The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies

The Correlation Between Odontogenic Infection and Total Spectrum of Dental Caries with Oral Health Related Quality of Life in Children with Intellectual Disabilities

Objective

: Children with Intellectual Disabilities (ID) have a higher rate of untreated caries and often progress to caries with pulpal involvement or odontogenic infections. This can be assessed using the Caries Assessment Spectrum and Treatment (CAST) index and the Pulp Ulcer Fistula Abscess (PUFA) index. Dental problems often have an impact on quality of life, so Oral Health-Related Quality of Life (OHRQoL) assessment is needed for ID children.

Purpose

To identify and analyze the correlation between odontogenic infection, the total spectrum of caries, and OHRQoL in ID children.

Methods

: The subjects of the research were 70 ID children who attended Special Needs Schools (SNS) Type D of the Foundation for the Development of Disabled Children (FDDC). This research uses an analytical survey using questionnaires and interviews to assess OHRQoL. The sampling technique, namely Total Sampling, obtained 43 ID child subjects who met the inclusion criteria. The data were tested statistically using the Spearman Correlation non-parametric test and the t-test.

Results

: The average value of odontogenic infection in the population was 1.79, including in the poor category, and the total spectrum of dental caries was 51.16%, including severe morbidity. Multivariate analysis showed a significant correlation between odontogenic infection, total spectrum of caries, and OHRQoL; odontogenic infection with total dental caries spectrum was significantly associated with each p-value = 0.0000, while the correlation between OHRQoL and both odontogenic infection and total caries spectrum had p-values > 0.05, respectively, so it is considered not significant.

Conclusion

: Odontogenic infection in ID children is a poor category. The total spectrum of dental caries in ID children mostly includes severe morbidity. There is a correlation between odontogenic infections, the total spectrum of dental caries, and OHRQoL, as well as between odontogenic infections and the total spectrum of dental caries.

A Tele-detection and referral pAthways model for early childhood cariEs control- a protocol for a randomized factorial study: the TRACE study

BACKGROUND

Early childhood caries (ECC) is one of the most common childhood diseases affecting the primary teeth of children younger than 6 years of age. ECC progression can be reversed in the early stages although these lesions often go undetected. New approaches are needed to detect oral diseases at an early stage when they can be better controlled. The aim of the study is to assess the effectiveness of ECC tele-detection methods combined with referral pathways with and without user fee removal in controlling ECC.

METHODS

A randomized factorial trial will be used to compare two tele-dentistry detection methods for ECC (intraoral camera and smartphone camera) and two referral pathways (user fee removal versus conventional care). The study will recruit children younger than 6 years of age in marginalized communities in Alexandria, Egypt. The primary outcome is the percentage of teeth receiving indicated care, while the secondary outcomes are the oral health-related quality of life, acceptance of teledentistry by dentists, procedure time, and child cooperation. Two-way analysis of variance will be used to assess the effect of the two factors as between group variables on the outcomes after 6 and 12 months. The interaction between detection methods and referral pathways will also be assessed, and the effect of confounders will be controlled in a multivariable linear regression model.

DISCUSSION

The findings of this study have the potential to inform clinical practice and oral healthcare policies for ECC management. Successful tele-detection and referral pathways could be integrated into oral healthcare systems, leading to improved oral health outcomes for children.

TRIAL REGISTRATION

The trial has been registered on ClinicalTrials.gov in August 2023 (initial release) ID: NCT06019884.

Simultaneous detection of dental caries and fissure sealant in intraoral photos by deep learning: a pilot study

BACKGROUND

Deep learning, as an artificial intelligence method has been proved to be powerful in analyzing images. The purpose of this study is to construct a deep learning-based model (ToothNet) for the simultaneous detection of dental caries and fissure sealants in intraoral photos.

METHODS

A total of 1020 intraoral photos were collected from 762 volunteers. Teeth, caries and sealants were annotated by two endodontists using the LabelMe tool. ToothNet was developed by modifying the YOLOX framework for simultaneous detection of caries and fissure sealants. The area under curve (AUC) in the receiver operating characteristic curve (ROC) and free-response ROC (FROC) curves were used to evaluate model performance in the following aspects: (i) classification accuracy of detecting dental caries and fissure sealants from a photograph (image-level); and (ii) localization accuracy of the locations of predicted dental caries and fissure sealants (tooth-level). The performance of ToothNet and dentist with 1year of experience (1-year dentist) were compared at tooth-level and image-level using Wilcoxon test and DeLong test.

