Previous Caries Experience Research Articles

Updates on Caries Risk Assessment-A Literature Review.

This narrative review aims to provide an update on caries risk assessment (CRA) and the available CRA tools. CRA can be used to monitor the status of oral care, as well as for documentation and research purposes. Caries risk is determined by the interplay of risk and protective factors. Common risk factors include suboptimal oral hygiene practices, previous caries experience, low plaque acidity, frequent snacking, cariogenic diet, enamel defects, reduced salivary flow, polypharmacy, and radiotherapy experience. Caries risk can be reduced through some preventive measures, such as the use of fluoride, gum chewing, dental sealants. The CRA process can be categorized as single or multifactor tools. Single-factor CRA tools include diet analysis questionnaires, cariogenic bacteria testing and saliva testing kits, whereas multifactor CRA tools encompass Caries Management by Risk Assessment (CAMBRA), Cariogram, and PreViser. Some CRA tools may quantify risk and protective factors to compute caries risk. Additionally, they can generate visual and educational presentations that foster success in oral care. Clinicians consider CRA beneficial for developing personalized care plans. However, the literature fails to reflect this and reveals limited studies supporting its use as evidence-based practice for caries management.

The state of oral health and its impact on the quality of life of six-year-olds in the city area of Živinice

Background: Oral health is the main indicator of general health, individual well-being, and quality of life. Oral health in children and adolescents is often reflected by the state of their dental hard tissues in a form of their previous caries experience. Poor oral health in children increases the likelihood of more complex dental treatment and emergencies, which can lead to absenteeism from school and reduced learning abilities, causing slowed physical development, and overall reduced oral health-related quality of life.Aim: To determine the state of oral health and its influence on the overall quality of the life in six-year-olds in the city of Živinice.Methods: The study participants were psychophysically healthy six-year-old children of both genders with residences in the urban and rural areas of the city of Živinice. Oral examinations were conducted according to the WHO Oral Health Survey manual. The previous caries experience indexes of primary teeth (dmft, SiC, pufa) were noted during clinical examinations of children, with a simultaneous filling of the POQL questionnaire by children's parents.Results and Conclusion: The state of oral health of six-year-olds in the area of the city of Živinice was not on a satisfactory level. Analyzed oral health indexes were higher worldwide and national findings. High scores of all analyzed indexes indicated that oral health could have an impact on the quality of life and that these values are high in comparison to the given recommendations. KEYWORDS: six-year-old children, dmft, pufa, SiC, POQL

Adolescents and oral health service utilization in Canterbury, New Zealand: A geospatial cross-sectional study.

Non-utilization of dental care during adolescence can result in poorer oral health and subsequently higher expenditures on dental services. This study examined the geospatial and epidemiological factors associated with utilization of the publicly funded Adolescent Oral Health Services (AOHS) in Canterbury, Aotearoa New Zealand (NZ). A secondary analysis of prospectively collected routine data from AOHS visits of adolescents in school Year 9 (13-14 years) for the financial year 2019-2020. Geographic information systems examined distance from home to dental practices. Multilevel mixed-effects Poisson regression models investigated associations between geospatial, demographic and clinical factors and non-utilization of dental services. Models were adjusted for sex, ethnicity, area-level deprivation, rural/urban classification, previous caries experience and the distance from home address to dental practice referred. Dental practices were concentrated in large urban areas and in the least deprived neighbourhoods, with several service area gaps identified. Rural areas and the most deprived areas of Christchurch City had the highest non-utilization rates. After adjustment, adolescents residing in the most deprived areas had a higher risk of non-utilization (adjusted risk ratio [aRR] = 1.38; 95% CI 1.26-1.51) compared to adolescents in the least deprived areas. Adolescents in remote areas also had an increased risk of non-utilization (aRR = 1.36; 95% CI 1.20-1.54) compared to adolescents in urban core areas. Finally, Māori (aRR = 1.37; 95% CI 1.29-1.46) and Pasifika (aRR = 1.46; 95% CI 1.35-1.59) adolescents had significantly higher risks of non-utilization compared to their NZ European counterparts. Inequitable utilization of dental services exists among adolescents in Canterbury, NZ, and is associated with Māori, Pasifika and those living in rural and most deprived areas. Adolescents at the greatest oral health risk are geographically underserved by current oral health services. The current health system should also explore the possibility of partnering with Māori and Pasifika communities to provide services within culturally appropriate settings.

