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

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.

Caries risk assessment by Caries Management by Risk Assessment (CAMBRA) Protocol among the general population of Pakistan-a multicenter analytical study

Background

Caries risk (CR) assessment tools are used to properly identify individuals with caries risk and to improve preventive procedures and programs. A tool such as CAMBRA determines the precise protective factors of caries and identifies an individual's specific therapeutic intervention. The purpose of this study was to assess the caries risk using the CAMBRA protocol among the general population of Pakistan.

Methods

This multicentre analytical study was conducted in ten dental hospitals in different provinces of Pakistan and the caries risk assessment was carried out using a questionnaire that was designed using the Caries Management by Risk Assessment (CAMBRA) protocol. All 521 participants were intra-orally examined to assess oral hygiene status and the presence of disease. Multiple logistic regression test was performed for analysis.

Results

A higher number of participants (61.2%) were found to be in the moderate risk category of caries risk assessment. The males are 51% less likely to have caries compared to the females (AOR = 0.49, P = 0.081). The majority of participants (71.3%) had one or more disease indicators, with white spots and visible cavities. Those with visible, heavy plaque were 13.9 times more likely to have caries compared to those without (AOR = 13.92, P < 0.001). Those using calcium and phosphate during the last 6 months were 90% less likely to have caries compared to those not using them (AOR = 0.10, P < 0.001). There was no significant interaction between all eight risk factors retained in the final model (P > 0.05), the Hosmer and Lemeshow Test P < 0.001, classification accuracy = 87.1%, and AUC = 91.2%.

Conclusion

The caries risk among the general population of Pakistan is moderate, with significant variation among age groups, education levels, and socioeconomic status.

Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review

OBJECTIVE

To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS).

BACKGROUND

The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services.

MATERIALS AND METHODS

Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria.

RESULTS

Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS.

CONCLUSION

This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

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.

Comparison of a resin-based sealant with a nano-filled flowable resin composite on sealing performance of marginal defects in resin composites restorations: a 36-months clinical evaluation

OBJECTIVES

Our goal was to evaluate the clinical behavior of resin-based composite (RBC) restorations with sealed marginal defects using nano-filled flowable RBCs (FRS) compared with resin-based sealant (RBS); this work used marginal adaptation, marginal staining, and secondary caries according to the World Dental Federation (FDI) criteria.

MATERIALS AND METHODS

This was a prospective, randomized, double-blind, controlled trial. Fifty-four patients who met the inclusion criteria (older than 18 years old; with high cariogenic risk determined by Cariogram software; and restorations with marginal defects, 3 and 4 according to FDI criteria) were randomly divided into three groups. There were three defective RBC restorations per patient and were repaired (n = 162). The groups were RBS-marginal sealing using a resin-based sealant (Clinpro Sealant, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); FRS-sealing using flowable resin (Filtek Flow Z350XT, 3 M ESPE, MN, USA) plus adhesive (Single Bond Universal, 3 M ESPE, MN, USA); and control-no repair treatment. All procedures were performed under complete isolation. Evaluations were evaluated at 1-week post treatment (baseline) as well as at 18 and 36 months after treatment regarding marginal adaptation, marginal staining, and secondary caries according to FDI criteria. The data were analyzed using the Wilcoxon test (α = 0.05) to compare the differences in each treatment group at different evaluation times.

RESULTS

Marginal adaptation of micro-repaired RBC restorations were seen in patients with a high risk of caries using flowable resin composite or resin-based sealants. There were differences (P < 0.001) when baseline was compared at 18 and 36 months. Marginal staining showed differences when baseline was compared to 18 months (P < 0.001) and 36 months (P = 0.001) for both treatments. Secondary caries parameters for RBS treatment showed differences when baseline was compared to 36 months (P = 0.025) and when 18 months was compared to 36 months (P = 0.046).

CONCLUSIONS

Micro-repair of RBC restorations resulted in clinical deterioration of marginal adaptation and marginal staining. Nano-filled flowable resin composites were sealed on defective restorations; 3 and 4 FDI marginal defects have better clinical performance to prevent secondary caries than resin-based sealants after 36 months.

CLINICAL RELEVANCE

Micro-repair with RBS does not seem to be an effective treatment to prevent secondary caries.

Validation of a Subjective Caries Risk Assessment Tool

OBJECTIVE

The objective was to evaluate the predictive validity of the American Dental Association's caries risk assessment (CRA) tool, adapted with permission, and used by the U.S. Department of Veterans Affairs dental services within their electronic dental record.

METHODS

This analytic epidemiologic study with a retrospective longitudinal design included Veterans who had a minimum of three years of available data. The primary outcome was caries-related treatment during the twelve-month predictive period following the CRA category identification.

