Caries Risk Profiles Research Articles

Remineralization of post-orthodontic white spot lesions with a fluoride varnish and a self-assembling P 11 - 4 peptides: a prospective in-vivo-study.

The objective was to evaluate the remineralization effects of fluoride varnish (Clinpro White varnish), self-assembling peptide (Curodont™ Repair) and their combined use on WSL after orthodontic treatment. Thirty-two subjects, aged of 10-18 (mean age 13.91 ± 2.92) with 107 post-orthodontic WSL were included in the study. Subjects were divided into four groups as control, tricalcium phosphate (TCP) containing fluoride varnish (Clinpro White varnish) group, self-assembling P11-4 peptides (Curodont™ Repair) group and combined application of the two products. At the beginning, each subjects' caries risk profile was assessed by evaluating diet cariogenicity, plaque index, gingival bleeding index and stimulated salivary flow rate. Before the application of the remineralization agents, WSL baseline demineralization values were determined with QLF Inspektor™ Pro, laser fluorescence using DIAGNOdent and color values were measured by Vita EasyShade. Remineralization data were obtained by measuring ΔF, ΔQ, and lesion area with QLF. The aesthetic improvement after the remineralization process was evaluated with a spectrophotometer at six weeks, three and six months. No statistically significant differences were found between the groups in terms of criteria determining patients' caries risk profiles, DIAGNOdent data, and plaque index scores (p > 0.05). Intra-group evaluation following remineralization revealed statistically significant increases in ΔF and ΔQ with a decrease in lesion area for the fluoride varnish group at six months, for the peptide group at three months, and for the combined application group at three and six months (p < 0.05). In inter-group comparisons, ΔF and ΔQ values were found to be statistically significant only in the fluoride group at six months compared to the other groups (p < 0.05). While the L* value decreased significantly in all groups at six months, a statistically significant difference in ΔE* values was observed only in the control group between three and six months. Fluoride varnish with TCP showed highest remineralization at 6 months, and the remineralization was positively affected in the short term (three months) after the use of self-assembling P11-4 peptides and their combined application. Remineralization obtained after single application of agents tested in six months in-vivo showed parallel results. In an attempt to trigger subsurface remineralization, the combined use of fluoride with self-assembling peptides as biomimetic remineralization agent needs further evaluation.

Evaluation of Caries Risk Using Cariogram Among Orthodontic Patients Before and During Treatment: A Comparative Study.

Objective The primary objective was to examine the Cariogram parameters among orthodontic patients with fixed appliances and evaluate the impact of preventive measures on mitigating the risk of dental caries during orthodontic therapy. Materials and methods Patients visiting the representative orthodontic clinics across 14 districts of Kerala participated in the comparative cross-sectional study from January 2023 to January 2024. The sampling method employed in this study was convenience quota sampling, where study subjects were allocated from each of the low, moderate, and high caries risk profiles until the sample size reached the minimal requirement within each group. The baseline Cariogram scores were used to divide the consented participants into two distinct groups. The intervention group was provided with preventive initiatives, including toothpaste comprising 1,450 ppm fluoride, 0.2% NaF mouthwash, pre-cut strands of SuperFloss, an orthodontic toothbrush designed for orthodontic braces, and an interdental flexible brush, as well as videos, pamphlets, and brochures that promoted oral health habits. In contrast, the control group received normal oral health education solely through the use of pamphlets and brochures. After six months, the Cariogram elements were re-evaluated for individuals in both groups. The independent sample t-test and paired t-test were applied to evaluate statistically significant differences between and within the two groups, respectively, using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, US). The distribution of patients based on their caries risk profiles was compared between groups at the commencement of the study and six months later using the Chi-square test. Results While the intervention group had 20 males and 22 females, the control group consisted of 21 males and 21 females. The average age in the intervention and control groups was 20.7±3.56 years and 21.2±3.12 years, respectively. Between the two groups, age (t=-0.68; p=0.50) and gender differences (λ2=0.05; p=0.83) were statistically insignificant. The percentage mean of the "Chance to avoid caries" associated with the intervention group increased significantly from 46.15±0.96 to 57.88±1.91, (p<0.001). On the other hand, the chance to avoid caries in the control group at the commencement of the treatment and six months later was found to be statistically insignificant. A statistically highly significant differences for all the Cariogram parameters were found when contrasted between the groups after six months of orthodontic treatment. The distribution of caries risk categorization between the control and intervention groups after six months of orthodontic treatment was found to be statistically significant (λ2=20.16;p<0.0001). Further, a statistically significant difference was observed during the pre-treatment phase and six months later in the intervention group (λ2=13.02; p=0.001). Conclusion The study findings reveal that it would be prudent to utilize 0.2% sodium fluoride mouth rinse, SuperFloss, an orthodontic toothbrush designed for orthodontic braces, and an interdental flexible brush, along with toothpaste containing 1450 ppm fluoride daily, to mitigate the risk of dental cavities during orthodontic treatment, in comparison to the control group.