Predictors of Dental Fear and Anxiety in 9-12-year-old Children in Bosnia and Herzegovina.

Oral health in children is additionally burdened with the presence of dental fear and anxiety (DFA). These clinical psychologic entities in their progressive stages inevitably lead to avoidance of dental appointments, which makes prevention and therapy of oral diseases more difficult. Upon the onset of DFA in general, as one of the emotional outcomes of stress in a dental office, most children patients could define the specific stressors that were most intense for them, which could predict the presence of DFA. To examine the predictors of DFA presence in 9-12-year-old children, and investigate how they could explain the DFA occurrence in study participants. The sample consisted of 200 children aged from 9 to 12 years. The DFA presence was determined by the modified version of the CFSS-DS scale. The child's behavior in the dental office during the treatment was evaluated by the trained observer using Venham anxiety and behavior rating scales. Socioeconomic status, characteristics of dental office visits, and previous caries experience were also analyzed. The main DFA predictors were related to invasive dental treatments, where the behavior during dental treatment was the most accurate expression of the DFA appearance. Invasive dental procedures are the main stressful factor for DFA occurrence. Predisposing factors could strengthen the DFA occurrence.

Oral Health-Related Quality of Life in Adolescents as Measured with the Child-OIDP Questionnaire: A Systematic Review

Oral health-related quality of life (OHRQoL) refers to impacts of oral health on physical, psychological, functional and social aspects of individuals. Among specific measurement instruments to assess OHRQoL in adolescents, the C-OIDP (Child Oral Impact on Daily Performances) questionnaire has demonstrated validity, reliability and suitable psychometric properties. Our aim was to identify cross-sectional studies using the C-OIDP questionnaire to perform a qualitative synthesis and assessment of their methodology and results. A literature electronic search was carried out on the PubMed-Medline, Scopus, Web of Science (WoS), EMBASE, LILACS and SciELO databases, followed by a study selection process and quality assessment. OHRQoL perceived by adolescents is related to age, sex and sociodemographic factors. Eating is the most frequently affected dimension and toothache is the first cause of impact, showing a generally mild intensity and severity of impact. The impact on oral quality of life is greater in younger adolescents. Several factors such as previous caries experience, the DMFT (Decayed, Missed, Filled, Tooth) index, caries in primary teeth, canker sores, bleeding gums and malocclusion have been associated with a lower level of OHRQoL. More longitudinal studies are needed to clarify divergent results and complete our knowledge of oral impacts on quality of life.

Analysis of the influence of low birth weight on the time of eruption of dental caries in children in early childhood.

To estimate the time, in days, from the beginning of the monitoring until the occurrence of dental caries and its association with low birth weight in early childhood. This longitudinal study, dynamic cohort type with a study population of 1,109 children from public, private, and philanthropic daycares in Salvador, Bahia. The independent variables considered were sociodemographic, perinatal, and behavioral, such as the type of breastfeeding. Survival analysis was used to estimate the time for the development of caries with the Kaplan-Meier method. The Cox Regression was used on the multivariate analysis to assess the association with low birth weight (LBW). Out of the total of 1,109 children, 419 developed the disease and the median time to the occurrence of caries was approximately 18 months. District of origin, type of daycare, age, skin color, maternal education, family income, living in a home with less than four rooms, breastfeeding habits, the presence of biofilm and of active white spot, and previous caries experience were identified as potential determinants of the time until the occurrence of caries. It was found a positive association between LBW and the time to the development of caries in both the not adjusted (RF = 1.21, 95 percent CI 0.88-1.65) and adjusted model (adjusted RF = 1.52, 95 percent CI 1.01-2.28). LBW was associated with dental caries.