RESULTS

At the image level, ToothNet achieved an AUC of 0.925 (95% CI, 0.880-0.958) for caries detection and 0.902 (95% CI, 0.853-0.940) for sealant detection. At the tooth level, with a confidence threshold of 0.5, the sensitivity, precision, and F1-score for caries detection were 0.807, 0.814, and 0.810, respectively. For fissure sealant detection, the values were 0.714, 0.750, and 0.731. Compared with ToothNet, the 1-year dentist had a lower F1 value (0.599, p < 0.0001) and AUC (0.749, p < 0.0001) in caries detection, and a lower F1 value (0.727, p = 0.023) and similar AUC (0.829, p = 0.154) in sealant detection.

CONCLUSIONS

The proposed deep learning model achieved multi-task simultaneous detection in intraoral photos and showed good performance in the detection of dental caries and fissure sealants. Compared with 1-year dentist, the model has advantages in caries detection and is equivalent in fissure sealants detection.

Agrawal and Shah Modified Cast Index - A Novel Index Assessing Prevalence of Dental Caries and Treatment Needs of the Adult Indian Population

Background

Agrawal and Shah modified CAST (Caries Assessment Spectrum and Treatment) is the novel index prepared specifically for the Indian population for the complete evaluation of the spectrum/range of dental caries described hierarchically.

Objective

To assess the prevalence of dental caries and treatment needs in an adult Indian population using Agrawal and Shah modified CAST index.

Materials and Methods

A cross-sectional transverse study was performed on 2000 adult patients in the age range of 19-70 years. All the adult patients were scored for caries presence by Agrawal and Shah modified CAST codes on a structured proforma. SPSS version 20 was used to analyze the data.

Results

The prevalence of dental caries calculated using Agrawal and Shah modified CAST index was 85.6%. 5.2% (104) adults had sound dentition, 4.1% (82) adults had restorations, 2.1% (42) adults had non-cavitated lesions, 13.7% (274) adults had the presence of caries in the enamel, 19% (380) adults had the presence of caries in dentine, and pulpal involvement was observed in 27.7% (554) adults. 10.3% (206) adults had presented with a root surface and cervical caries. 13.6% (272) adults had lost at least one tooth due to caries, and 3% (60) adults had lost teeth due to any other reason except dental caries. 1.3% (26) adult patients do not show any caries-related diagnosis but were having predisposing conditions.

Conclusion

Agrawal and Shah modified CAST index proved to be simple, useful, and appropriate in assessing dental caries prevalence in the Indian population along with the treatment needs of the Indian population.

Using the Caries Assessment Spectrum and Treatment Index to Determine the Caries Incidence in Primary and Permanent Molars Among School Children of Kolkata: A Cross-Sectional Study

INTRODUCTION

Caries in their early stages cannot be properly classified using the decayed, missing, and filled teeth (DMFT) index because it does not record precavitated lesions. Thus, the caries assessment spectrum and treatment (CAST) index is a good alternative as it is equipped to record the whole range of dental illnesses and count restored teeth as healthy ones.

MATERIALS AND METHODS

The participants in this cross-sectional study included 300 children who were seven-to-eight years of age. We used the CAST index to assess the extent of caries in the deciduous and permanent molars of these children. For this, all the permanent and baby teeth, the primary and secondary permanent molars, as well as the first and second deciduous molars were examined to determine the prevalence of each carious stage. The correlation of the distribution of the CAST codes between the first and second molars, the second and first molars, the right and left sides of the dental bend, and the opposing jaws was analyzed using Spearman's rank correlation coefficient, while the cut-off for statistical significance was a p-value of 0.05. The quantitative analysis was conducted using IBM SPSS Experiences Version 20 for Windows.

RESULTS

By comparing CAST codes in the right and left molars, we were able to observe how the development of caries in paired teeth might affect one another. The rank correlation value was found to be less than 0.5 only in the primary second molars (55/65 and 85/75), which were found exclusively in the deciduous first molars. Moreover, the r values for the neighboring deciduous and permanent molars were found to be below 0.3, i.e., 65/64 (0.497), 74/75 (0.327), and 84/85 (0.411), which indicated a weak connection between them. When comparing the teeth in different jaws, we found reasonable correlations (r = 0.33-0.49), with only 64/74 outliers (0.501).

CONCLUSIONS

We found that, in the examined population, there was a well-established correlation between the stages of caries development in the deciduous molars on the left side of the mouth.

Assessment of caries diagnostic thresholds of DMFT, ICDAS II and CAST in the estimation of caries prevalence rate in first permanent molars in early permanent dentition-a cross-sectional study

Background

The actual burden of dental caries prevalence varies with the caries assessment tool used. Therefore, the present study evaluated the caries diagnostic potentials of Decayed, Missing and Filled Teeth (DMFT); International Caries Detection and Assessment System (ICDAS) II and Caries Assessment Spectrum and Treatment (CAST) indices in estimating the caries prevalence rate of first permanent molar (FPM) in Saudi male children aged 7–9 years.

