Caries Risk Prediction Research Articles

Determinación de ácido láctico en el dorso de la lengua: Su relación con la presencia de caries activa

Resumen: Fundamento: el diagnostico de susceptibilidad a la caries es un reto que actualmente tienen que abordar los procedimientos diagnosticos. La presencia de acidos en el medio oral produce una reduccion del pH, siendo el acido lactico el maximo responsable de esta situacion. La posibilidad de detectar sus niveles en la boca puede plantearse como una medida diagnostico adecuada para estimar el riesgo individual frente a la caries. Objetivo y Metodologia: este estudio evalua, de forma preliminar, un test recientemente introducido en el mercado por la casa 3M (Clinpro Cario L-Pop) que permite medir mediante una escala ordinal la presencia de acido lactico en la superficie lingual. Para ello se ha relacionado el numero medio de caries sin tratar en 24 ninos de 6 a 14 anos con los valores de acido lactico presentes en la superficie lingual determinados por el test. Resultados: observamos que en aquellos sujetos en los que el test indica una baja cantidad de acido lactico (riesgo bajo), no existe ningun diente con caries activa, incremen- tandose la media de dientes con caries activa en los pacientes que presentan un riesgo medio o alto segun el test. Conclusiones: este pudiera ser un instrumento que nos ayudara en la evalua- cion del diagnostico de susceptibilidad individual, no obstante se precisan estudios longitudinales que evaluen su eficacia en la prediccion del riesgo de caries. Palabras clave: Caries dental, Diagnostico de susceptibilidad, Acido lactico.

Evaluation of mutans streptococci in plaque and saliva: correlation with caries development in preschool children

Objectives. To test the ability of a site-specific method of evaluating mutans streptococci (MS) present in plaque in order to predict caries risk in children and to compare the results with those obtained from estimating the levels of MS present in saliva. Methods. Caries prevalence was examined twice, 6 months apart, in 129 preschool children ranging in age from 1.5 to 5. A commercial strip method was used to evaluate the MS score (0–3) in plaque collected from four selected tooth surfaces at two interdental spaces and in saliva. Results. The screening criteria of the MS score for caries incidence between scores 1 and 2, and scores 0 and 1 were the most valid for evaluating plaque (accuracy of prediction, 80%) and saliva (accuracy of prediction, 71%), respectively. Based on these screening criteria, the evaluation of saliva MS was invalid when the plaque MS score was considered. Screening plaque MS was effective, regardless of caries experience at baseline, according to the chi-square test ( p<0.01), but screening saliva MS was ineffective when caries experience was present at baseline. A multivariate logistic regression analysis including six variables showed that the plaque MS score and caries experience at baseline were significantly correlated with caries incidence: caries experience at baseline (OR=5.02, 95%CI: 1.81–14.59) and high plaque MS score (2 or 3) (OR=12.59, 95%CI: 3.18–67.08). Conclusions. These results suggest that the semi-quantitative evaluation of plaque MS sampled from only two proximal sites on the molars is more effective for screening preschool children at a high risk of developing caries in their primary dentition than other important caries risk indicators.

Salivary mutans streptococci and caries development in the primary and mixed dentitions of children.

For more than 25 years, both cross-sectional and longitudinal studies of dental caries have focused on the role of salivary mutans streptococci (SMS) as a predictor of caries risk. This study examined the relationship between SMS and longitudinal caries development in the primary and mixed dentitions. Eighty-five children, initial mean age 3.8 years, were examined for dental caries at baseline and once annually for 6 years. Children's SMS were sampled with a tongue blade, which was impressed onto plates containing a medium selective for SMS. After incubation, colony forming units of SMS were determined semi-quantitatively and categorized as low, moderate or high. Children classified as high caries risk at baseline had significantly greater (P<0.05) dmfs scores for all teeth, and in the primary molars, than children classified as moderate or low caries risk at every age but 9 (P<0.10). Children classified as high risk at age 3 had the greatest DMFS increment through age 8. Based on annual examinations, there was a trend towards increasing mean dmfs/DMFS scores among children classified as high risk in every year. The current study is among the first to report on the ability of annual measurements of SMS to identify long-term caries risk in both the primary and the mixed dentitions. Despite limitations in predicting caries risk using microbiological methods, this longitudinal study supports the overall benefits of this type of testing.

The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants.

This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, "Preventing Pit and Fissure Caries: A Guide to Sealant Use," as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.

齲蝕活動性試験による幼児期の齲蝕罹患リスクの検出に関するコホート研究

齲蝕活動性試験による幼児期の齲蝕罹患リスクの検出に関するコホート研究

Microbiological predictors of caries risk.

The prediction of caries risk has been of long-standing interest. Generally, few of the tests involving oral bacteria or their products have become accepted. Presently, the main focus is on counts of lactobacilli (L) and mutans streptococci (MS). Due to their positive numerical association with human caries and the linkage of this association to carbohydrate consumption, counts of L and MS may, potentially, serve not only as a caries risk predictor but also as an indicator of carbohydrate consumption, another caries-risk factor. The value of counts of L and MS as caries-risk predictors has been evaluated by means of studies providing data on test sensitivity, specificity, and predictive values. These and other studies indicate that their use for the prediction of caries risk of individuals is not possible but is more promising for that of the caries risk of groups (e.g., identification of high-caries-risk subjects); further, the prediction of low caries risk may be more reliable than that of high caries risk. The influence of test variables on the test results has been discussed. These include the level of caries increment, subject age, methods of caries evaluation, use of saliva or dental plaque as test sample, sampling frequency, type of bacterial growth medium, and the use of simplified methods rather than conventional laboratory procedures for microbial enumeration. An approach to optimize the use of microbiological caries-risk predictors in different populations as well as their use in conjunction with other caries-risk predictors has been discussed. The latter include the incipient caries lesion or past caries experience and salivary buffering capacity and flow rate. Due to the multifactorial nature of caries etiology, it is expected that multivariate approaches rather than the use of single parameters may improve caries risk prediction for individuals as well as groups of subjects.

Integrated caries prevention: effect of a needs-related preventive program on dental caries in children. County of Värmland, Sweden: results after 12 years.

Twenty years ago the caries prevalence in Swedish children was among the highest in the world; within Sweden, it was highest in the County of Värmland. Ongoing clinical research projects were initiated to evaluate the separate and combined effects of preventive measures, and in 1978 a preventive program, based on caries risk assessment, was introduced for 3- to 19-year-olds in the county. The effects were monitored by a computerized epidemiological system. From 1979 to 1991, caries prevalence and incidence decreased by 75-90 and 75-85%, respectively. The percentage of caries-free 3-year-old children increased from 51 to 94%, and in 12-year-old children, the caries prevalence decreased from 6.5 to 1.0 DFS, the lowest in Sweden. The program is very cost-effective, and in 1990 the mean annual treatment time per child was the lowest in Sweden. Currently, new methods of caries risk prediction and integrated caries prevention are being developed, with special reference to cost-effectiveness.

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.