A comparative evaluation of the effects of respiratory diseases on dental caries

PurposeThe aim of this study is to evaluate the susceptibility of patients suffering from asthma and chronic obstructive pulmonary disease (COPD) to dental caries by analyzing the physical, chemical, and microbiological characteristics of saliva, which are influenced by the medications they use.MethodsA cohort of 104 individuals, spanning from 18 to 70 years of age, underwent a meticulous categorization based on their unique medical profiles and prescribed medication routines. Subsequently, a comprehensive evaluation was conducted to elucidate potential risk factors associated with dental caries. Alongside the assessment of decayed, missing, and filled teeth (DMFT index), decayed, missing, and filled surfaces (DMFS index), and Green and Vermillion Oral Hygiene Index-Simplified (G&V OHI-S) values, measurements were performed to gauge salivary flow rate, buffering capacity, and the presence of S. mutans, L. casei, S. aureus, and C. albicans. The acquired data were then inputted into the Cariogram software, enabling the derivation of personalized caries risk profiles for each individual.ResultsThe diseased group exhibited significantly elevated levels of DMFT, DMFS, and G&V OHI-S values in comparison to the control group (p < 0.01). Moreover, the caries risk levels derived from the Cariogram were found to be significantly higher in patients diagnosed with asthma and COPD (p < 0.01). Notably, no substantial distinction was observed between these two experimental groups. Furthermore, it was discerned that COPD patients utilizing two or three distinct medications did not display any discernible variation in terms of their susceptibility to dental caries (p > 0.05).ConclusionAsthma and COPD patients exhibit an increased susceptibility to dental caries as a result of their medication regimens. Hence, it is highly advisable for these individuals to demonstrate heightened vigilance in terms of oral hygiene practices and seek regular dental check-ups for continuous monitoring and preventive care.

Caries Risk Profiles in 13–15-year-old Schoolchildren in Guntur City Using Cariogram: A Cross-sectional Study

Background and Objectives: Dental caries continues to be a major health concern for populations worldwide. In India, the prevalence is increasing at an alarming rate among child population. Assessing caries risk in children is more beneficial than treating the disease in terms of economic as well as public health outcomes. Hence, a study was conducted to assess caries risk in 13–15-year-old government and private schoolchildren in Guntur city using Cariogram model and to identify the particular risk factors that were most frequent among schoolchildren. Materials and Methods: A comparative cross-sectional study was conducted among government and private high schoolchildren in Guntur city. A total of 100 children aged 13–15 years were selected randomly. Data were obtained by means of questionnaire, intraoral examination, and salivary analysis. The information obtained was entered into Cariogram model to calculate the “percentage chance to avoid caries.” Results: Of the total 100 schoolchildren, 43 were boys and 57 were girls. The government schoolchildren had a higher mean decayed, missing, and filled teeth (1.50 ± 1.669) compared to the private schoolchildren (0.40 ± 0.833), which was significant. The mean chance to avoid caries was significantly higher in private schoolchildren (70.56%) compared to government schoolchildren (57.32%). Conclusion: Diet incorporates a major role in assessing caries risk in the present study including its content and frequency. The Cariogram model could find out the factors contributing to the development of caries in the individual and help to plan targeted preventive actions.