Risk factors of early childhood caries (ECC) among children in Beijing - a prospective cohort study

BackgroundEarly childhood caries (ECC) was a serious oral health concern with high prevalence and a low treatment rate in China, and few researches have focused on preschool children. This study aimed to explore the risk factors of ECC in Beijing, China.MethodsTotle of 712 children (mean age: 46.37 ± 5.44 months) participated in this prospective cohort study. Questionnaires and the levels of mutans streptococci in dental plaques and non-stimulated saliva, assessed using Dentocult SM strips, were collected at baseline, respectively. Two calibrated examiners checked for dental caries according to the WHO 1997 criteria at baseline and 1-year follow-up. Negative binomial regression was used for multivariate analysis of factors related to caries development.ResultsFor caries-free children at baseline, only plaque mutans streptococci (PMS) levels were associated with caries development (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.08–2.61, P = 0.02). Children with high PMS levels (scored 2 and 3) had higher caries incidence (46.2% vs. 33.8%) and more caries increment (1.87 ± 3.17 vs. 0.90 ± 1.89) than those with low levels (scored 0 and 1). Among all participants, PMS (OR = 1.69, 95% CI: 1.32–2.23, P < 0.001) and previous caries experience (OR = 2.80, 95% CI: 2.20–3.56, P < 0.001) were related to caries increment.ConclusionsFor caries-free children, the only significant risk factor for ECC was high PMS levels. For all participants, besides high PMS levels, previous caries experience was another significant risk factor for caries development.Trial registrationThe study design, protocol, and informed consent forms were undertaken with the understanding of Declaration of Helsinki and were approved by the Human Research Ethics Committee of the School of Stomatology, Peking University, China (PKUSSIRB-2012042).

Threshold values affect predictive accuracy of caries risk assessment

Objective: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment.Material and methods: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists’ risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds.Results: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk.Conclusions: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

Risk factors for caries-free time: longitudinal study in early childhood.

ABSTRACTOBJECTIVE To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease.METHODS The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time.RESULTS Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27–2.77), category of day care (HR = 3.88, 95%CI 2.04–7.38), age (HR = 1.77, 95%CI 1.15–2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04–2.51), presence of active white spots (HR = 2.70, 95%CI 1.07–6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02–2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80–7.42) was found for previous caries experience.CONCLUSIONS Social variables were considered as of high risk for the development of dental caries.

Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial

Low-fluoride dentifrices (LFD) have been recommended for young children aiming to minimize excessive fluoride intake during tooth brushing. Given the uncertainties surrounding the clinical efficacy of such formulations, alternatives to increase their anticaries effect have been investigated. ObjectivesThis double-blind, randomized controlled trial assessed the clinical efficacy of LFDs supplemented with Calcium Glycerophosphate (CaGP) or Sodium Trimetaphosphate (TMP) on the progression of dental caries in the deciduous dentition. MethodsChildren (average age 48 months old) from two Brazilian cities (Araçatuba and Fernandópolis) were randomly assigned into 3 groups, according to the dentifrice to be used: 500ppm F plus 1% TMP (“500TMP”, n=206), 500ppm F plus 0.25% CaGP (“500CaGP, n=201) and 1100ppm F (‘1100F’, n=193). Clinical exams (dmfs) were performed at baseline and 18 months after dentifrices started to be used, and the increment in the number of carious lesions (final dmfs – initial dmfs) was calculated. Data were analyzed by multivariate linear regression analysis to verify the influence of city, gender, previous caries experience and type of dentifrice on dmfs increment (p<0.05). ResultsMean caries increment observed for 500TMP (0.26) was significantly lower when compared with 1100F (0.74), while values found for 500CaGP (0.54) were not significantly different from 1100F. Caries increment was significantly higher in children from Araçatuba and in those with previous caries experience. ConclusionThe results indicate that clinical efficacy of LFDs supplemented with TMP is superior to that observed for a conventional formulation (1100F), while the addition of CaGP leads to similar efficacy when compared to 1100F. Clinical SignificanceChildren brushing with 500ppm F toothpastes containing phosphate salts developed fewer caries lesions when compared with those using a 1100ppm F dentifrice. The tested toothpastes can be regarded as a safe alternative to conventional formulations for children under 6 years of age, based on risk-benefit considerations.

Relationship between premature loss of primary teeth with oral hygiene, consumption of soft drinks, dental care, and previous caries experience.