RESULTS

The sample included 57,675 Veterans; 50.1% classified as low, 33.2% as moderate and 16.8% as high caries risk. During the twelve-month predictive period, both teeth/person and teeth with caries-related treatment rose sequentially from low to high CRA categories. However, poor sensitivity (0.34-0.58) and better specificity (0.53-0.78) values were observed. Similarly, better negative predictive values (0.72-0.79) compared to positive predictive values (0.28-0.34) were found. Adjusted logistic regression models showed that current treated caries (caries detected at the time of the CRA exam) was more strongly associated with future caries-related treatment than the subjective CRA determination.

CONCLUSIONS

The subjective CRA tool evaluated in this study is better at identifying patients at low risk of requiring future caries-related treatment versus those at higher risk. This makes it difficult to target the most caries susceptible patients with preventive measures. Furthermore, we found that the amount of caries treatment required at the time of the CRA exam had the strongest association with caries-related treatment during the subsequent twelve-month predictive period.

CLINICAL SIGNIFICANCE

The amount of caries-related treatment required at the time of the caries risk classification is the strongest predictor of future caries.

Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

OBJECTIVES

To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses.

DATA/SOURCES

We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

STUDY SELECTION

A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00.

CONCLUSION

The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies.

CLINICAL SIGNIFICANCE

Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.

Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities <0.5 and underestimates the risk for forecast probabilities >0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required.

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

BACKGROUND

Cariogram®, 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.

METHODS

The 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.

RESULTS

The 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.

CONCLUSION

Cariogram 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.

Validation of different Cariogram settings and factor combinations in preschool children from areas with high caries risk

BACKGROUND

Caries risk assessment in preschool children has been limited validated.

AIM

To validate caries predictive ability of Cariogram using different combinations of factors and settings in preschool children from areas with high caries risk.

DESIGN

Two to five years old children (N = 175) were examined for caries (cavitated and non-cavitated lesions), at baseline and after 1 and 2 years. Mutans streptococci counts (MS) and saliva buffer capacity (SBC) were measured with chair side tests. Diet and oral health attitude were assessed through a parental questionnaire. Baseline caries risk was calculated using standard and high-risk group variables in Cariogram either with nine factors or excluding MS and SBC. Poisson regression models, ROC analysis and information criteria (AIC and BIC), P < 0.05, were used to investigate the predictive ability of Cariograms and to quantify the associations.

RESULTS

Accuracy of Cariogram was found limited. Cariograms with MS showed higher sensitivity but lower specificity than those without bacterial counts. Standard set Cariograms with MS counts performed slightly better than the other models, but the difference was not statistically significant. Caries prediction with standard and high set Cariograms was also found limited.

CONCLUSIONS

Cariogram with various factors and settings displayed suboptimal ability to predict caries in this population.

The effect of mobile personalised texting versus non-personalised texting on the caries risk of underprivileged adults: a randomised control trial

Background

In the Republic of Ireland (RoI), fluoridation has been effective and efficient for caries prevention at population level, regardless of income status; however, at individual level it still has limitations. This study aimed to compare personalised versus non-personalised text messaging on ‘chance of avoiding new cavities’ with the Cariogram, a computer-based caries risk assessment (CRA) model, in an economically disadvantaged adult population in the RoI.

Methods

The intervention was via a CRA summary letter plus 24 weekly personalised mobile-phone short text messages (text messages) based on the individual’s CRA, compared with a non-personalised approach via a non-personalised letter and a predetermined, fixed set of 24 weekly text messages. The study was designed as a two-arm parallel-group, single-blinded (assessor), randomised controlled study in County Cork, RoI. The primary outcome was a comparison of ‘chance of avoiding new cavities’ calculated by the Cariogram with clinical examination, interview, CRT® (Ivoclar Vivadent, Liechtenstein) and three-day food diary between the two groups at follow-up. We combined stratified randomisation with blocked randomisation for 171 participants who completed baseline. Of them, 111 completed follow-up and were analysed (56 and 55 from the personalised and non-personalised groups, respectively). Due to protocol violations, both intent-to-treat (ITT) and per-protocol analyses were conducted.

Results

The ITT analysis did not show a personalised intervention effect on ‘chance of avoiding new cavities’. Of the secondary outcome measures, only the stimulated saliva flow factor showed a personalised intervention effect, p = 0.036, OR = 0.3 (95% CI = 0.1, 0.9). The per-protocol analysis with 21 personalised and 33 non-personalised participants within two-message deviations showed no significant effect on ‘chance of avoiding new cavities’.

Conclusions

The null hypothesis in regard to the primary outcome for both ITT and per-protocol analyses was not rejected; however, as the minimal clinically important difference was included in the 95% CI for the per-protocol analysis, replication studies will be worth conducting to explore the potential of mobile devices for individual caries risk reduction.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry (UMIN000027253) on 10 May 2017. The study was retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0729-1) contains supplementary material, which is available to authorized users.