Predictive validity of the reduced Cariogram model for caries increment in non-cavitated and cavitated lesions: cohort study

BackgroundThe aim of this study is to assess the caries prediction of the reduced Cariogram by comparing baseline caries risk profiles with non-cavitated and cavitated lesions over periods of six, twelve, and 18 months.MethodsFrom May 2016 to October 2017, seven schools in Bhakkar, Pakistan, participated in a cohort study. First base line examination was conducted followed by examinations at 6, 12 and 18 months. Children intraoral examinations were performed on portable dental chair with in school premises by a trained examiner. A modified ICDAS index was used to measure caries at baseline and at follow-up examinations after 6, 12, and 18-months. A receiver operating curve (ROC) analysis was performed to evaluate its effectiveness for predicting dental caries increment.ResultsAbout 40% of children had a low-risk status, 30.5% medium risk, and 29.7% high risk, at baseline risk assessment. At 18 months, 73% of high-risk children, 59% of medium-risk children, and 41% of low-risk children showed a caries increment. For the reduced Cariogram model, the area under the curve on the 6, 12 and 18 months follow-up was 0.63, 0.65 and 0.70 respectively.ConclusionsOur findings indicates that a reduced Cariogram can predict the progression of caries in both cavitated and non-cavitated lesions and model exhibits a level of discriminatory ability. While it might not achieve a very high accuracy, it suggests that the model is able to predict caries increment effectively than random guessing.

Utilization of local food on the prevention of dental caries among the elementary school children in the fishing community

The potential benefits of local food derived from rebon shrimp (Acetes sp.) as a preventive measure for dental caries are described in this study, which focused on Bagan Serdang village. Situated in the coastal area of Pantai Labu subdistrict, Deli Serdang Regency, this village relies mainly on fisheries for income resources, with rebon shrimp being one of the leading marine products. The high abundance of calcium in rebon shrimp is well-known, with 2,306 mg of shrimp paste equivalent to 16 times the calcium content of 100 g of dietary milk. This preliminary study aimed to investigate the potential of rebon shrimp as a preventive measure for dental caries in school children aged 8-12 years from public elementary school 106448 in Bagan Serdang village. The study utilized Cariogram software to assess caries risk factors, including caries experience, pH and saliva secretion, plaque index, diet contents and frequency, fluoride exposure program, and clinical judgment. Atomic Absorbed Spectrophotometer (AAS) method was used to measure salivary calcium ions. In addition, the calcium content in rebon shrimp was measured in the laboratory of the industrial research center in Medan. The concentration of salivary calcium ions was found to be very low, with a mean of 0.75±0.32 mmol/L. The Cariogram assessment revealed a high caries risk of 54.12% among elementary school children. The laboratory results showed that dried rebon shrimp had a calcium content of 1.50% (w/w), while fresh rebon shrimp had a calcium content of 1.54% (w/w). Given the high prevalence and caries risk profile of elementary school children in Bagan Serdang village, the study suggests that the low concentration of salivary calcium ions and the high availability of calcium-enriched rebon shrimp can be used as a preventive strategy against dental caries in this population.

Oral health and caries risk profile assessment using the the Cariogram in thalassemia patients with or without splenectomy: A cross-sectional study.

Splenectomy is performed in β-thalassemia cases due to the destruction of red blood cells (RBCs), and the consequent splenomegaly. The aim of the present study was to compare oral health and the caries risk between β-thalassemia patients with or without splenectomy, using the Cariogram. In a cross-sectional study carried out in both the Maternity and Children Hospital and the King Fahad Hospital, Al-Madinah al-Munawwarah, Saudi Arabia, interviews, salivary sampling and oral clinical examinations were performed on 60 children and adolescents with β-thalassemia major (mean age: 13 ±3 years; 65% with splenectomy). The Cariogram program was used to calculate the caries risk. The main outcome measures were the number of decayed, missing due to caries, and filled teeth (DMFT), plaque and gingival indices, and the caries risk. Of individuals with and without splenectomy, tooth brushing was reported in 49% and 57%, respectively (p > 0.05). Individuals with splenectomy had lower plaque and gingival bleeding scores (p ≤ 0.05). Salivary secretion was identical in both groups. Caries experience and the caries risk were higher in individuals without splenectomy (p > 0.05 and p ≤ 0.05, respectively). Within the study limitations, children and adolescents with β-thalassemia had high plaque and gingival bleeding scores, as well as caries experience and caries risk. Those with splenectomy demonstrated lower figures than those without. Individuals with β-thalassemia, particularly those with splenectomy, need to be educated about the oral side effects of the disease and its treatment.

