Evaluation of a computer-based caries risk assessment program in an elderly group of individuals

Profiles of dental caries and periodontal disease in individuals with or without psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory disease that is manifested on the skin. Studies of oral health in psoriasis patients are limited. The aim of this study is to assess the experience and risk of caries and periodontal disease in individuals with and without psoriasis.

METHODS

The material consisted of 89 individuals with mild-to-moderate chronic plaque psoriasis and 54 without psoriasis, recruited at the University Hospital in Gothenburg, Gothenburg, Sweden. Psoriatic arthritis (PsoA) was diagnosed in 25 of the individuals with psoriasis. All participants answered questionnaires and were subjected to saliva sampling and oral radiologic and clinical examinations. Two computer applications were used for illustration of oral disease risk profiles.

RESULTS

Individuals with psoriasis had lower salivary pH, fewer remaining teeth, fewer sites with probing depth ≤4 mm, and a lower radiographic alveolar bone level than individuals without psoriasis (P <0.05). Most of the differences remained significant after controlling for confounders. Differences in alveolar bone levels were no longer significant, particularly after introducing the confounder sex into the regression model. Similar numbers of decayed and filled teeth, sites with deep pockets, sites that bled on probing, and risk profiles were observed. Individuals with PsoA exhibited a lower stimulated salivary secretion rate than those without psoriasis (P <0.05).

CONCLUSIONS

There were no differences in profiles of caries and periodontal disease experience and risk between individuals with and without psoriasis. Fewer remaining teeth were observed in individuals with psoriasis. However, the exact reason for tooth loss could not be identified. Meanwhile, the reduced salivary pH in individuals with psoriasis and salivary secretion in individuals with PsoA may pose some risk for future caries.

The relation between 6-n-propylthiouracil sensitivity and caries activity in schoolchildren

Caries activity tests are being used to assess caries risk in children. In recent years the purpose of most studies has been to develop practical, quick, reliable and economic tests. Clinical studies showed that the difference in sensitivity to the bitter taste of 6-n-propylthiouracil (PROP) is a heritable trait and may influence children's nutritional habits and caries development. The aim of this study was to investigate the relation between PROP sensitivity and caries activity in schoolchildren, in comparison with different caries activity tests. One hundred and twenty children aged between 7 and 12 years (mean age 9.97 ± 1.59) were investigated to determine socioeconomic status and oral hygiene habits, fluoride consumption, DMFT, DMFS, df, dfs, plaque indexes, and nutritional habits. Children were divided into three groups according to their caries risk status based on the Cariogram. The solution test and the PROP-impregnated filter paper test were used together to determine PROP sensitivity. After all associated factors had been controlled, stepwise regression analyses revealed that DMFT and dfs scores were important determinants of PROP. According to dfs, the sensitivity of the Cariogram and of PROP tests was 0.85 and 0.70, respectively, and specificity was 0.32 and 0.33, respectively. There was an inverse significant relationship between PROP sensitivity and DMFT, DMFS, and dfs results (p < 0.01). In conclusion, PROP nontasters were significantly more likely to have high caries risk than PROP tasters (p < 0.01).

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

OBJECTIVES

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Risk assessment of dental caries by using Classification and Regression Trees

OBJECTIVES

Being able to predict an individual's risks of dental caries would offer a potentially huge natural step forward toward better oral heath. As things stand, preventive treatment against caries is mostly carried out without risk assessment because there is no proven way to analyse an individual's risk factors. The purpose of this study was to try to identify those patients with high and low risk of caries by using Classification and Regression Trees (CART).

METHODS

In this historical cohort study, data from 442 patients in a general practice who met the inclusion criteria were analysed. CART was applied to the data to seek a model for predicting caries by using the following parameters according to each patient: age, number of carious teeth, numbers of cariogenic bacteria, the secretion rate and buffer capacity of saliva, and compliance with a prevention programme. The risks of caries were presented by odds ratios. Multiple logistic regression analysis was performed to confirm the results obtained by CART.

RESULTS

CART identified high and low risk patients for primary caries with relative odds ratios of 0.41 (95%CI: 0.22-0.77, p = 0.0055) and 2.88 (95%CI: 1.49-5.59, p = 0.0018) according the numbers of cariogenic bacteria. High and low risk patients for secondary caries were also identified with the odds ratios of 0.07 (95%CI: 0.01-0.55, p = 0.00109) and 7.00 (95%CI: 3.50-13.98, p < 0.0001) according the numbers of bacteria and existing caries.

CONCLUSIONS

Cariogenic bacteria play a leading role in the incidence of caries. CART proved effective in identifying an individual patient's risk of caries.

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.

Root caries risk indicators: a systematic review of risk models

OBJECTIVE

To identify risk indicators that are associated with root caries incidence in published predictive risk models.

METHODS

Abstracts (n = 472) identified from a MEDLINE, EMBASE, and Cochrane registry search were screened independently by two investigators to exclude articles not in English (n = 39), published prior to 1970 (none), or containing no information on either root caries incidence, risk indicators, or risk models (n = 209). A full-article duplicate review of the remaining articles (n = 224) selected those reporting predictive risk models based on original/primary longitudinal root caries incidence studies. The quality of the included articles was assessed based both on selected criteria of methodological standards for observational studies and on the statistical quality of the modeling strategy. Data from these included studies were extracted and compiled into evidence tables, with information about the cohort location, incidence period, sample size, age of the study participants, risk indicators included in the model, root caries incidence, modeling strategy, significant risk indicators/predictors, and parameter estimates and statistical findings.

