Caries Risk Profiles Research Articles

Caries risk profiles in 2- to 6-year-old Greek children using the Cariogram

To assess the caries risk profiles in 2- to 6-year-old Greek children using a computer-based program and to evaluate the contribution of various risk factors. The study group consisted of 814 preschool children. A questionnaire on family, demographic and socioeconomic factors, general health, oral hygiene and dietary behavior was completed by the parents. Children were examined for cavitated and white-spot lesions (WSL). Salivary mutans streptococci (MS) and buffer capacity were estimated. Caries risk profiles were assessed with Cariogram. Cavitated lesions were found in 30% of the children; WSL were found in 26% of those included. MS and low buffer capacity were detected in 28% and 26% of the children, respectively. The majority (70%) displayed neglected oral hygiene. Based on the questionnaires, 83% of the children had a cariogenic diet, and 17% did not use any form of fluoride. The Cariogram revealed that 26% of the children had high caries risk, while only 9% exhibited low caries risk. The most significant caries risk variables, determined by regression analysis (R(2)=0.88), were insufficient fluoride exposure (ß=0.160) and the presence of WSL (ß= 0.159). One-fourth of the children were categorised as high caries risk. The presence of WSL and lack of fluoride exposure were the most significant caries risk determinants.

Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram—a comparative study

Objectives. To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. Materials and methods. All 19-year-old patients registered at eight public dental clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. Results. The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as ‘some risk', while 16.7% were assessed as being of ‘high' or ‘very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The agreement between the two models was found acceptable (77.5%) for those assessed as low risk, while discrepancies were disclosed among those classified with higher risks. Conclusions. Although the proportion of subjects assessed with high or very high risk was similar using the PDS guidelines and the Cariogram model, the agreement between the models was fair. An acceptable agreement was only disclosed for the low risk category.

Cariogram Validity in Schoolchildren: A Two-Year Follow-Up Study

The validity of Cariogram in relation to caries increment over a 2-year period was evaluated. In 2007, the caries risk profile in a group of Sardinian schoolchildren (957) aged 7–9 years was assessed using the Cariogram software. A re-examination using the same criteria was performed 2 years later on 861 individuals from the original sample (drop-out 10.0%). The possible correlated variables were analyzed using the principal component analysis (PCA). The performances of Cariogram in predicting caries increment were evaluated by receiver operating characteristic (ROC) analysis. At follow-up examination, 54.4% of the sample had developed new carious lesions (mean DFS 1.6, 95% CI 1.5–1.8). The mean caries increment (ΔDFS) was 0.5, 95% CI 0.4–0.5. PCA showed that Cariogram, gingival status and dietary sugar frequency, both at baseline and at follow-up, tend to form a separate cluster (goodness of fit ≧0.75). Sensitivity and specificity measured by ROC analysis were 0.83 and 0.85, respectively, so the gain in certainty was 1.68, while the area under the ROC curve was 0.93. A strong correlation between caries risk profiles at baseline and caries incidence in the permanent teeth after 2 years was found. The validity of Cariogram was confirmed, the software fulfilling the criteria for a good risk assessment model: precision, accuracy and ease of use.

Caries risk profile of 12 year old school children in an Indian city using Cariogram

Objectives: The present study was conducted with an aim to assess the caries profile of 12 year old Indian children using Cariogram. Study design: Hundred children were interviewed to record any illness, oral hygiene practices and fluoride exposure after obtaining a three day diet diary. Examination was done to record plaque and dental caries status. Stimulated saliva was collected and salivary flow rate, salivary buffering capacity, Streptococcus mutans and Lactobacillus were assessed. The information obtained was scored and Cariogram was created. Differences between mean decayed, missing and filled teeth ( DMFT) and Cariogram risk groups were assessed using ANOVA. Spearman Correlation coefficients were used to explore correlation among Cariogram scores and individual variables. Results: It was found that 21, 45, 21 and 13 children had 0-20%, 21-40%, 41-60% and 61-100% chance of avoiding caries respectively in future. Significant correlation was observed between cariogram score and DMFT, diet content, diet frequency, plaque scores, Streptococcus mutans counts and fluoride programme. Conclusions: Cariogram model can identify the caries-related factors that could be the reasons for the estimated future caries risk, and therefore help the dentist to plan appropriate preventive measures. Key words:Cariogram, caries risk assessment, risk factors, children, India

Caries Risk and Periodontitis in Patients With Coronary Artery Disease

There is considerable variation in studies on the oral health of patients with coronary artery disease (CAD). The aims of this investigation are to study the caries risk profile using the Cariogram computer program and the periodontal disease severity in patients with CAD. A total of 127 participants (54 test and 73 control) were included. Participants were asked about their general health and daily habits. Clinical examinations, radiographs, and salivary sampling were performed. Cariologic data were entered into the computer program for risk-profile illustration. The onset of CAD conditions was also documented. Compared with controls, participants with CAD consumed less sugar, used fluoride toothpaste less frequently, and had significantly less favorable periodontal parameters (P <0.005). Generally, differences in cariologic parameters between the two groups were not significant. Significantly more participants with CAD exhibited low salivary-secretion rates than controls. The actual chance (percentage) of avoiding new cavities according to the Cariogram was low in the test and control groups (31% and 40%, respectively; P <0.05). Only gingival recession was correlated with the onset of CAD. Test and control groups had a relatively high caries risk. More severe periodontal disease was observed in participants with CAD.