Are standardised caries risk assessment models effective?

Data sourcesPubMed, Scopus and Embase were searched from 2000 to 2016.Study selectionA search strategy was developed to identify randomised clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies that tested standardised caries risk assessment (CRA) models. There was no restriction with respect to patients' age, but caries data should have been recorded using the Decayed, Missing, Filled Tooth/Surface (DMFT/S) or the International Caries Detection and Assessment System (ICDAS) indices.Data extraction and synthesisTwo authors independently assessed the papers for inclusion, carried out data extraction and the papers' methodological quality using a customised quality assessment tool developed by the National Heart, Lung and Blood Institute and Research Triangle Institute International for Observational Cohort and Cross-Sectional Studies. For comparison between studies, the caries values were organised in two-by-two tables from which sensitivity, specificity values and their 95% confidence intervals were calculated.ResultsA total of 1239 papers were retrieved of which 32 were included. The most frequent CRA model investigated was the Cariogram. Sixteen studies were carried out on children and 12 on adults. The results showed an association between the risk determined by the model and the actual caries status and/or the development of new carious lesions, this association being statistically significant. With respect to the quality of the studies included in the review, 19 were classified as of good quality, while eight and five were judged as of fair and poor, respectively. On the basis of seven studies, it was observed that Cariogram sensibility varied from 41.0 to 75.0, while its specificity ranged from 65.8 to 88.0.ConclusionsThere is insufficient evidence to assert that CRA models are effective in determining patients' actual caries risk or in predicting their probability of developing new carious lesions. Moreover, the validity of standardised CRA models is still limited.

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review

BACKGROUND

Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment.

METHODS

Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment.

RESULTS

One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels.

CONCLUSIONS

The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

Caries risk profiles in orthodontic patients: A 4-year follow-up study using the Cariogram model in governmental vs. private clinics

OBJECTIVES

To (1) analyze caries-related factors and (2) evaluate caries risk using the Cariogram model for governmental and private orthodontic patients at de-bonding and 4 years after de-bonding.

MATERIALS AND METHODS

Forty orthodontic patients with mean age of 26.4 years were recruited from a governmental (G) group (n = 20) and private (P) group (n = 20) and were examined at de-bonding (T1) and 4 years after de-bonding (T2). The examination included a questionnaire, plaque scoring, caries examination, bitewing radiographs, and assessment of salivary secretion rate, buffering capacity and cariogenic microorganisms. The data were entered into the Cariogram program to illustrate the caries risk profiles.

RESULTS

The chance to avoid new cavities was higher in P-group compared to G-group at T1 (58% and 31%, respectively) (P < 0.01) and T2 (77% and 52%, respectively) (P < 0.001). Plaque index was significantly higher in G-group, and fluoride was used significantly more in P-group at T1 and T2 (P < 0.05). The chance to avoid new cavities was higher at T2 compared to T1 (64% and 44%, respectively) (P < 0.001). Saliva secretion rate and buffer capacity were significantly increased, and the plaque index was significantly decreased at T2 compared to T1 (P < 0.01).

CONCLUSION

According to the Cariogram, orthodontic patients were less likely to avoid new cavities at de-bonding and 4 years after de-bonding in government clinics compared to private clinics, and the caries risk significantly decreased 4 years after orthodontic treatment for all patients, regardless of the location of treatment.

Experience of dental care, knowledge and attitudes of older immigrants in Sweden-A qualitative study

OBJECTIVES

Knowledge about the oral health and dental care habits of older immigrants is limited. The aim of this study was to explore dental service utilization, oral care habits, and attitudes to and knowledge about oral diseases and their prevention among older immigrants in Sweden.

METHODS

A qualitative research method was used, and data were collected in individual interviews to gain a deeper understanding of the immigrants' views. Thirteen immigrants, seven women and six men, recruited from meeting places for older immigrants, participated, all aged between 59 and 88 (median 72 years). Interviews were tape-recorded and transcribed verbatim. Eight interviews were carried out with the help of an authorized interpreter.

RESULTS

In the analytical process, performed using the content analysis method, meaning units were identified and condensed into codes which were labelled and grouped into subcategories and categories. The interview analysis resulted in four categories: Experiences of dental care, Attitudes, Barriers and Prevention of oral diseases. The elderly immigrants described a mix of regular and acute dental care and were often not satisfied with the outcome of the treatments. They stated that oral health was important and that they were responsible for their own teeth. Barriers to dental care were costs, language problems and lack of confidence in dental services. Daily oral hygiene routines were performed using a traditional chewing stick and/or regular toothbrush.