Methods

This descriptive, cross-sectional study included 390 children by multistage stratified cluster sampling method in Al-Jouf Province, Saudi Arabia. The prevalence rates of FPM caries were determined by DMFT, ICDAS II and CAST indices at various diagnostic cut-off points. Intra- and inter-examiner reliability was determined.

Results

The prevalence rates of FPM caries determined by DMFT (decayed), ICDAS II (codes 1–6) and CAST (codes 3–7) were 64.4% (61.6–67.2), 71.5% (69.2–73.2) and 71.0% (68.7–73.3), respectively. The prevalence rates of FPM caries determined by ICDAS II at various diagnostic cut-offs were as follows: ‘sound’ (code ‘0’), 28.5% (26.3–30.8); ‘enamel caries’ (codes 1–3), 57.2% (54.7–59.7) and ‘dentinal caries’ (codes 4–6), 14.3% (12.6–16.1). Similarly, the prevalence rates estimated by CAST at different diagnostic cut-off points were: ‘healthy’ (scores 0–2), 28.1% (25.9–30.4); ‘premorbid’ (score 3, enamel carious), 56.5% (54.0–59.0); ‘morbid’ (scores 4–5, cavitated carious dentin), 7.9% (6.6–9.3); ‘severe morbidity’ (scores 6–7, pulp exposure/fistula/abscess), 6.6% (5.4–8.1) and ‘mortality’ (score 8, lost), 0.8% (0.4–1.4).

Conclusion

Enamel caries lesions were found in more than half of the FPMs investigated in the current study. CAST index is preferable because it detects the complete spectrum of caries. ICDAS II at codes 1–6 and CAST at codes 3–7 projected similar caries prevalence rates in FPMs.

Prevalence of dental caries in the first permanent molar and associated risk factors among sixth-grade students in São Tomé Island

Background

Dental caries is one of the most preventable oral diseases among children in developing countries. This study aims to estimate the prevalence and severity of dental caries in the first permanent molar and analyze the related risk factors among sixth-grade students in São Tomé Island.

Methods

A cross-sectional study with a stratified cluster sampling method was conducted on 1855 sixth-grade school children, mainly aged 11 to 14 years old, from 10 schools in 6 regions of São Tomé Island, from April 17 to June 27, 2021. Dental caries examination was performed by using the CAST criteria (DMFT) index, and the self-administered questionnaires about family background, oral hygiene, and relevant behaviors were collected. Multivariable logistic regression was used to study risk factors related to dental caries of the first permanent molar, and all data analyses were done using SPSS version 25.

Results

The prevalence of dental caries in the first permanent molar was 68.79%, without significant difference between gender, age, residence, and whether only child or not. The mean Decayed, Missing, and Filled Teeth (DMFT) index and mean Decayed, Missing, and Filled Surface (DMFS) index were 1.751 ± 1.514 and 3.542 ± 3.941, respectively. The rate of filling teeth was 5.50%, and Pit and Fissure Sealant (PFS) rate was 2.21%. The overall prevalence and DMFT index of dental caries of permanent teeth was 76.01% and 2.753 ± 4.569, respectively. The results of logistic regression analysis indicated that the frequency of candy/chocolate consumption (OR = 1.095) and fair self-assessment of dental health (OR = 1.354) were significantly associated with dental caries (P < 0.05).

Conclusions

The high prevalence of dental caries in the first permanent molar was a public health issue among sixth-grade school children in São Tomé Island. The prevalence of dental caries, mean DMFT and DMFS scores were higher, while the rate of filling and PFS teeth were lower than the average score of other African countries. Thus, oral health education, implement oral health preaching to school children and their parents is crucial to prevent dental caries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01846-z.

Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review

Background:

Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.

Objectives:

The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.

Methods:

Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.

Results:

The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.

Conclusion:

Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.

Dental caries spectrum profile in Brazilian public school children and adolescents

Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

SOS Teeth: Age and Sex Differences in the Prevalence of First Priority Teeth among a National Representative Sample of Young and Middle-Aged Adults

BACKGROUND

"SOS teeth" are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present.

OBJECTIVES

To assess the prevalence and distribution of SOS teeth with regard to age and sex difference among young to middle-aged adults.

METHODS

This is a cross-sectional records-based study of a nationally representative sample, consisting of young to middle-aged military personnel, who attended the military dental clinics of the Israel Defense Forces (IDF) for one year. SOS teeth definition corresponds to code number 6 of the "Caries Assessment Spectrum and Treatment (CAST)" as an instrument to assess dental caries. Data pertaining to age and sex were drawn from the central demographic database and that of SOS teeth were obtained from the Dental Patient Record (DPR).