RESULTS

Thirteen articles were selected for data extraction. The overall quality of the included articles was poor to moderate. Root caries incidence ranged from 12% to 77% (mean ± SD = 45 ± 17%); follow-up time of the published studies was ≤ 10 years (range = 9; median = 3); sample size ranged from 23-723 (mean ± SD = 264 ± 203; median = 261); person-years ranged from 23 to 1540 (mean ± SD = 760 ± 556; median = 746). Variables most frequently tested and significantly associated with root caries incidence were (times tested; % significant; directionality): baseline root caries (12; 58%; positive); number of teeth (7; 71%; three times positive, twice negative), and plaque index (4; 100%; positive). Ninety-two other clinical and nonclinical variables were tested: 27 were tested three times or more and were significant between 9% and 100% of the times tested; and 65 were tested but never significant.

CONCLUSIONS

The root caries incidence indicators/predictors most frequently reported were root caries prevalence at baseline, number of teeth, and plaque index. This finding can guide targeted root caries prevention. There was substantial variation among published models of root caries risk in terms of variable selection, sample size, cohort location, assessment methods, incidence periods, association directionality, and analytical techniques. Future studies should emphasize variables frequently tested and often significant, and validate existing models in independent databases.

Caries risk and periodontitis in patients with coronary artery disease

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Test and control groups had a relatively high caries risk. More severe periodontal disease was observed in participants with CAD.

Caries risk assessment in school children using a reduced Cariogram model without saliva tests

Background

To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren.

Methods

The study group consisted of 392 school children, 10-11 years of age, who volunteered after informed consent. A caries risk assessment was made at baseline with aid of the computer-based Cariogram model and expressed as "the chance of avoiding caries" and the children were divided into five risk groups. The caries increment (ΔDMFS) was extracted from the dental records and bitewing radiographs after 2 years. The reduced Cariogram was processed by omitting the variables "salivary mutans streptococci", "secretion rate" and "buffer capacity" one by one and finally all three. Differences between the total and reduced models were expressed as area under the ROC-curve.

Results

The baseline caries prevalence in the study population was 40% (mean DMFS 0.87 ± 1.35) and the mean 2-year caries increment was 0.51 ± 1.06. Both Cariogram models displayed a statistically relationship with caries development (p < 0.05); more caries was found among those assessed with high risk compared to those with low risk. The combined sensitivity and specificity decreased after exclusion of the salivary tests and a statistically significant reduction of the area under the ROC-curve was displayed compared with the total Cariogram (p < 0.05). Among the salivary variables, omission of the mutans streptococci enumeration impaired the predictive ability the most.

Conclusions

The accuracy of caries prediction in school children was significantly impaired when the Cariogram model was applied without enumeration of salivary tests.

Building Caries Risk Assessment Models for Children

Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a “one-year caries increment”, screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. Abbreviations: decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).

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.

Risk profile of adults with several dental restorations using the Cariogram model

OBJECTIVE

The aims of the study were: 1) to evaluate the caries profile in a group of Saudi adults with several dental restorations by assessing various caries-related factors using the Cariogram model, and 2) to correlate the Cariogram data, expressed as "the chance of avoiding caries", with initial caries lesions (DiS), total initial and manifest caries lesions (Di+mS), and filled surfaces (FS).

MATERIAL AND METHODS

175 individuals in Saudi Arabia, aged between 18 and 56 years, were included. All were interviewed about their oral health, dietary habits, and use of fluoride, and were examined for dental caries, both clinically and radiographically. Salivary and microbiological factors, including the number of mutans streptococci and lactobacilli, buffer capacity, and secretion rate, were obtained using chair-side tests.

RESULTS

The number of teeth, total Di+mMFS, Di+mS, and FS were 26.0, 53.8, 19.3, and 22.6, respectively. The mean chance of avoiding caries was 31%+/-19.7. The individuals were divided according to Cariogram data "the chance of avoiding caries" into four risk groups: 0-20% (n=66) "high-risk", 21-40% (n=43) "medium-risk", 41-60% (n=50) "low-risk", and 61-100% (n=16) "very low-risk". ANOVA revealed statistically significant differences between the high-risk group and the other three groups with respect to Di+mS (p<0.01) and FS (p<0.05). The mean DiS of the high-risk group differed significantly from that of the low-risk group (p<0.05).

CONCLUSIONS

The Cariogram model can identify the caries-related factors that could be the reasons for the estimated future caries risk. There is a direct association between the categorized outcomes of the Cariograms and the DiS and Di+mS indices.

Caries risk assessment in Bosnian children using Cariogram computer model

AIM

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.

MATERIAL AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Validation of a Simple Approach to Caries Risk Assessment

OBJECTIVE

This study examined the predictive validity of a simple subjective method promoted to dentists for assessing their patients' caries risk.

METHODS

Data from two large group practices that have used guideline-assisted caries risk assessment (CRA) for several years were analyzed retrospectively to determine the receipt of caries-related treatment following a CRA. Patient age and receipt of caries preventive treatment subsequent to the CRA were control variables in logistic regressions to determine the likelihood of caries-related treatment for low, moderate, and high risk groups.

RESULTS

Among 45,693 individuals in the two plans, those categorized as being at high caries risk were approximately four times as likely to receive any caries-related treatment as those categorized as being at low caries risk. Those categorized as at moderate risk were approximately twice as likely to receive any treatment. In addition, for those at elevated risk who required any treatment, the number of teeth requiring treatment was larger.

CONCLUSION

The results of this study provide the first large-scale, generalizable evidence for the validity of dentists' subjective assessment of caries risk.