CONCLUSION

The participants stated that, despite the barriers to treatment described above, they valued good oral health and visited dental services when they needed to.

Development of Caries Risk Assessment Tool for Iranian Preschoolers: A Primary Validation Study

BACKGROUND

The aim of the present study was to develop a dental caries risk assessment tool for Iranian preschoolers.

METHODS

In a validation and cross-sectional study, a random sample of 150 preschool children was involved. This study was conducted in three phases: questionnaire design (expert panel and peer evaluation), questionnaire testing (pilot evaluation and field testing), and validation study. The initial assessments include interview, dental examination, and laboratory investigations. Validity and reliability indices, content validity index (CVI), content validity ratio (CVR), impact score, and test-retest and Cronbach's alpha were measured. Decayed, missing, filled teeth (dmft) scores were calculated according to the WHO guidelines.

RESULTS

The Iranian version of caries risk assessment (CRA) questionnaire contained 17 items. Cronbach's alpha coefficient (0.86) indicated a suitable internal consistency. The mean scores for the CVI and the CVR were 0.87 and 0.78, respectively. The prevalence rate of dental caries in the study group was 69.3%, and the mean dmft was 4.57 (range 0-19).

CONCLUSIONS

The Persian version of CRA questionnaire was adapted to the Iranian population. The findings demonstrated overall acceptable validity and also reliability in the application of test-retest. The results of the present study provide initial evidence that the designed CRA form could be a useful tool for CRA in the Iranian preschoolers.

Evaluation of the Cariogram for root caries prediction

OBJECTIVES

The aim of this study was to evaluate complete and reduced Cariogram models in predicting root caries risk in independently living older adults by comparing the caries risk assessment of the programme to observed root caries increment over a two-year period.

METHODS

A prospective study recording root caries incidence was conducted on 334 dentate older adults. Data were collected on participant's medical history, fluoride exposure, and diet. Saliva samples were collected to measure salivary flow rate, buffer capacity and bacterial counts. Clinical examination was completed to record decayed, missing and filled teeth (DMFT) and also exposed, filled and decayed root surfaces (RDFS). This was repeated after 12 and 24 months. Scores were entered into the Cariogram and baseline risk category was recorded. Reduced Cariogram models were generated by omitting individual salivary variables and all salivary variables. The performance of the complete and reduced Cariogram models in predicting root caries incidence were evaluated by receiver operating characteristic (ROC) analysis.

RESULTS

280 participants were examined at two year follow up. 55.6% of those in the highest risk group developed new caries compared to 3.8% in the lowest risk group. The mean root caries increment in the highest risk group was 2.00 (SD 3.20) compared to 0.04 (SD 0.20) in the lowest risk group. The area under the ROC curve for the complete Cariogram model was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Omitting individual or all salivary variables did not significantly alter the predictive ability of the Cariogram.

CONCLUSION

Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries.

CLINICAL SIGNIFICANCE

Identification of a caries risk assessment tool which could reliably select high-risk individuals for root caries prevention strategies would maximise the cost effectiveness of professionally delivered prevention measures.

[Difficulty influence factors of dental caries clinical treatment]

Dental caries is a major disease that threaten human's oral healthy severely with the characteristics of high incidence, low rate of treatment and high rate of retreatment. At present, restorative treatment remains the main method for caries treatment. With the development of the Minimally Invasive Cosmetic Dentistry (MICD), reasonable application of various treatment technologies, maximum preservation of tooth tissues and realizing the maximization of treatment effects become problems that call for immediate solution in dental clinics. In addition, there still exist a large number of old restorations that need standard retreatments. Here, some difficulty influence factors of dental caries clinical treatment such as systemic and oral factors, individual caries susceptibility, treatment technologies and materials, retreatment methods of old restorations and technique sensitivity are analyzed, and corresponding processing strategies are also put forward.

Older people's description of factors that facilitate and impede regular dental care - a qualitative interview study

OBJECTIVES

The aim of this study was to achieve an understanding of older people's view of the benefits of regular dental care and investigate factors that facilitate and impede regular dental care.

METHODS

A qualitative research method was used. To gain a deeper understanding of the elderly people's views, individual interviews were conducted. Fifteen respondents, eleven women and four men aged between 65 and 95, participated, all recruited from senior social centres. All interviews were tape-recorded and transcribed verbatim, and the content analysis method was then used. Meaning units were identified and condensed into codes which were labelled and grouped into categories and subcategories.

RESULTS

Findings were grouped into three categories: experiences of dental care, obstacles and facilitators to dental care and about oral health and responsibility. The elderly had experience of both regular and irregular dental care. Obstacles to visiting dental services included high costs and complicated dental insurance, other practical obstacles, lack of confidence in dentistry and seeing no benefits of dental care at their age. Views of the importance of oral health varied, and some people thought poor teeth were shameful. Some expressed that oral health was your own responsibility, while others thought that oral health was the responsibility of the dental services.