Artificial Intelligence for Caries Detection: Value of Data and Information

If increasing practitioners’ diagnostic accuracy, medical artificial intelligence (AI) may lead to better treatment decisions at lower costs, while uncertainty remains around the resulting cost-effectiveness. In the present study, we assessed how enlarging the data set used for training an AI for caries detection on bitewings affects cost-effectiveness and also determined the value of information by reducing the uncertainty around other input parameters (namely, the costs of AI and the population’s caries risk profile). We employed a convolutional neural network and trained it on 10%, 25%, 50%, or 100% of a labeled data set containing 29,011 teeth without and 19,760 teeth with caries lesions stemming from bitewing radiographs. We employed an established health economic modeling and analytical framework to quantify cost-effectiveness and value of information. We adopted a mixed public–private payer perspective in German health care; the health outcome was tooth retention years. A Markov model, allowing to follow posterior teeth over the lifetime of an initially 12-y-old individual, and Monte Carlo microsimulations were employed. With an increasing amount of data used to train the AI sensitivity and specificity increased nonlinearly, increasing the data set from 10% to 25% had the largest impact on accuracy and, consequently, cost-effectiveness. In the base-case scenario, AI was more effective (tooth retention for a mean [2.5%–97.5%] 62.8 [59.2–65.5] y) and less costly (378 [284–499] euros) than dentists without AI (60.4 [55.8–64.4] y; 419 [270–593] euros), with considerable uncertainty. The economic value of reducing the uncertainty around AI’s accuracy or costs was limited, while information on the population’s risk profile was more relevant. When developing dental AI, informed choices about the data set size may be recommended, and research toward individualized application of AI for caries detection seems warranted to optimize cost-effectiveness.

Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations-Adults and children.

This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups' data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: "low risk" = 61-100% or 81-100% chance to avoid caries, "moderate risk" = 41-60% or 21-80% and "high risk" = 0-40% or 0-20%, named model 1 and 2; b) four risk categories with two different thresholds as: "low risk" = 61-100% or 76-100%, "moderate/low risk" = 41-60% or 51-75%; "moderate/high risk" = 21-40% or 26-50% and "high risk" = 0-20% or 0-25%, model 3 and 4; c) five risk categories as: "very low risk" = 81-100%; "low risk" = 61-80% "moderate risk" = 41-60%; "high risk" = 21-40% and "very high risk" = 0-20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen's kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen's Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen's Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children's samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups' convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.

Caries increment in Bosnian women associated with caries risk factors according to the Cariogram during pregnancy. A four-year longitudinal study.

The aim of this study was to determine dental caries increment in women after four years associated with caries risk factors according to the Cariogram during pregnancy. Study design: The study population consisted of 96 pregnant women between 20 and 42 years of age at the start of the study. After four years, 80 women (83.33% recall rate) were re-examined by the baseline examiner using the same procedure employed at baseline. Caries prevalence was registered according to the WHO criteria and presented by the Decayed Missing and Filled Teeth (DMFT) index. Saliva tests were carried out according to instructions of the manufacturer. Nine factors/variables were entered into the Cariogram to obtain an individual caries risk profile. The chance of avoiding caries was scored into the five Cariogram risk categories. The results suggest that the dental caries increment in women after four years is significantly associated with caries risk factors according to the Cariogram during pregnancy.

Determination of Caries Risk by Your Fingertips – A Mobile Application Based Study

Background: Technology has become a fundamental part of our daily life. It has been delivered to our fingertips since the first smartphone arrived in market. In this regard, Cariogram has been developed to bring caries prevention to the fingertips. This particular caries assessment method was selected for the study as it is considered one of the most reliable models as per reports. Methods: A questionnaire-based survey was carried out among 90 school going children in the age group of 7-10-years in North Bengaluru, Karnataka. A cariogram model was used to create caries risk profiles of 45-males and 45-females. The caries risk profiles generated by the cariogram software were observed amongst different genders and age groups. Results: The results obtained showed that children aged 10-years had comparatively less chance to avoid new caries as compared to age groups 7, 8, and 9 years. On comparison between male and female subjects, females had more chances of avoiding new caries as compared to males, even though they did not have a significant difference in their oral hygiene practices, dietary practices, and socioeconomic background. Conclusion: The Cariogram program is functional and has certain benefits such as providing recommendations for preventive care and motivating the patient with its presentation in the form of pie-chart, viewing the multifactorial caries risk assessment instead of single variables.

