the high caries-risk susceptible individuals who need individual protection to avoid having an unacceptably high number of new cavities. In addition, the outline of a typical caries prediction study is presented with an example. Finally, the accuracy of an actual caries prediction is compared with the accuracy of predicting the onset of acute myocardial infarction in order to point out the fact that the risk of any disease is difficult to assess accurately.     

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.     

银川市儿童青少年龋病患病趋势分析

的　分析银川市儿童青少年龋病患病的发展趋势及特点。方法　1990、1996和2001年采用WHO口腔 流行病学调查方法对银川市3岁、5岁、12岁和15岁的儿童青少年进行调查,记录龋均、龋面均和龋齿充填比率,并 进行统计分析。结果　1990~2001年,3岁、5岁和12岁儿童青少年的龋患呈下降趋势(P<0·01), 15岁青少年龋 患无明显变化;少部分儿童乳牙龋患严重;龋齿的充填比率较低。结论　随着口腔健康教育的开展,银川市儿童青 少年龋患呈下降趋势,但应加强对龋易感儿童的诊断、预防和早期治疗,提高龋齿充填比率。     

Dental Fluorosis and Caries Prevalence in Children Residing in Communities with Different Levels of Fluoride in the Water

Objectives: This study investigated the prevalence of dental fluorosis and caries in 7–14-year-old children residing in communities with negligible (NF: 0.2 ppm), optimal (OPF: 1.0 ppm), and four-times optimal (4X OPF: 4.0 ppm) naturally occurring fluoride in their water systems. Methods : Examinations were performed on 344 children who were lifetime residents of their communities. Results : Whether using the tooth surface index of fluorosis or Dean's index, children examined in the 4X OPF community had the highest prevalence of dental fluorosis. While the severity of fluorosis seen in the OPF and NF communities was mild in appearance, the results indicate that fluorosis does occur in optimally and negligibly fluoridated communities. Compared to the NF community, DMFT and DMFS scores in the OPF community were 9.2 percent and 21.2 percent lower, respectively. Conclusions : The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.     

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。     

Dental Caries Prevalence and Treatment among Navajo Preschool Children

Objectives: The purpose of this study was to assess the dental health of Navajo preschool children, a population about whom little dental information is published. Methods : Caries data were collected and analyzed for 2,003 Navajo children aged 3–5 years in the Head Start program, and for a convenience sample of 115 children younger than three years old from the Women, Infants and Children (WIC) program. Results : Each age group had an extremely high mean dmfs; however, as much as 70 percent of this index comprised treated surfaces. Maxillary anterior caries was observed in the WIC children under two years of age and posterior proximal caries was observed as early as two years of age. The prevalence of maxillary anterior caries reached a maximum of 68 percent in the three-year-old Head Start children, and may be associated with the high level of posterior caries in this population. Conclusions : Most children in this population may be considered at risk for developing caries. This Navajo preschool population has perhaps the earliest caries onset, among the highest caries prevalence, and among the highest level of treatment of any reported population.     

A Best Practices Approach to Caries Management

Caries management by risk assessment represents best practices and is an evidence-based model that focuses on treating and preventing disease at the patient level rather than a surgical/restorative approach at the tooth level.BackgroundDental caries is a multifactorial, biofilm and pH mediated disease that affects people of all ages and disproportionally affects certain populations at epidemic proportions. Simply restoring cavitated teeth does nothing to resolve the disease. At the heart of the CAMBRA philiosphy is identifying the patient's unique risk level for future caries disease. This can be done by completing a caries risk assessment (CRA). Several easy to use CRA questionnaires are available. Once the patient's unique risk level has been determined, preventive and therapeutic interventions, based on the specific risk level, can then be implemented.MethodsLandmark publications, original research, and systematic reviews are analyzed and reviewed to form the basis for this shift in patient care related to caries disease.ConclusionsCaries management by risk assessment has emerged as the new paradigm in patient care and represents an evidence-based, best practices approach with the potential for significant advantages over traditional methods.     

Three-year Root Caries Incidence and Risk Modeling in Older Adults in North Carolina

Objectives : The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults. Methods : Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three-year follow-up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina. Results : During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P<.05). The mean net DFS increment per person was 0.55±0.13 root surfaces for blacks vs 0.80±0.21 for whites (P>.32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession ≥2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession ≥4 mm, an average probing pocket depth ≥2 mm, and taking antihistamines were more likely to develop new lesions. Conclusions : These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.     

Examiner Agreement Between Hygienists and Dentists for Caries Prevalence Examinations

Dentists have been used as examiners in caries prevalence examinations almost exclusively. Only rarely have dental hygienists been reported as examiners in these types of studies. This article describes the degree of agreement for prevalence data (DMFT, dmft) and specific caries prediction information collected by hygienist-screeners and dentist-examiners. A total of 5,233 first- and fifth-grade children were screened by hygienist-screeners using a tongue blade only and then examined by dentist-examiners using an explorer and mirror. Agreement was analyzed in terms of percent agreement and the kappa statistic. The values for screener-hygienist dentist-examiner agreement were compared to interexaminer and interscreener reliability values. Means were also calculated for the caries indices. The results indicated good agreement for the caries indices between the screener-hygienist and dentist-examiner. Agreement for the prediction indices tended to be lower. The results suggest that hygienists can be used as examiners in caries prevalence studies.     

The Prevalence and Patterns of Dental Caries in Labrador Inuit Youth

Objectives: This study was undertaken to examine the prevalence of dental caries in Inuit (Eskimo) youth aged 5–22 years. Methods : Both tooth-oriented indices and child-oriented caries patterns were recorded in a field study conducted in 1991 in Nain and Hopedale, Northern Labrador. Seventy-eight percent (N=347) of all schoolchildren in these two locations were examined by a single examiner. Results : Three percent of the population were caries free and 88 percent of those with caries experience had untreated dental decay. The mean combined dmft and DMFT per child for all ages was 6.85, while the mean combined dmfs and DMFS was 15.72. About 38 percent of subjects had pit and fissure caries; 2 percent had hypoplastic lesions; 4 percent had faciolingual caries; 31 percent had molar-approximal caries and 22 percent had faciolingual and molar-approximal caries, the most destructive caries pattern. About 68 percent of the 5–6-year-olds and 26 percent of the 15–22-year-olds experienced the most destructive pattern of decay in their primary and permanent dentitions, respectively. Conclusions : Preventive measures should start well before the age of 5 years. Describing caries patterns according to the dentition type complemented the traditional indices.     

Caries Prevalence in Head Start Children, 1986–87

Since the early 1970s, caries prevalence among school-aged children in the United States has declined. It appears that a small percentage of the children experience most of the caries increment. In addition, a large proportion of children in the US who need dental care receive it. An important factor in the amount of treatment received by children is the socioeconomic status of the family. Data on caries prevalence among preschool populations are limited. The Head Start program serves low-income families in the US and offers a unique opportunity to look at individuals who may be at greater risk of health problems and may experience less access to health services. A survey of 1,796 three- to five-year old Head Start children from low-income families was conducted in 1986-87. Caries prevalence, baby bottle tooth decay prevalence and relative need for dental care are reported for fluoridated and non fluoridated communities in California, Hawaii, and Micronesia. The data reveal scores that are higher in the sample population than in five-year-olds in national surveys and among Head Start children in previous surveys.