CONCLUSIONS

Several factors which hamper regular dental care have been identified, and taken together, these obstacles often became unsurmountable. However, individuals taking their own responsibility for their dental status and dental services making certain adaptations, both encourage people to seek regular dental care.

Salivary Bacterial Levels and Clinic Attendance Patterns may be Longitudinally Associated with Caries Outcomes in Established Adult Dental Patients

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Multicenter study on caries risk assessment in Japanese adult patients. Arino M, Ito A, Fujiki S, Sugiyama S, Mayashi M. J Dent 2015;43(10):1223-8.

SOURCE OF FUNDING

The Japan Society for the Promotion of Science, an independent administrative institution under the Ministry of Education, Culture, Sports, Science, and Technology, provided a Grant-in-Aid for Scientific Research (25293387) TYPE OF STUDY/DESIGN: Retrospective cohort (chart review).

Oral health status in older immigrants in a medium-sized Swedish city

AIM

The aim of the study was to investigate oral health and oral care habits among older immigrants to Sweden from countries outside the Nordic region.

METHOD

Participants ≥60 years of age from senior social centers for immigrants were invited to attend oral examinations. Data was collected on the number of teeth, dentures, caries, periodontal status, saliva secretion, and plaque scores. Participants also described their general health and oral care habits.

RESULTS

Fourteen men and 28 women, median age 71.5 years, participated. Seventeen percent were edentulous, women often than men. Three out of four had caries and 63% had gingival bleeding. Two-thirds brushed their teeth twice per day and 60% had visited dental services in the last 2 years.

CONCLUSION

The group had a high prevalence of oral diseases and discomfort. They used dental services and brushed their teeth less frequently than Swedish populations of the same age.

Comparison of risk assessment based on clinical judgement and Cariogram in addition to patient perceived treatment need

Background

Predicting future risk for oral diseases, treatment need and prognosis are tasks performed daily in clinical practice. A large variety of methods have been reported, ranging from clinical judgement or “gut feeling” or even patient interviewing, to complex assessments of combinations of known risk factors. In clinical practice, there is an ongoing continuous search for less complicated and more valid tools for risk assessment. There is also a lack of knowledge how different common methods relates to one another. The aim of this study was to investigate if caries risk assessment (CRA) based on clinical judgement and the Cariogram model give similar results. In addition, to assess which factors from clinical status and history agree best with the CRA based on clinical judgement and how the patient’s own perception of future oral treatment need correspond with the sum of examiners risk score.

Methods

Clinical examinations were performed on randomly selected individuals 20–89 years old living in Skåne, Sweden. In total, 451 individuals were examined, 51 % women. The clinical examination included caries detection, saliva samples and radiographic examination together with history and a questionnaire. The examiners made a risk classification and the authors made a second risk calculation according to the Cariogram.

Results

For those assessed as low risk using the Cariogram 69 % also were assessed as low risk based on clinical judgement. For the other risk groups the agreement was lower. Clinical variables that significantly related to CRA based on clinical judgement were DS (decayed surfaces) and combining DS and incipient lesions, DMFT (decayed, missed, filled teeth), plaque amount, history and soft drink intake. Patients’ perception of future oral treatment need correlated to some extent with the sum of examiners risk score.

Conclusions

The main finding was that CRA based on clinical judgement and the Cariogram model gave similar results for the groups that were predicted at low level of future disease, but not so well for the other groups. CRA based on clinical judgement agreed best with the number of DS plus incipient lesions.

Multicenter study on caries risk assessment in adults using survival Classification and Regression Trees

Dental caries is an important public health problem worldwide. This study aims to prove how preventive therapies reduce the onset of caries in adult patients, and to identify patients with high or low risk of caries by using Classification and Regression Trees based survival analysis (survival CART). A clinical data set of 732 patients aged 20 to 64 years in nine Japanese general practices was analyzed with the following parameters: age, DMFT, number of mutans streptococci (SM) and Lactobacilli (LB), secretion rate and buffer capacity of saliva, and compliance with a preventive program. Results showed the incidence of primary carious lesion was affected by SM, LB and compliance with a preventive program; secondary carious lesion was affected by DMFT, SM and LB. Survival CART identified high-risk patients for primary carious lesion according to their poor compliance with a preventive program and SM (≥10⁶ CFU/ml) with a hazard ratio of 3.66 (p = 0.0002). In the case of secondary caries, patients with LB (≥10⁵ CFU/ml) and DMFT (>15) were identified as high risk with a hazard ratio of 3.50 (p < 0.0001). We conclude that preventive programs can be effective in limiting the incidence of primary carious lesion.