Caries risk profile using the Cariogram in governmental and private orthodontic patients at de-bonding

To analyze various caries-related factors in orthodontic patients at de-bonding, and to test the null hypothesis that there is no difference in caries risk between governmental and private orthodontic patients immediately after orthodontic treatment. A cross-sectional examination was carried out on 89 orthodontic patients aged 13-29 years, mean age 21.5 years. They were divided into two groups based on the center of treatment, governmental group (G) (n = 45) and private group (P) (n = 44). The investigation comprised a questionnaire, plaque scoring, caries examination, bitewing radiographs, salivary secretion rate, buffering capacity, and cariogenic microorganisms. Data were entered into the Cariogram PC program to illustrate caries risk profiles. Findings revealed that "the chance of avoiding new cavities," according to the Cariogram, was high in the P-group and low in the G-group (61% and 28%, respectively) (P < .001). Decayed, missing, and filled surfaces (DMFS), plaque index, mutans streptococcus and lactobacillus counts, and salivary buffer capacity were significantly higher in the G-group compared with the P-group (P < .05). The total number of caries lesions at de-bonding in the G-group was more than two times higher than that in the P-group (150 vs 68) (P < .001). The "chance to avoid new cavities" in orthodontic patients at de-bonding was less in the governmental group compared with the private group, as illustrated by the Cariogram. The governmental group also had significantly less favorable values than the private group for most of the caries-related factors.

Root caries and risk profiles using the Cariogram in different periodontal disease severity groups

Objectives. To study root caries and risk profiles using the Cariogram in relation to periodontal disease severity and to analyse indicators associated with high caries risk. Material and methods. A cross-sectional examination was carried out on 112 patients with periodontal disease from two government clinics in Saudi Arabia. The investigation comprised a questionnaire, bitewing radiographs, measurement of salivary secretion rate, buffering capacity and cariogenic microorganisms, and registration of periodontal status, plaque amount and coronal and root caries/fillings (DFT and RDFT). The data were then entered into the Cariogram pedagogic model to illustrate the caries risk profiles. Results. Patients were grouped according to periodontal disease severity into one of three groups: (1) gingivitis (n = 44); (2) mild-to-moderate periodontitis (n = 33); and (3) severe periodontitis (n = 35). The prevalence of RDFT in the total sample was 17%. There were no statistically significant differences between the three groups in number of root lesions or mean ‘Actual Chance to Avoid New Cavities’ (Chance-AC) according to the Cariogram. Of the total sample, 22% displayed high caries risk (Chance-AC ≤40%). The most significant risk indicators in high caries risk patients were infrequent use of fluoride and unfavourable salivary and microbial parameters. Conclusions. Root surface lesions and high caries risk were present in about one-fifth of the patients referred for periodontal treatment. A combination of risk indicators rather than a single one contributed to the increased risk. Caries and risk profiles were not significantly correlated with periodontal disease severity.

Caries risk profiles in schoolchildren over 2 years assessed by Cariogram

Caries risk assessment is an important tool in clinical decision making. To evaluate longitudinal changes in caries risk profiles in a group of schoolchildren in relation to caries development. The Cariogram model was used to create caries risk profiles and to identify risk factors in 438 children being 10-11 years at baseline. The assessment was repeated after 2 years and the caries increment was recorded. The frequency of unfavourable risk factors were compared between those considered at the lowest and the highest risk. Fifty percent of the children remained in the same risk category after 2 years. One third of the children were assessed in a higher-risk category while 18.4% showed a lower risk. Those with increased risk compared with baseline developed significantly more caries than those with an unchanged risk category. The most frequent unfavourable risk factors among those with high risk at baseline were high-salivary mutans streptococci and lactobacilli counts as well as frequent meals. Half of the children showed a changed risk category after 2 years, for better or for worse, which suggests that regular risk assessments are needed in order to make appropriate decisions on targeted preventive care and recall intervals.

