Risk Indicators For Caries Research Articles

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study.

The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. In this cross-sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. Examinations were carried out in two local clinics by standardized examiners. One hundred twenty-nine dentate persons were examined. The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14-20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14-20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.

Maternal risk indicators for childhood caries in an inner city population.

This study evaluated whether characteristics of mothers, such as high mutans streptococci (MS) level, caries experience, reported sugar consumption and demographic variables, could be important risk indicators of caries for their children. Mothers selected on the basis of the caries status of their 3-5-year-old-children were tested for MS, caries, reported sugar consumption and demographic variables. We found strong associations between children's caries and their mothers' MS levels (high/low adj. OR = 11.3), maternal active caries (yes/no adj. OR = 4.0) and maternal sugar consumption (high/low adj. OR = 4.2). In this small study, mothers' demographic variables were not associated with the status of caries in their children. Our findings suggest that maternal high MS levels, maternal active decay and maternal sugar consumption are strong risk indicators for children's caries. Although further study is needed, these three maternal risk indicators, taken together, may prove useful in predicting children's caries risk.

Assessing risk indicators for dental caries in the primary dentition.

The aim of the present study was to assess indicators shown to be associated with the prevalence of caries in the primary dentition of 7-year-old Flemish schoolchildren. Cross-sectional first year data of the longitudinal Signal-Tandmobiel survey were analysed (n=4468). Gender, age, oral hygiene habits, use of fluorides, dietary habits, geographical factors and parental modelling were the considered predictors. From the multiple logistic regression analysis, including schools as a random effect, and after adjusting for the confounding variables-educational system and province (stratification variables), gender and age-it became clear that the following risk indicators remained significant (at 5% level) for the presence of caries: frequency of toothbrushing (P=0.05) with an OR 1.24 for brushing less than once a day, age at start of brushing (P<0.001) with an OR=1.22 for a delay of 1 year, regular use of fluoride supplements (P<0.001) with an OR=1.54 for no use, daily use of sugar-containing drinks between meals (P<0.001) with an OR=1.38, and number of between-meals snacks (P=0.012) with an OR=1.22 for using more than 2 between-meal snacks. There was a significant difference (P<0.05) in caries experience determined by the geographical spread, with an explicit trend of caries declining from the east to the west. In a model with an ordinal response outcome, the daily use of sugar-containing drinks between meals had a more pronounced effect when caries levels were high. From this study it became obvious that, in Flemish children, an early start of brushing and a brushing frequency of at least once a day need to be encouraged, while the use of sugar-containing drinks and snacks between meals needs to be restricted to a maximum of 2 per day. Geographical differences need to be investigated in more detail.

Clinical and behavioural risk indicators for root caries in older people.

To investigate the clinical and behavioural factors indicating root caries risk among older people. Cross-sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators, including sugars intake. A national sample of older British adults, free-living and institutionalised. 462 dentate adults aged 65 years or over. Nine or more intakes of sugars per day more than doubled the odds of root caries being present (OR 2.2-2.4). Other clinical and behavioural factors affecting root caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1-2.6) and infrequent tooth brushing (OR 2.8-4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root caries, as measured by the RCI(d). Of the factors open to possible clinical or behavioural intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.

A cross-sectional study into the prevalence of root caries in periodontal maintenance patients.

The aim of this cross-sectional study was to investigate cross-sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0-19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites: 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >106 mutans streptococci/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Changes in dental health and dental health habits from 3 to 5 years of age.

This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.

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. 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. 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. 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.

Partial dentures as an independent indicator of root caries risk in a group of older adults.

To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults. Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk. Data collected in the field from three areas of England. Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners. Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures. The presence of root caries, unsound and sound root restorations. Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface caries in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations. In this study, where RPDs were present, the odds of untreated disease being present increased substantially.

Relationship between caries and level of metabolic balance in children and adolescents with insulin-dependent diabetes mellitus.