Monitoring of caries disease by risk assessments and activity

ABSTRACT Dental caries is a non-communicable disease and is considered a public health problem. For diagnosis and correct treatment, the study of risk assessment and caries activity is necessary. The caries risk assessment is a way to formalize the balance and imbalance of predictably disease to diagnose dental caries. Therefore, the caries risk assessment is performed through different evaluation systems. Another parameter of great importance to be studied is the activity of caries, because through it is done the correct treatment decision for the patient. The objective of this article is to inform the reader about: the concepts and caries risk factors; the different caries risk assessment systems described in the literature; and which systems are validated. In addition, this literature review provides for identification and evaluation of risk factors and activity of caries lesions in order to enable greater objectivity in the diagnosis and facilitate the decisions of a successful treatment.

WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME?

BACKGROUND

Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan.

AIMS

Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care.

DESIGN

Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles.

RESULTS

In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans.

CONCLUSIONS

The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.

Multicenter study on caries risk assessment in Japanese adult patients

OBJECTIVES

This study was conducted to identify significant risk factors for the onset and the accumulation of new caries in adult patients undergoing regular preventive therapy.

METHODS

The data of 732 patients from nine Japanese general dental practices were retrospectively analyzed. Classification and regression tree (CART) analysis was applied to develop a caries prediction model using the following patient parameters: age, number of teeth with caries experience (DMFT), levels of mutans streptococci (SM) and lactobacilli (LB), saliva flow rate and buffer capacity, and compliance with a preventive program. Poisson regression analysis was conducted to identify factors affecting caries accumulation within three years.

RESULTS

CART analysis identified patients at high risk for primary caries with an odds ratio of 3.08 (95%CI, 1.55-5.79; p=0.0018) according to SM levels and compliance; and those for secondary caries with an odds ratio of 3.69 (95%CI, 2.29-5.91; p<0.0001) according to LB and SM levels. Poisson regression analyses showed that accumulation of primary caries was affected by compliance (p<0.001), SM (p<0.001) and LB (p=0.013). Accumulation of secondary caries was affected by DMFT (p<0.001), SM (p<0.001) and LB (p<0.001).

CONCLUSIONS

CART is an important tool in identifying the risk of caries development in individual adult patients. Cariogenic bacteria are important factors for both the onset and accumulation of primary and secondary caries.

CLINICAL SIGNIFICANCE

Participation in a regular preventive program limits the onset and the accumulation of primary caries in adult patients.

Risk assessment - can we achieve consensus?

OBJECTIVE

The object of this conference paper was to review and discuss caries risk assessment in general practice from the questions i) 'Why', ii) 'When', and iii) 'How'.

METHOD

Narrative review.

RESULTS

i) Patient caries risk assessment is the basic component in the decision-making process for adequate prevention and management of dental caries and for determination of individual recall intervals. ii) Caries risk assessment should always be performed at a child's first dental visit and then regularly throughout life, and especially when social or medical life events are occurring. iii) There are several risk assessment methods and models available for but the evidence for their validity is limited. Although there is no clearly superior method for predicting future caries, the use of structured protocols combining socioeconomy, behavior, general health, diet, oral hygiene routines, clinical data, and salivary tests or computer-based systems are considered best clinical practice. The accuracy ranges between 60% and 90%, depending on age. Caries risk assessment is more effective in the selection of patients at low risk than those with high caries risk.

CONCLUSION

As evidence suggests that past caries experience is far from ideal but the most important single risk component for more caries at all ages, any clinical sign of likely active demineralization on smooth, occlusal, and proximal tooth surfaces should be taken as a signal for the implementation of individually designed preventive and disease management measures.

Caries management pathways preserve dental tissues and promote oral health

In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided.

Sealing Composite With Defective Margins, Good Care or Over Treatment? Results of a 10-year Clinical Trial

Purpose

The objective of this study was to clinically evaluate sealed composite restorations after 10 years and compare their behavior with respect to controls.

Methods and Materials

The cohort consisted of 20 patients aged 18 to 80 years with 80 composite restorations. All participants in the sealing and no-treatment groups presented with clinical features for the marginal adaptation that deviated from the ideal and were rated Bravo (United States Public Health Service criteria). Composites with Alfa values for the marginal adaptation were used as the positive control.

Results

The marginal adaptation behavior was similar between the sealing and control (+) groups, with a high frequency of Bravo values in the 10th year (80% and 51%, respectively). Most of the no-treatment (-) group maintained the Bravo values (91%) for 10 years, although some restorations (9%) progressed to Charlie values. The anatomy parameter differed significantly between the first and 10th years, with deterioration in all three groups (p&lt;0.05). The secondary caries parameter had a similar behavior in the three groups (p&gt;0.05).