We determine the relationship between premature loss of primary teeth and oral hygiene, consumption of soft drinks, dental care and previous caries experience. This study focused on 833 Mexican schoolchildren aged 6–7. We performed an oral examination to determine caries experience and the simplified oral hygiene index. The dependent variable was the prevalence of at least one missing tooth (or indicated for extraction) of the primary dentition; this variable was coded as 0 = no loss of teeth and 1 = at least one lost primary tooth. The prevalence of at least one missing tooth was 24.7% (n = 206) (95% CI = 21.8–27.7). The variables that were associated with the prevalence of tooth loss (p < 0.05) included: the largest number of decayed teeth (OR = 1.11), the largest number of filled teeth (OR = 1.23), the worst oral hygiene (OR = 3.24), a lower frequency of brushing (OR = 1.60), an increased consumption of soda (OR = 1.89) and use of dental care (curative: OR = 2.83, preventive: OR = 1.93). This study suggests that the premature loss of teeth in the primary dentition is associated with oral hygiene, consumption of soft drinks, dental care and previous caries experience in Mexican schoolchildren. These data provide relevant information for the design of preventive dentistry programs.

Incidence of dental caries in primary dentition and risk factors: a longitudinal study.

The objectives of this prospective, longitudinal, population-based study were to estimate the incidence of dental caries in the primary dentition, identify risk factors and determine the proportion of children receiving dental treatment, through a two-year follow up. The first dental exam was conducted with 381 children aged one to five years, at health centers during immunization campaigns; 184 of them had dental caries and 197 had no caries experience. The second exam was carried out two years later at a nursery or at home with the same individuals who participated in the first exam. The diagnosis of dental caries was performed using the dmft criteria. Parents were interviewed regarding socioeconomic indicators. Descriptive, bivariate and adjusted Poisson regression analyses were performed. Among the 381 children, 234 were reexamined after two years (non-exposed: 139; exposed: 95). The overall incidence of dental caries was 46.6%. The greatest incidence of dental caries was found in the group of children with previous caries experience (61.1%). Among the children without dental caries in the first exam, 36.7% exhibited caries in the second exam. The majority of children (72.6%) received no treatment for carious lesions in the two-year interval between examinations. Children with previous dental caries (RR: 1.52, 95%CI: 1.12-2.05) had a greater risk of developing new lesions, compared with the children without previous dental caries. The incidence of dental caries was high and most of children's caries were untreated. Previous caries experience is a risk factor for developing new carious lesions in children.

Evaluation of Caries Prevalence in Children of Rural Karad Area

Dental caries is the most prevalent oral disease. Its very high morbidity potential has brought this disease into the main focus of the dental health profession. There is practically no geographic area in the world whose inhabitants do not exhibit some evidence of dental caries. It affects both the sexes, all races, all socioeconomic status, and all age groups.1 The seriousness and societal costs of dental caries in preschool children are enormous. National data shows that caries is highly prevalent in poor and near-poor Indian preschool children, yet this disease is infrequently treated. The etiology includes elevated colonization levels of Streptococcus mutans, frequent sugar consumption, and developmental defects in primary teeth. A necessary first step in preventing dental caries in preschool children is evaluating the child’s caries risk factors that include socioeconomic status, previous caries experience, presence of white spot lesions, presence of visible plaque, perceived risk by dental professionals, and microbiologic testing for the presence or quantity of S. mutans. Based on this knowledge, different preventive strategies, as well as different intensities of preventive therapies, can be employed.

Oral health, medical diagnoses, and functioning profiles in children with disabilities receiving paediatric specialist dental care – a study using the ICF-CY

Purpose: To describe 0–16-year-old children with disabilities receiving paediatric specialist dental care from a biopsychosocial perspective, with focus on relationship between oral health, medical diagnosis, and functioning. Method: A questionnaire with an International Classification of Functioning, Disability and Health – Children and Youth version (ICF-CY) Checklist for Oral Health was completed using structured interview, direct observation, and information from dental records. Descriptive data analysis was performed together with principle component analysis to calculate factors of functioning used in cluster analysis in order to present functioning profiles. Results: Ninety-nine children with at least one major medical diagnosis were included. Twenty had previous caries experience. Two factors of functioning were calculated, labelled “Physical ability” and “Intellectual ability, communication, and behaviour”. Based on functioning profiles three clusters were determined. There were no statistically significant differences in caries experience between medical diagnoses or clusters. Conclusion: It was possible to identify profiles of functioning in children with disabilities receiving specialist dental care. Despite complex disabilities, the children had good oral health. Neither medical diagnosis nor functioning was found to have a clear relationship with oral health. To understand the environmental context leading to high-quality oral health, further studies of dental management in relation to medical and oral diagnoses and child functioning are needed.Implications for RehabilitationChild Oral HealthThe use of ICF-CY makes it possible for paediatric dentists to assess children’s functioning, disability, and health from a biopsychosocial perspective, showing that the medical diagnosis alone is not enough to assess functions relevant for oral health in the individual.In order to adequately organize, plan, and improve dental care for this heterogenic group of young patients with disabilities a biopsychosocial approach is valuable, aiding a holistic perspective on oral health.Despite complex medical and functional disabilities that may challenge oral health and dental care, this study finds oral health to be good in a group of children with disabilities attending a specialist dental clinic.