The relationship between the occurrence of caries and diabetes was explored in 80 children and adolescents with insulin-dependent diabetes mellitus. The mean age of the subjects was 14.5 years (range 11.7-18.4 years) and duration of diabetes 0.3-15.0 years (mean 6.0 years). DFS indices in poorly controlled subjects (glycosylated haemoglobin, HbA1, values over 13%) were significantly higher than in moderately (HbA1 10.0-12.9%) or in well-controlled cases (HbA1 values < 10%). However, the difference was not statistically significant if adjustments were made for age, age at the onset of diabetes and duration of diabetes (p = 0.1, Ancova). Subjects with caries and/or fillings had significantly higher short- and long-term HbA1 values than subjects with intact teeth, both if all subjects or subjects with long-term disease (duration of diabetes of at least 2 years, n = 62) were included. This finding was valid after adjustments for age, duration of diabetes and age at the onset of diabetes. Association between poor control and the loss of intact dentition was also demonstrated in subjects whose diabetes was diagnosed before the age of 7. Presence of yeasts was highly associated with poor control of diabetes, and yeasts were more frequently found in the saliva samples of subjects with decayed and/or filled teeth. Instead, salivary flow rates, salivary lactobacilli and Streptococcus mutans counts, buffering capacity and pH were not different between the subjects. As well, home care practices were similar, and all subjects had received similar regular dental treatment. In conclusion, poor control of diabetes was found to be associated with caries. The presence of yeasts may be a caries risk indicator in subjects with diabetes, since diabetes may enhance yeast growth, particularly if poorly controlled.

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

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 + DMFS; 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 (n = 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.

Ethnicity and maternal education as risk indicators for dental caries, and the role of dental behavior

The aim of this study was to assess differences in dental health between socioeconomic and ethnic groups in a cohort of 5-yr-old children born in 1982 and in a cohort of 11-yr-old children born in 1976. A further aim was to evaluate the putative role of dental behaviors as intervening factors between ethnicity and maternal education on the one hand and caries experience on the other. A secondary analysis was performed on data collected in a study monitoring the oral health of youths covered by public health insurance (Ziekenfonds) in the Netherlands. The results showed both ethnicity and maternal education to be indicators of caries risk in the primary dentition. For caries in the permanent dentition, only maternal education could be identified as a risk indicator. Dental behaviors were related to caries experience as well as to ethnicity and maternal education, though the evidence for the role of these dental behaviors as intervening factors was weak. It is concluded that the validity and reliability of the behavioral measurements might be questionable and that the mechanism underlying the differences in caries experience between the various groups is still little understood.

Risk indicators and potential risk factors for caries in 5-year-olds of different ethnic groups in Amsterdam.

The aim of this study was threefold: first, to assess the oral health of Turkish, Moroccan, Surinamese, Dutch and "other" 5-yr-old children living in Amsterdam; second, to identify risk indicators for caries, in addition to ethnicity; and third, to identify potential risk factors related to differences in caries experience in these children. Results showed the mean dmfs scores of Turkish and Moroccan children to be much higher than that of the Dutch and Surinamese children; 8.1 and 8.2 versus 3.6 and 3.4, respectively. The educational level of the parents and the gender of the children were important risk indicators, in addition to ethnicity. The age of the child at which the parents had started to brush their child's teeth, the use of fluoride tablets and the regularity of the brushing behavior in the past could be identified as potential risk factors.

The Epidemiology of Root Surface Caries

Although a secular decline is being seen in coronal caries in children in industrialized countries, there appears to be a relatively high prevalence of root caries, with chronologically older adults exhibiting the highest prevalences. This paper reviews the descriptive and analytical epidemiology of root caries as found in recent national, regional, and local studies. A review of the variety of study designs, populations surveyed, and epidemiologic criteria for root caries comprising recent studies is presented as a background for comparison of prevalence rates which range from 7.3% to 69.7% of the population with root decay. In the few incidence studies reported, attack rates range from 1.6 surfaces per 100 surfaces at risk to 6.3 per 1000 surface-months at risk. Risk indicators for root caries are also reviewed with studies applying multivariate techniques implicating age, fluoride, educational level, use of dental services, coronal caries, loss of attachment, and number of teeth as possible risk factors. Although incidence studies have isolated risk factors, the small number of studies result in little agreement. Risk factor models from the Iowa 65+ Oral Health Study and a Risk Indicator model from the Piedmont 65+ Dental Study are presented to illustrate the variety of factors that may be involved in the expression of root surface caries in human populations.