Conclusions

Sealing the margins of the composite resin restorations had no significant effect compared with the control groups, under the conditions of this study. Sealing the restorations substantially improved the marginal staining and marginal adaptation parameters, although by the tenth year they were similar to the group without intervention.

Baseline caries risk assessment as a predictor of caries incidence

Few studies have evaluated clinical outcomes following caries risk assessment in large datasets that reflect risk assessments performed during routine practice.

OBJECTIVES

From clinical records, compare 18-month caries incidence according to baseline caries risk designation.

METHODS

For this retrospective cohort study, data were collected from electronic records of non-edentulous adult patients who completed an oral examination and caries risk assessment (CRA) at a university instructional clinic from 2007 to 2012 (N=18,004 baseline patients). The primary outcome was the number of new decayed/restored teeth from the initial CRA to the ensuing oral examination, through June 30, 2013 (N=4468 patients with follow-up). We obtained doubly-robust estimates for 18-month caries increment by baseline CRA category (low, moderate, high, extreme), adjusted for patient characteristics (age, sex, payer type, race/ethnicity, number of teeth), provider type, and calendar year.

RESULTS

Adjusted mean decayed, restored tooth (DFT) increment from baseline to follow-up was greater with each rising category of baseline caries risk, from low (0.94), moderate (1.26), high (1.79), to extreme (3.26). The percentage of patients with any newly affected teeth (DFT increment>0) was similar among low-risk and moderate-risk patients (cumulative incidence ratio, RR: 1.01; 95% confidence interval, CI: 0.83, 1.23), but was increased relative to low-risk patients among high-risk (RR: 1.28; 95% CI: 1.10, 1.52), and extreme-risk patients (RR: 1.52; 95% CI: 1.23, 1.87).

CONCLUSIONS

These results lend evidence that baseline caries risk predicts future caries in this setting, supporting the use of caries risk assessment to identify candidate patients for more intensive preventive therapy.

CLINICAL SIGNIFICANCE

Identification of patients at greater risk for future caries helps clinicians to plan appropriate personalized care. In this study, a multifactorial approach to caries risk assessment effectively stratified patients into groups of higher or lower caries propensity. Dentists can apply risk assessment in practice antecedent to patient-tailored caries management.

Self-reported changes in using fluoride toothpaste among older adults in Sweden: an intervention study

OBJECTIVE

The aim of the study was to investigate the possibility of increasing knowledge about the caries-reducing effects of fluoride (F) toothpaste and to increase the use of F toothpaste among older adults through an intervention.

MATERIALS AND METHODS

63-67-year-olds in Sweden, who 2 years earlier had answered a questionnaire about their knowledge of F toothpaste, toothbrushing and toothpaste habits and who had shown less favourable habits with regard to toothpaste use, were invited to participate. The 20-min intervention, performed at a Public Dental Clinic, was implemented by a dental hygienist (author OJ) and consisted of individual information and instruction on the use of F toothpaste. The questionnaire was repeated 4 months after the intervention and a population in another city in Sweden served as control.

RESULTS

In the intervention group, 68 individuals responded and 151 in the control group. Knowledge of the benefits of F toothpaste in the intervention group had improved between the times of the first and second questionnaires, but the same effect was also noted in the control group. After the intervention, a clear improvement concerning the use of F toothpaste was reported: the individuals brushed for a longer time, used more toothpaste and used less water during and after brushing. In the control group, there were no changes of habits between the first and second occasions.

CONCLUSION

Individually-based interventions performed by a dental hygienist had a positive effect on changing the way older adults used F toothpaste.

Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia?

OBJECTIVES

The aim of this study was to correlate the caries-related variables of special needs patients to the incidence of new caries.

MATERIALS AND METHODS

Data for socio-demographic information and dental and general health status were obtained from 110 patients treated under general anesthesia because of their insufficient co-operation. The Cariogram program was used for risk assessment and other caries-related variables were also analyzed. Within a defined follow-up period (16.3 ± 9.5 months), 64 patients received dental examinations to assess newly developed caries.

RESULTS

At baseline, the mean (SD) values of the DMFT (decayed, missing and filled teeth) and DT (decayed teeth) for the total patients were 9.2 (6.5) and 5.8 (5.3), respectively. During the follow-up period, new caries occurred in 48.4% of the patients and the mean value (SD) of the increased DMFT (iDMFT) was 2.1 (4.2). The patients with a higher increment of caries (iDMFT ≥3) showed significantly different caries risk profiles compared to the other patients (iDMFT <2) (p < 0.05). Close correlations existed between the caries increment and several caries-related variables; baseline DMFT, insufficient self-tooth-brushing and malocclusion were greatly associated with new caries development.