Assessment of the specific caries risk profile of patients with fixed orthodontic technique

Assessment of the specific caries risk profile of patients with fixed orthodontic technique

Exploring the relationship among dental caries, nutritional habits, and peri-implantitis.

A study was made of the prevalence, co-occurrence and association among caries, nutritional habits, and peri-implant disease, with an analysis of the influence of other patient and implant factors upon peri-implant disease. The included subjects underwent a clinical examination and were asked to complete a questionnaire. Demographic data and potential lifestyle/behavioral variables were collected. Clinical and radiographic assessment allowed calculation of the decayed, missing and filled teeth (DMFT) index and peri-implant diagnosis. Uni- and multivariate multinomial logistic regression analyses were applied to identify predictors of peri-implant disease. A total of 169 patients with 311 implants were studied. At patient level, 92.2% of the subjects presented at least one carious lesion, whereas 22.5% and 56.2% were diagnosed with peri-implantitis and mucositis, respectively. Those patients with more than two caries had a higher risk of mucositis (OR=3.33). Statistically significant associations for peri-implantitis included full mouth periodontal indexes, sugar-rich diets, keratinized mucosa width, number of missing teeth and interproximal untreated caries or fillings adjacent to implants. High caries risk profiles and mucositis/peri-implantitis tended to accumulate within subjects. A sugar-enriched diet and untreated caries or fillings adjacent to implant sites may be further considered as risk indicators of peri-implantitis.

Oral Health, Caries Risk Profiles, and Oral Microbiome of Pediatric Patients with Leukemia Submitted to Chemotherapy.

Background Chemotherapy is the primary treatment modality used for patients with acute lymphoblastic leukemia (ALL), but inevitably causes microbiota-related oral complications. This study is aimed at investigating the effects of chemotherapy on oral health status, caries risk, and oral microbiome in pediatric patients with ALL. Methods Thirty-nine children with ALL receiving chemotherapy were enrolled, and a gender-, age-, dentition stage, and socioeconomic class matched healthy counterpart were recruited. Demographic information and overall health condition were obtained through the questionnaire and medical records. Oral examination was performed to assess caries and salivary status, plaque index, and other oral manifestations. Cariogram was used to assess the overall caries risk. Supragingival samples of thirteen ALL subjects and their counterparts were randomly selected to perform a 16S ribosomal RNA gene 454 pyrosequencing. Raw sequence data were screened, trimmed, and filtered using Seqcln and MOTHUR. Results The prevalence of dental caries, gingivitis, oral mucositis, xerostomia, and candidiasis in ALL groups was higher than that of the control group (p < 0.05). Children with ALL demonstrated higher caries risk compared to healthy controls (HC) based upon Cariogram (p < 0.05). The oral microbial structure of ALL patients receiving chemotherapy is different from that of healthy controls. Oral microbiota of ALL groups showed less alpha diversity and significant differences in the composition of the oral microbiome compared to healthy controls. Conclusions ALL patients receiving chemotherapy demonstrated compromised oral health, high caries risk, alteration of caries-related factors, and dysbiosis of oral microbiota. These findings may be of clinical importance in developing better strategies for personalized preventive management of oral diseases for pediatric children with ALL.

A cross-sectional cariogram-based comparison of caries risk profile in children with various levels of intellectual disability.

