Caries status in young Colombian children expressed by the ICCMS™ visual/radiographic combined caries staging system

A systematic review and meta-analysis on early-childhood-caries global data

OBJECTIVES

The present study systematically reviewed and provided a meta-analysis on early childhood caries (ECC) global prevalence and its association with socioeconomic indicators, both geographical and regarding unemployment rate, national income as well as income inequalities.

METHODS

Only cross-sectional or cohort studies covering ECC prevalence and experience in children younger than 71 months, reporting sample size, diagnostic criteria and conducted in urban and rural communities were considered. No language restriction was selected. Studies published from 2011 to 2022 available in PubMed, Web of Science, Embase and Open Grey literature were retrieved by ad hoc prepared search strings. The meta-analyses were conducted for both overall ECC prevalence and experience stratified by country of publication as well as measures of socioeconomic indicators using a random effects model using STATA 18®.

RESULTS

One hundred publications reporting ECC data from 49 countries (published from 2011 to 2022) were included and summarized by meta-analysis. The lowest prevalence was reported in Japan (20.6%) and Greece (19.3%). The global estimated random-effect pooled prevalence of ECC was 49% (95%CI: 0.44-0.55). The random-effect pooled caries prevalence (ECC) was 34% (95%CI: 02.20-0.48) (Central/South America), 36% (95%CI: 0.25-0.47) (Europe), 42% (95%CI: 0.32-0.53) (Africa), 52% (95%CI: 0.45-0.60) (Asia-Oceania), 57% (95%CI: 0.36-0.77) (North America) and 72% (95%CI: 0.58-0.85) (Middle East). When stratified by gross national income (GNI) the ECC prevalence ranged from 30% ($20,000-$39,999) to 57% in countries with the lowest GNI (<$5000). Stratification by inequality index (Gini index) resulted in an ECC prevalence range of 39% (low inequality) to 62% (no inequality), while for life expectancy the ECC prevalence ranged from 28% in countries with the highest life expectancy (< 80 years) to 62% in countries with 71-75 years life expectancy.

DISCUSSION

Within the limitations of this study (lack of certainty about the results as many countries are not represented and lack of uniformity in prevalence and experience data represented), results from 49 different countries reported a wide range of ECC prevalence. These reports indicated persisting high worldwide distribution of the disease. Both ECC prevalence and experience were associated with geographical areas and GNI.

REGISTRATION

PROSPERO: CRD-42,022,290,418.

Evaluation of Effect of Silver Diamine Fluoride in Arresting Dental Caries Using International Caries Classification and Management System (ICCMS): An In Vivo Study

Background

In terms of maintaining esthetics and function, reducing pain, and encouraging wellness, primary dentition care is just as important as permanent tooth care. The purpose of this research was to see how efficient silver diamine fluoride is at preventing tooth decay.

Materials and method

The 3- month clinical experiment included a sample size of 30 children (both males and females) aged 4-8 years by applying silver diamine fluoride on the carious tooth to evaluate the efficacy of silver dimaine fluoride in arresting the caries. The children were kept on follow-up and IOPA's were taken to check the arrest of caries at baseline, 1 month and after 3 months. To assess the progression of caries radiographic interpretation of IOPA X-rays was done using ICCMS scores at baseline, 1 month and 3 months.

Results and conclusion

The current study found that topical 38% silver diamine fluoride arrest tooth decay and was effective for treating dental caries in school-aged children in the short term.

How to cite this article

Sharma M, Tuli A, Dhawan P, et al. Evaluation of Effect of Silver Diamine Fluoride in Arresting Dental Caries Using International Caries Classification and Management System (ICCMS): An In Vivo Study. Int J Clin Pediatr Dent 2022;15(S-2):S172-S175.

Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study

BACKGROUND

Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched.

AIM

To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used.

DESIGN

Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods.

RESULTS

The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR.

CONCLUSIONS

The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.