CONCLUSIONS

Caries risk assessment could predict the incidence of future caries in hospital-based dentistry. Past caries experience and inadequate oral hygiene maintenance were largely related to caries development in special needs patients.

Dietary and oral hygiene habits of active athletes and adolescents attending ordinary junior high schools

BACKGROUND

Active sports require sufficient energy intake. How do young athletes meet this need? The aim of this study was to investigate self-reported health and oral behaviors of young athletes and to compare them with a population-based sample of ordinary adolescents.

DESIGN

A computer-based questionnaire on oral hygiene habits and dietary habits was conducted in two junior high schools with special classes for athletes in 2011. Adolescents of similar age (n=1230) attending ordinary classes had responded the same questionnaire earlier in the city of Oulu (in 2004) and in Kajaani, Finland (in 2006-2007). Answers to individual questions as well as sum scores of the answers were analyzed. The answers of the athletes and ordinary adolescents were analyzed by gender using cross-tabulation and chi-square testing.

RESULTS

The mean sum score of the athletes indicated their more favorable health behavior compared with the other adolescents. They also ate more frequently the four daily than the others; in addition, they ate the school lunch as an entity which it was intended. However, the athlete boys consumed more fizzy/soft drinks and ate chocolate more often than the rest. The athletes also brushed their teeth more frequently than ordinary adolescents. Oral health behavior of the girls was better than that of the boys.

CONCLUSIONS

Health behavior of the young athletes is better than that of other adolescents. Continuous oral health education should be targeted to all adolescents; growing boys should be target group of information on healthy sources of energy.

Can repair increase the longevity of composite resins? Results of a 10-year clinical trial

OBJECTIVES

The aim of this double-blind clinical trial was to assess the longevity of repairs to localized clinical defects in composite resin restorations that were initially planned to be treated with a restoration replacement.

METHODS

Twenty-eight patients aged 18-80 years old with 50 composite resin restorations (CR) were recruited. The restorations with localized, marginal, anatomical deficiencies and/or secondary caries adjacent to CR that were "clinically judged" to be suitable for repair or replacement according to the USPHS criteria were randomly assigned to Repair (n=25) or Replacement (n=25) groups, and the quality of the restorations was scored according to the modified USPHS criteria. The restorations were blind and two examiners scored them at baseline (Cohen Kappa agreement score 0.74) and at ten years (Cohen Kappa agreement score 0.87) restorations. Wilcoxon tests were performed for comparisons within the same group (95% CI), and Friedman tests were utilized for multiple comparisons between the different years within each group.

RESULTS

Over the decade, the two groups behaved similarly on the parameters of marginal adaptation (MA) (p>0.05), secondary caries (SC) (p>0.05), anatomy (A) (p<0.05), and colour (C) (p>0.05).

CONCLUSIONS

Given that the MA, SC, A and C parameters behaved similarly in both groups, the repair of composite resins should be elected when clinically indicated, because it is a minimally invasive treatment that can consistently increase the longevity of restorations.

CLINICAL SIGNIFICANCE

The repair of defective composite resins as an alternative treatment to increase their longevity proved to be a safe and effective treatment in the long term.

Minimal intervention dentistry: part 2. Caries risk assessment in adults

Risk-based, patient-centred decision-making, supported by best available evidence is an essential component for the correct prevention, control and management of dental caries. This article reviews the importance of caries risk assessment in adults as a prerequisite for appropriate caries preventive and treatment intervention decisions. A clinical case will be used to demonstrate how risk assessment can be easily incorporated in everyday clinical practice, using information readily available in the dental-medical history and clinical examination.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

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.

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

How regular visits and preventive programs affect onset of adult caries

If it is to be effective, preventive dental treatment must be based on an individual's risk of caries and periodontal disease. However, hitherto, preventive treatment has been generally conducted without proper caries-risk assessment because of lack of knowledge about an individual's caries risk. This study sought to identify high-risk adult patients and examine the effectiveness of preventive programs. Data for 442 patients from a single general practice who met the inclusion criteria were analyzed. Multiple logistic-regression analysis showed that high levels of mutans streptococci (SM) correlated with the onset of primary and secondary caries, with odds ratios of 2.34 (95%CI: 1.15-4.76, p = 0.019) and 2.22 (95%CI: 1.06-4.62, p = 0.034), respectively. Lactobacilli (LB) also correlated with secondary caries, with an odds ratio of 3.34 (95%CI: 1.35-6.85, p = 0.007). When the patients were checked after three years of a preventive program, the correlation with SM and LB disappeared. Survival analyses by Cox regression models and Kaplan-Meier methods showed that secondary caries was difficult to control by conventional preventive programs alone in patients with high levels of cariogenic bacteria. In conclusion, cariogenic bacteria play an important role in the incidence of caries, and additional intensive preventive treatment should be considered for high-risk patients.