Factores socioeconómicos y de comportamiento relacionados con caries dental en escolares del distrito de La Molina, Lima, Perú

El propósito del estudio fue determinar los factores socioeconómicos y de comportamiento relacionados con la historia de caries dental (HCD) en niños de 6 y 12 años de edad de colegios estatales del distrito de La Molina, en Lima, Perú. Se examinó clínicamente una muestrarepresentativa de 257 y 139 niños de 6 y 12 años respectivamente siguiendo los criterios diagnósticos de la OMS para la caries dental. La información sobre los posibles indicadores de riesgo de caries fue recolectada por medio de un cuestionario dirigido a los padres. En los niños de 6 años, la prevalencia de caries fue de 81,7 % con un ceo-d de 4,35, mientras que en los niños de 12 años la prevalencia fue de 92,8% con un CPO-D de 3,86. En el análisis de regresión logística binaria múltiple se encontró que, en los niños de 6 años, únicamente el hábito dehigiene bucal y la valoración de la salud dental estuvieron asociados significativamente con la HCD. En los niños de 12 años ninguno de los factores estudiados mostró significancia estadística. En los niños de 6 años la HCD en dentición decidua fue mayor en aquellos que cepillaban susdientes una vez al día y acudieron al dentista por motivo de urgencia. En los niños de 12 años, ninguno de los factores socioeconómicos y de comportamiento evaluados fue suficiente para identificar los niños con mayor HCD en dentición permanente

Caries Prevalence in Swedish 20-Year-Olds in Relation to Their Previous Caries Experience

Background/Aim: There are few studies of caries development and caries-related factors from early age to young adulthood. The aim of the present study is to analyse caries prevalence in 20-year-olds in relation to their previous caries experience. Method: Oral health from 3 to 20 years of age was followed longitudinally in a cohort of 499 individuals. The clinical and radiographic incidence of caries and restorations in 494 20-year-olds was related to caries data at 3, 6 and 15 years of age. Results: Twenty-six per cent of the 20-year-olds were caries-free. The mean number of initial and manifest lesions and restorations (D_{i + m}FS) was 5.8. Initial lesions comprised 40% of the D_{i + m}FS. Of the occlusal surfaces of molars and premolars, 12 and 4%, respectively, had manifest caries or restorations. Compared with individuals who had been caries-free during childhood (primary dentition) and adolescence, those with a history of caries activity while growing up had statistically significantly more approximal lesions at the age of 20 (D_mFSa 0.6 vs. D_mFSa 4.6, respectively). Those with manifest caries during childhood but caries-free at 15 years had a low caries prevalence at 20 years of age (D_mFSa 1.3). Few new lesions developed after age 15. However, 50% of initial lesions at this age had progressed to manifest lesions at age 20. Conclusion: There is a relationship between caries prevalence at age 20 and early caries experience.

Caries risk assessment in preschool children in Saudi Arabia.

Caries is a prevalent condition in Saudi Arabia. At present, knowledge regarding caries risk factors in Saudi Arabia is limited. The present study aimed to identify characteristic features of Saudi preschoolers at high risk for caries, using the American Academy of Pediatric Dentistry caries risk assessment tool (CAT ) and to report the most significant caries risk predictors. A sample of 407 children aged 4 and 5 years was selected randomly from private and public nursery schools. Their parents answered a questionnaire prepared using the CAT . Each child was examined for the presence of caries and his/her oral hygiene status. According to the CAT , almost all children (89%) were considered to be at high risk. Caries was significantly more prevalent among children attending public than private schools. All CAT variables were significantly related to the presence of caries except general health condition and water fluoridation. Logistic regression analysis showed previous caries experience, enamel demineralisation, and socio-economic status to be the most significant caries risk factors. Most of the Saudi children are considered to be at high risk for caries. Previous caries experience, enamel demineralisation and socioeconomic status are the most significant caries risk predictors. These groups should be targeted for inclusion in caries prevention programmes.