To compare the caries risk profile in children with mild, moderate, and severe intellectual disability (ID) using cariogram. A cross-sectional study was conducted to compare caries risk profile using cariogram among 150 children aged 6-18 years, with various levels of ID (50 each in Mild ID, Moderate ID, and Severe ID groups), attending special schools in Bengaluru city. The risk assessment consisted of: a questionnaire, an interview, estimation of oral hygiene, saliva sampling, microbial evaluation and clinical examination. Statistical analysis of the results obtained was performed using Chi-square/Fischer's exact test, Kruskal-Wallis test and Mann-Whitney test. The overall comparison showed significant differences between the groups across all parameters except diet (P = 0.131), fluoride exposure (P = 1), salivary flow rate (P = 0.3), and buffer capacity (P = 1). Caries risk was high among children with severe intellectually disability while the actual chance to avoid caries was found to be high in the Mild ID group. Bacteria was one of the dominant caries risk sectors followed by susceptibility, circumstances, and diet. Cariogram can be used as an effective tool in assessing caries prediction, thus aiding in identifying different risk groups in a community so that appropriate preventive measures can be implemented to overcome the caries risk.

USE OF CARIOGRAM AS A RISK ASSESSMENT OF CARIES LESIONS IN THE CITY OF ARRAIAL DO CABO, BRAZIL / USO DO CARIOGRAMA COMO AVALIAÇÃO DE RISCO DE LESÕES DE CÁRIE NA CIDADE DE ARRAIAL DO CABO, BRASIL

The aim of this study was to establish a caries risk profile for the population served in the Family Health Program in the city of Arraial do Cabo, Rio de Janeiro, comparing the Cariogram results when using DMF-T and ICDAS. 165 individuals divided into different age groups were evaluated by 1 examiner. The factors evaluated were caries experience, systemic diseases, diet (content and frequency), amount of plaque, fluoride program, salivary secretion and clinical evaluation of the evaluator. Was used the SPSS software, version 17.0, to perform the work and adopted the significance level of 1% and 5% probability (P &lt;0.050). Chances in avoiding caries were observed according etiological factors evaluated. DMF-T/dmf-t and ICDAS predominant score was 3, DMF-T value was 9.44, and ICDAS was 11,9. The chances to prevent carious lesions showed a statistical difference at 1 %: diet content (p = 0.000) and its frequency (p = 0.000), presence of biofilm (p = 0.00), and fluorides (p = 0.000). When DMF-T was used to access caries, cariogram preventive measures proposed type 2 ( high risk for caries - 34,5 % ). With ICDAS, 37.6 %, of the proposals where for the type 2 and 38.2 % for type 3. The Cariogram showed more risk factors for the occurrence of carious, concerning content of diet and presence of biofilm, proposing a more intensive preventive program when ICDAS was used.

Validation of Cariogram in Caries Prediction in Women and Their Children 4 Years After Pregnancy - Longitudinal Study.

BackgroundCariogram®, an algorithm-based software model, for predicting caries risk has been used to assess the caries risk profile of many different groups. The aims of the study were to evaluate Cariogram caries risk assessment during pregnancy with DMFT/dmft incidence in mothers and their children 4 years after pregnancy and to check if there is an association between children’s caries risk profiles using Cariogram and caries risk profiles (by Cariogram) of their mothers during pregnancy.MethodsThe study population consisted of 96 pregnant women (average age 27.4±7.2 years at baseline) who completed clinical baseline examination and salivary tests. The follow-up study was initiated 4 years later and the 80 pairs of mother and children (from that pregnancy) were re-examined using the same procedure at baseline. An individual caries risk profile and DMFT/dmft incidence were made for each woman and child. The prediction of the Cariogram was compared to the actual dental experience in 4 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for two cut-offs were calculated to express the outcome.ResultsThe results showed a strong association between the risk categories of pregnant women and their offspring as well as between caries development in offspring and the Cariogram risk categories of pregnant women. Sensitivity and PPV for new DMFT (ΔDMFT>0) 4 years after for women were high (>80%) for those participants assessed with 0–60% “chance to avoid caries”, as well as diagnostic accuracy (74.00%). High specificity (91.00%), very high PPV (95.00%) and clinically useful values according to Youden’s index (0.53) were obtained for moderate-risk and two lowest-risk groups for dmft in children.ConclusionCariogram was valid in the authors’ sample only and highly predictive in caries risk assessment in investigated children based on caries risk assessment of their mothers in pregnancy.

Association between nutritional status and early childhood caries risk profile in a suburban Nigeria community.