Inclusion of initial caries lesions in a population-based sample of Brazilian preschool children: Impact on estimates and treatment needs

This study aimed to assess changes in epidemiological estimates and treatment needed when initial caries lesions are included in a population-based survey of preschool children. A cross-sectional survey was conducted in a Brazilian municipality, collecting data of preschool children in 16 health centers. Caries detection used the merged codes (epi-codes) for ICDAS/ICCMS. An option for treatment, according to ICCMS, was chosen during the examination. Caries experience (dmft/dmfs) and prevalence were estimated considering three thresholds (A- initial, moderate, and severe lesions, B- only moderate and severe lesions and C- severe lesions). Incremental need for non-operative care was also verified. The sample consisted of 663 children aged 2–4 years (response rate of 99.85%). Including initial lesions, a 2-fold increase in dmft was observed (A: 3.36, B: 1.02, p<0.001). With the inclusion, the caries prevalence increased to 75% compared to threshold B only (28%). The majority (76%) of children who required any intervention (56%) should be scheduled for non-operative care. We suggest that including initial caries lesions in an epidemiological survey may significantly impact assessment of population caries experience.

Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review

PURPOSE

To systematically evaluate the diagnostic efficacy of intraoral radiographs and evidence supporting the indications for taking of intraoral radiographs in children in the following five clinical categories: caries, pathological conditions (including acute odontogenic infections and periodontal disease), dental/developmental anomalies, dental trauma, and enhancement of comfort/technique for taking radiographs in children. This was carried out to facilitate the updating of existing European Academy of Paediatric Dentistry (EAPD) guidelines on dental radiography in pediatric dentistry.

METHODS

A systematic electronic literature search was conducted on Cochrane Library (1992-24 July 2018), MEDLINE (PubMed, 1946-24 July 2018), EMBASE (Embase.com, 1974-24 July 2018) and Scopus (pre-1970-24 July 2018). Hand search of handbooks and grey literature search was also performed. Study screening and study inclusions were agreed upon by three authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies.

RESULTS

A total of 9581 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the final analysis. The included studies were further categorized into five main clinical categories for analysis: caries, pathological conditions, dental/developmental anomalies, dental trauma and comfort/technique-related studies. Only one paper was found to be of good quality and at low risk of bias; while, 9 papers were found of be at moderate risk of bias and 26 papers were at high risk of bias. Meta-analysis was not possible for any of the aforementioned clinical situations, and only a narrative synthesis was done.

CONCLUSION

There is insufficient high-quality evidence for the use of intraoral radiographs in pediatric dentistry and current guidelines are based largely on expert opinion. There is a clear need for well-conducted and standardized studies regarding the use of intraoral radiography in pediatric dentistry.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

BACKGROUND

This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018.

AIM

The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy.

DESIGN

This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC.

RESULTS

Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care.

CONCLUSIONS

This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

How Long does it Take to Examine Young Children with the Caries ICDAS System and how do they Respond?

A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers' informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child's behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.

Diet and lifestyle habits associated with caries in deciduous teeth among 3- to 5-year-old preschool children in Jiangxi province, China

Background

The purpose of this study was to investigate the status of caries in deciduous teeth and the effect of diet and lifestyle habits on dental caries among 3- to 5-year-old preschool children in Jiangxi Province, China.

Methods

In total, 2880 cases involving preschool children were selected by stratified cluster sampling. The dental examination methods and criteria followed the WHO guidelines. SPSS 19.0 was used for the statistical analysis. Chi square tests were used to compare the caries prevalence among children with different social characteristics. Non-parametric tests were used to compare the decayed, missing and filled teeth (dmft) index values. Univariate and multivariate regression analyses were used to study the effect of diet and lifestyle habits on dental caries.

Results

The caries prevalence among the 2880 cases of 3- to 5-year-old preschool children in Jiangxi Province, China was 49.13%. There was no gender difference in this rate (P > 0.05). The caries prevalence increased with age (P < 0.05). The prevalence of caries in the rural areas was higher than that in the urban areas (P < 0.05). The deciduous central incisors and deciduous molars had a higher caries prevalence than the other deciduous teeth. According to the multivariate logistic regression analysis, the caries risk increased with living in a rural area, exclusive breastfeeding, greater frequency of daily snacking, high frequency of snacking before sleep and beginning to brush teeth at a late age; the caries risk decreased when parents helped their children brush their teeth.