Oral Health Changes during Early Phase of Orthodontic Treatment

The aim of the study was to assess the influence of fixed orthodontic appliance on Streptococcus (S.) mutans and S. sobrinus counts in orthodontic patients with regard to their previous caries experience (Decayed, Missing and Filled Teeth (DMFT) index) during the first 12 weeks of orthodontic treatment. Twenty-two patients that satisfied inclusion criteria (healthy systemic and periodontal condition, avoidance of antibiotic therapy and antiseptic mouthwashes in the past three months) were included. All clinical measurements took place prior to and 12 weeks after fixed orthodontic appliance placement, in the following order: 1) stimulated saliva flow (SS); 2) Simplified Oral Hygiene Index (OHI-S); and 3) DMFT. The method of polymerase chain reaction (PCR) was used to detect the presence of S. mutans and S. sobrinus at T1 and T2. T-test showed significant increase in DMFT index and SS between T1 and T2. Results also indicated significant improvement in OHI-S index. By use of the PCR method, S. mutans was detected in two patients at T1. At T2, two more patients had S. mutans, but the increase was not statistically significant. Using the same method, S. sobrinus was detected only in two patients at T2. In conclusion, fixed orthodontic appliances did not induce statistically significant changes in caries microflora even in the presence of enhanced oral hygiene habits.

Longevity of posterior dental restorations and reasons for failure

Tooth-coloured restorative materials are being used increasingly more often in Class II preparations in permanent teeth. Using a practice-based study design, we aimed to assess the survival time of Class II restorations and to identify factors relevant to their longevity. Class II restorations (n = 4,030), consisting of resin composites (81.5%), compomers (12.7%), amalgams (4.6%), and glass-ionomer cement restorations (1.2%), were placed in 1,873 patients with a median age of 15 yr. In total, 92.7% of restorations were placed due to primary caries and 5.8% were replacements. After an average follow-up period of 4.6 yr, 61.6% of the restorations were successful, 11.2% had failed, and 27.2% were not available for evaluation (owing to patient drop-out). The mean annual failure rate was 2.9% for resin-composite restorations and 1.6% for amalgams. For resin-composite restorations, secondary caries was the most common reason for replacement (73.9%), followed by loss (8.0%), fracture (5.3%), and marginal defects (2.4%). Multilevel Cox-regression analyses identified young age of the patient, high previous caries experience, deep cavities, and saucer-shaped preparation technique as predisposing to shorter longevity of resin-composite restorations. One brand of resin composite had a shorter survival time than the others.

A longitudinal study of occlusal caries in Newark New Jersey school children: Relationship between initial dental finding and the development of new lesions

ObjectiveDental caries is a significant public health problem especially amongst children from low-income backgrounds. This longitudinal study examined the development of new occlusal caries in 227 Newark, NJ children ages 10–18. The role of previous caries experience and the presence of occlusal white and dark lesions in predicting the development of new lesions were examined. DesignAt each visit, the patient's teeth were given a visual-tactile examination and the subject's decayed, missing and filled (DMFS) score was determined. Next, molars lacking probeable caries or restorations were examined using transillumination for occlusal white and dark spots. This examination was repeated periodically. A Cox proportional hazard was used to analyse data concerning the development of new occusal caries in molars. ResultsThe longitudinal data indicates that patients who were caries free at visit-1 developed significantly fewer occlusal caries during the longitudinal study. The hazard ratio for subjects who had first-visit caries was 2.27 compared to caries free subjects. Intact molars with occlusal white or dark lesions had caries hazard ratios of 0.78 and 1.49 respectively, compared to molars lacking initial colour changes. ConclusionHaving a prior caries history places the subject at increased risk of developing future caries. Teeth with dark lesions but not white lesions are at significantly increased risk for developing decay. White lesions may represent remineralizing or slowly progressing lesions. The results of this study can help identify patients and tooth surfaces at risk for future occlusal decay.