Malnutrition is associated with oral health problems. To determine the association between malnutrition (undernourished and over-nourished) and early childhood caries (ECC) in a suburban population in Nigeria. Data were extracted from a database of a household survey of 1549 under 6-year-old children. Explanatory variables were nutritional status (normal, undernourished [wasted, stunted and underweight], or over-nourished). The outcome measure was the prevalence of ECC. Children's sociodemographic characteristics (socio-economic status, sex, age) and caries-risk variables (frequency of sugar consumption in-between-meals, oral hygiene status) were the confounders. Association between ECC and malnutrition was determined using the Poisson regression analysis. Statistical significance was set at P≤.05. About one-third (31.4%) of children had expected height/weight for age; 848 (54.7%) were undernourished; and 215 (13.9%) were over-nourished. Nutritional status was not significantly associated with the prevalence of ECC. Children who consumed sugar in-between-meals three or more times a day were twice as likely to have ECC as were those who consumed sugar less often in-between-meals (APR: 2.23; 95% CI: 1.30-3.81; P=.003). Children 3-5years old were more likely to have ECC than were those 0-2years old (APR: 2.40; 95% CI: 1.10-5.22; P=.03). ECC was not associated with undernourished and over-nourished in a suburban population in Nigeria.

A methodological study to assess the measurement properties (reliability and validity) of a caries risk assessment tool for young children

ObjectivesTo assess the CAMBRA caries risk assessment tool (CRAT) in terms of its measurement properties: reliability, validity and responsiveness to change in caries estimates over time. MethodsSecondary data from the VicGeneration (VicGen) birth cohort study were used. Caries risk status at child age18 months was compared against caries development at 36 and 48 months. Questionnaire data for the 18-month-old children, were used to generate the CRAT item responses. Five examiners assessed the caries risk profile for each 18-month-old child and assigned a risk status. The analytic method was informed by the COnsensus-based Standards for the selection of health Measurement INstruments Checklist. ResultsEach examiner applied the CAMBRA CRAT to 214 cases from the VicGen study. At 18 months of age, the proportion of low-, moderate- and high-risk children were 17 %, 17 % and 66 %, respectively. Caries prevalence at 36 and 48 months of age was 18 % and 35 %, respectively. Almost perfect reliability (both inter- and intra-reliability) was achieved in caries risk categorisation. For criterion validity and responsiveness, the area under the curve was approximately 0.50. For the dichotomised risk, the sensitivity of the CAMBRA CRAT to predict caries at 36 and 48 months, was 74 % and 70 %, respectively. The corresponding specificity scores were 35 % and 36 %, respectively. ConclusionsThe results from this study show that the CAMBRA CRAT, in its current form, is not a good predictor of future caries among young Victorian children and in fact overestimates the proportion of children at high-risk of future disease. As such, it may not be ideal for use among young Victorian children and it is highly likely it’s use could be driving over treatment. Clinical Significance: This study provides evidence for the applicability of the CAMBRA CRAT with young Victorian children to inform decision making on caries risk-based management. It also highlights the important measurement properties and related analytics (applicable to any CRAT) that should be considered when selecting a CRAT for use in clinical practice.

Complex Systems Model of Dynamic Mechanisms of Early Childhood Caries Development

Early childhood caries (ECC) is a largely preventable condition that occurs when children develop caries in their primary teeth before the age of six. National trends of ECC indicate that prevalence is decreasing, but disparities between various sociodemographic groups may be increasing, despite intervention efforts. Dynamic mechanisms in caries development are hypothesized to be responsible for the observed population distributions of disease. Agent-based models (ABMs) have been utilized to explore similar hypotheses in many areas of health research. Therefore, we developed an ABM of ECC development mechanisms and examined population outcomes of hypothetical preventive intervention scenarios. We found that risk-based targeting had minimal impact on population averages or disparities and was largely due to the strength of the dynamic mechanisms among those considered to be at high caries risk. Universally increasing intervention access reduced population caries prevalence, but increased disparities between different groups of caries risk profiles. We show that population distributions of ECC can emerge as a result of dynamic mechanisms that have been shown to drive disease development. Understanding the effectiveness of a proposed intervention in relation to the hypothesized mechanism(s) that contributes to the outcome of interest is critical to future efforts to address population disparities in ECC.