Conclusion

The caries prevalence among 3- to 5-year-old preschool children in Jiangxi was lower than the level throughout the country and lower than the rate in other developing countries. The children’s diet and lifestyle habits were closely related to dental caries. Parents and children should be more aware of oral health, and parents should help their children develop healthy lifestyle behaviours.

Visual and radiographic merged-ICDAS caries progression pattern in 2-6 years old Colombian children: Two-year follow-up

AIM

To describe the 2-year clinical and combined with radiographic caries progression pattern in three cohorts of 2-(a), 4-(b), and 6-yr-old children (c).

DESIGN

Baseline sample comprised 600 children (each-cohort: n = 200). Children's dental surfaces were clinically assessed at schools without air-drying (epi) in terms of: Clinical (C) caries lesions (d/D) with ICDASepi-merged system (C-ICDASepi-d/D:Sound/Initial-epi/Moderate/Extensive); fillings (f/F), and missing teeth (m/M). Clinical ICDAS (C) and Radiographic ICDAS (R) indexes were combined (C + R). Caries experience (dmf + DMF) was expressed as: C-dmfs + DMFS (Moderate/Extensive-d/D); C-ICDASepi-dmfs + DMFS (including Initial-epi-d/D); C + R-dmfs + DMFS; and C + R-ICDASepi-dmfs + DMFS. Follow-up caries progression corresponded to more severe caries score.

RESULTS

Two-year follow-up sample was n = 352 (58.7%-baseline sample): a: n = 81; b: n = 131; c: n = 140. Around 100% of children presented C + R-ICDASepi-dmf + DMF ≥ 1, with following C + R-ICDASepi-dmfs + DMFS means: a: 7.3 ± 14.1; b: 12.2 ± 19.5; c: 13.3 ± 16.9. Progression was about 60% in all cohorts, mainly corresponding, in cohort b and c, to occlusal and distal surfaces of lower first/second-molar-primary teeth, and in cohort a to buccal surfaces of upper primary-incisor teeth. The addition of radiographs increased caries mean and prevalence in 10% as compared to only visual examination.

CONCLUSIONS

Children showed a high C + R caries experience progression rate, mainly related to occlusal and proximal surfaces in lower-molar teeth and buccal in upper-incisor teeth.

Relationship between depth of approximal caries lesions and presence of bacteria in the dentine in primary and permanent posterior teeth: a radiographic examination with microbiological evaluation

OBJECTIVES

We aimed to determine the relation between the radiographical depth of approximal lesions and the presence of bacteria in the dentine in posterior teeth in both dentitions.

MATERIAL AND METHODS

Sample 1 consisted of 34 approximal lesions in primary molars in children aged 5-7 years old. Sample 2 consisted of 48 approximal lesions in molars and premolars in adult patients aged 18-67 years old. All lesions were in need of restorative treatment according to the dentists. During the operative interventions dentine biopsies were collected with a sterile bur just pulpally of the enamel-dentin junction. Two authors evaluated the presence/absence of bacterial colonies. The lesions depth on bitewing radiographs (R_SCORING) were assessed independently by two examiners twice using the ICCMS classification system: R_I=initial-; R_M=moderate-; R_E=extensive caries.

RESULTS

In sample 1, the R_SCORING was distributed as follows: R_I=15; R_M=12; RE = 7. In 9 cases the lesions were clinically cavitated. Bacteria were visible on the agar plates in one case (7%) of the R_I lesion, 86% of the R_M lesions and in all the R_E lesions, (p < .001). In sample 2, R_SCORING was distributed as follows R_I=14; R_M=23; R_E=9. In 15 cases, the lesions were clinically cavitated. In 2 cases (14%), there were visible bacteria on the agar plates among the R_I lesions, while this was the case in 86% of R_M lesions and in 100% of R_E lesions (p < .001).

CONCLUSIONS

R_M and R_E lesions seem to harbor bacteria in the dentine and are candidates for invasive treatment. In contrast, R_I lesions should in general be managed non-invasively.