Evaluation of the caries profile and caries risk in adults with endodontically treated teeth

The present study was set up to explore (1) a potential association between a person's caries risk profile and the presence or absence of root-filled teeth, and (2) the caries risk in endodontically treated teeth. Two hundred Saudi adults were divided into an Endodontic Group (EG; n = 100), with a minimum of 2 root-filled teeth, and a Non-Endodontic Group (NEG; n = 100), without any root filling. Various caries risk factors were evaluated using a computer-based program (Cariogram). Clinical and radiographic examinations were also carried out. Cariogram findings showed that "the chance of avoiding caries" was low in both groups (35% in EG and 37% in NEG), and there was no statistically significant difference between the 2 groups. However, DMFS, recurrent caries, and mutans streptococcus count in saliva were significantly higher in the EG compared to the NEG (P < .05). When teeth in the EG were evaluated independently, the proportion of recurrent caries to the total fillings associated with endodontically treated teeth was 31.6% versus 19.2% in the non-endodontically treated teeth. Data were not in favor of an association between caries risk profile and presence of root-filled teeth, but supported the notion that root-filling procedures might make the tooth more susceptible to caries.

Risk profile and quality of dental restorations: A cross-sectional study

Objectives. The aims of the present study were (1) to evaluate the percentage of recurrent caries with respect to the estimated caries risk profile obtained with a Cariogram, (2) to evaluate the quality of restorations in a Saudi population with several restorations and (3) to determine the additional value of bite-wing radiographs as an aid to quality evaluation. Material and methods. A total of 803 restorations were examined in 100 adults according to the United States Public Health Service/Ryge criteria. Salivary and microbiological factors, dietary habits and plaque index were investigated. The Cariogram was used to evaluate the risk profiles. Class II bite-wing radiographs (n = 281) were taken to examine the marginal integrity and the anatomic form proximally. Results. The patients were categorized according to ‘the chance of avoiding caries’ into three risk groups: 0%–20% (n = 38), 21%–40% (n = 28) and 41%–100% (n = 34). ANOVA revealed statistically significant differences between the risk groups with respect to the recurrent caries (P < 0.05). A high percentage of the total restorations (56%) were diagnosed with recurrent caries. The quality of anatomic form and surface texture was unacceptable in the majority of cases. After adding the evaluations of class II bite-wings, the percentage of unacceptable restorations increased by 28% and 17% with regard to marginal integrity and anatomic form, respectively (P < 0.001). Conclusions. Recurrent caries was related to the percentage ‘chance of avoiding caries’ as estimated by the Cariogram. The importance of bite-wings was emphasized as an aid to quality evaluation.

Sociodemographic Determinants for Oral Health Risk Profiles

The present study aimed to explore the association between caries risk profiles and different sociodemographic factors . The study sample (n = 104) was randomly selected within an urban population in Flanders, Belgium. Caries risk was assessed by anamnesis, clinical examination, salivary tests, and a questionnaire. Age, gender, and socio-economic status were extracted from social insurance data files. Social indicators were “occupational status,” “being entitled to the increased allowance for health care interventions” and having access to the “Maximum Bill” (MAF), initiatives undertaken to protect deprived families. In the bivariate analysis there were significant differences in risk profiles between occupational groups (P < .001), between entitled and non-entitled individuals to the increased allowance (P = .02), and between access or no-access to the MAF (P < .01). The multiple logistic model showed a significantly higher chance of being in the low risk group for individuals with no-access to the MAF compared to those with access (OR:14.33–95% C.I. 2.14–95.84).

Caries Risk Profiles in Orthodontic Patients at Follow-Up Using Cariogram

To analyze caries-related factors shortly after orthodontic treatment and to use the Cariogram computer program to describe caries risk profiles at follow-up in these patients. One hundred orthodontic patients age 12-29 years, with a mean age of 17.5 years, were included in the study. They were divided into two groups (50 in each) based on their prebonding decayed, filled surfaces index (DFS). High (5 > or = DFS) and low (2 < or = DFS) groups were created. All patients were examined after debonding in the following order: interview, plaque score, caries examination, saliva samples, bitewing radiographs, panoramic radiographs, and intra-oral digital photos. All types of carious lesions in both the enamel and dentine were diagnosed clinically and radiographically and included in the DFS index. A paraffin-stimulated whole saliva sample was collected for estimations of secretion rate, buffer capacity, and number of mutans streptococci and lactobacilli. The low caries group (2 < or = DFS) displayed a statistically significant difference and low values for the following factors, DFS (P < .001), lactobacilli (P < .001), mutans streptococci (P < .001), and high Cariogram percent (P < .001). The plaque index displayed very close significance (P = .051). Patients with high (5 > or = DFS) numbers before orthodontic treatment ran a higher risk of developing caries. They had significantly higher numbers of mutans streptococci and lactobacilli and had less chance of avoiding new cavities according to the Cariogram.

Caries risk profiles in Sardinian schoolchildren using Cariogram

Objective. The aim of our study was to assess the caries risk profile in a group of Sardinian schoolchildren and to compare the outcome with their history of caries. Material and methods. Using the computer-based program “Cariogram”, 957 subjects aged 7, 8, and 9 years were enrolled in this cross-sectional study. The children were examined to evaluate dmfs/DMFS and gingival conditions. Data on dietary and oral hygiene habits were collected and saliva was analyzed, including levels of mutans streptococci (MS) and lactobacilli (Lb). Based on the Cariogram profiles, the children were divided into five risk groups in accordance with “chance of avoiding caries”. Results. Almost 50% of the children had a low caries risk, while more than a quarter had less than 40% “chance of avoiding caries”. A significant linear trend between the five Cariogram categories and dmfs/DMFS was observed in the three age groups (p<0.001). Conclusions. The Cariogram risk profile showed strong correlations to the caries experience of Sardinian schoolchildren and that efforts to reduce caries risk are necessary.

Validation of an age-modified caries risk assessment program (Cariogram) in preschool children

Objectives. (i) To validate caries risk profiles assessed with a computer program against actual caries development in preschool children, (ii) to study the possible impact of a preventive program on the risk profiles, and (iii) to compare the individual risk profiles longitudinally. Material and methods. Caries risk was assessed in 125 two-year-old children invited to participate in a 2-year caries-preventive trial with xylitol tablets. At 7 years of age, 103 were available for follow-up, 48 from the former intervention group and 55 from the control group. At baseline and after 5 years, 7 variables associated with caries were collected through clinical examinations and questionnaires, and scored and computed with a risk assessment program (Cariogram). Results. Children assessed as having a “low chance (0–20%) of avoiding caries” had significantly higher caries at 7 years of age compared to children with a lower risk in the control group (p<0.05) but not in the intervention group. Overall predictive accuracy and precision, however, were moderate in both groups. Less than half of the children remained in the same risk category at both ages, despite a largely unchanged consumption pattern of sugar. The majority of the children who changed category displayed a lowered risk at 7 years. The intervention program seemed to impair the predictive abilities of Cariogram. Conclusion. A modified Cariogram applied on preschool children was not particularly useful in identifying high caries risk patients in a low-caries community.

Caries risk assessment in Bosnian children using Cariogram computer model

To examine caries risk using the Cariogram model, interactive PC program for caries risk evaluation in 12-year-old children and to correlate caries risk in children of different socioeconomic backgrounds. 109, Sarajevo 12-year-olds in three groups based on socioeconomic background. Baseline data on general health condition, diet frequency and use of fluoride were obtained. DMFT and plaque scores were calculated. Saliva analyses included lactobacillus and mutans streptococci levels in saliva, saliva secretion and buffer capacity. Scores were entered into the Cariogram model and risk was calculated for each child. Most 12-year-old children have a medium risk of caries, with a 59.4% chance of avoiding future caries. In an average caries risk profile of children from Sarajevo the dominant sector is diet, with 12.5% risk; bacteria sector (plaque and mutans streptococci level) 10.8% risk; susceptibility (fluoride, saliva secretion and buffering capacity) 9.7% risk; circumstances (caries experience and medical history) 7.4% risk. Caries risk profiles showed that there are differences in the socioeconomic status of children with significantly greater risk in children with poor living conditions who also have the most unfavourable caries risk profiles. The Cariogram model can successfully determine caries risk profiles for 12-year-old children of different socioeconomic status and can be used in developing preventive strategies for reducing caries risk in children.

Cariogram – a multifactorial risk assessment model for a multifactorial disease

This paper reviews some common methods for the assessment of caries risk. It also describes a new way of illustrating the caries risk profile of an individual, the Cariogram. Past caries experience and socioeconomic factors are often used for prediction of caries. As prediction models, the methods are simple, inexpensive and fast. However, they are not risk models, as they do not specify which particular risk factors are operating. Various biological factors can be used for risk assessment. Common ones are bacteria, diet and host factors. Taken separately, these biological factors often have limited predictive values. Socioeconomic factors often have a heavy impact on the biological factors as they can explain why an individual, for example, has a cariogenic diet or neglects oral hygiene. The biological factors are the immediate cause of the cavities. Caries experience is an illustration of how the host copes up with the biological activity. To facilitate the interpretation of biological data, the Cariogram was developed. It is a computer program showing a graphical picture that illustrates a possible overall caries risk scenario. The program contains an algorithm that presents a 'weighted' analysis of the input data, mainly biological factors. It expresses as to what extent different etiological factors of caries affect caries risk. The Cariogram identifies the caries risk factors for the individual and provides examples of preventive and treatment strategies to the clinician.