RESULTS

The study included 132,529 dental records. The prevalence of patients with SOS teeth was 9.18 % (12,146/132,323). The number of teeth that were found to be SOS teeth was 18,300, i.e., 1.5 SOS teeth per "diseased" patient (18,300/12,146). The mean number of SOS teeth per the whole study population was 0.14 ± 0.52 and the range was 0-20. The mean number of SOS teeth per patient had a statistically significant negative correlation with age (p < 0.001; Odds Ratio (OR) = 0.997; 95% confidence interval: 0.997-0.998) and with male sex compared to females (p < 0.001; OR = 1.029 confidence interval: 1.023-1.036).

CONCLUSION

Assessment of first priority SOS teeth may be part of the dentist's work-up. It provides dentists and health authorities with useful information regarding urgent dental care needs to plan dental services.

Reliability of Caries Assessment Spectrum and Treatment Tool in the Indian Subcontinent

BACKGROUND

Accurate diagnosis, reporting of caries and its consequences, is absolute mandate for planning an efficient, effective community health-care program. Literature reports indicate shortcomings of existing caries assessment tools. Caries assessment spectrum and treatment (CAST) is novice caries quantification tool, which quantifies the entire spectrum of carious lesions. This tool records give an insight into the status of restorations along with various progressive developmental stages of dental caries. This instrument has been validated for face, content, and construct by an expert group, and currently, its usage is on the rise.

AIM

The aim of this study was to report the reliability of this assessment tool with regard to the primary and permanent dentition of school children and adults belonging to a south Indian district.

MATERIALS AND METHODS

A cross-sectional study was carried out by two trained and calibrated examiners by examining 192 school children in the age-group between 4 and 6 years and 262 adults between 19 and 69 years. The study sample was reexamined by the same examiners after a gap of 4 weeks. The κ coefficient values and percent of agreement were calculated for the data recorded from the study subjects.

RESULTS

The analyzed data showed moderate intra-examiner and inter-examiner reproducibility for either of the dentition as revealed by κ coefficient values (0.80-0.89). Inter- or intra-examiner agreement was found to be substantial to almost perfect (percent agreement above 90%) with respect to both the age-groups.

CONCLUSION

The CAST tool seems quite promising to be the future for quantifying caries spectrum for a community or an individual.

Association of dental caries morbidity stages with oral health-related quality of life in children and adolescents

BACKGROUND

Dental caries morbidity stages and their impact on oral health-related quality of life (OHRQoL) have not yet been established.

AIM

To compare the association of dental caries morbidity stages with OHRQoL in children and adolescents from public schools of Patos-PB, Brazil.

DESIGN

A cross-sectional study was performed on 461 students at 8-10 years and 454 at 11-14 years. Caries was evaluated by Caries Assessment Spectrum and Treatment (CAST) instrument. The maximum CAST code per individual was registered. OHRQoL was assessed using the Child Perceptions Questionnaires for children (CPQ_8-10 ) and adolescents (CPQ_11-14 ).

RESULTS

Morbidity stage was the most prevalent caries condition in children (40.8%) and adolescents (38.1%). Factors associated with higher CPQ_8-10 scores in the multivariate regression analysis after adjustments were age [9 years, prevalence ratio (PR): 1.24; 95% confidence interval (CI): 1.06-1.45; and 10 years, PR: 1.32, CI: 1.13-1.55] and dental caries status [morbidity, PR: 1.23, CI: 1.03-1.48; and severe morbidity, PR: 1.30, CI: 1.04-1.61]. The factor associated with higher CPQ_11-14 scores was dental caries status [morbidity, PR: 1.20, CI: 1.00-1.44].

CONCLUSIONS

The OHRQoL of children was negatively associated with morbidity and severe morbidity stages of dental caries, while for adolescents, only morbidity had a negative association with their OHRQoL.

CAST instrument in epidemiological surveys: Results presentation in comparison to the WHO criteria

Resumo O CAST (Caries Assessment Spectrum and Treatment) é um instrumento desenvolvido para a detecção de cárie a ser utilizado em levantamentos epidemiológicos. Foi validado e tem se mostrado efetivo, fornecendo um diagnóstico mais preciso do estado de saúde bucal do que o critério OMS, recomendado pela Organização Mundial da Saúde. O objetivo deste artigo é comparar a apresentação dos resultados de cárie dentária utilizando o instrumento CAST e o critério OMS, numa mesma população. Foram avaliados por dois examinadores treinados na utilização do instrumento CAST 680 escolares de 6 a 8 anos do Distrito Federal, Brasil. A avaliação constou do índice de placa visível (IPV) e do índice de sangramento gengival (ISG). Os escores CAST dente foram convertidos em componentes ceo/CPO e calculados os ceod/CPOD. Os pais responderam a um questionário sociodemográfico. A idade média foi 7,45 anos (± 0,91). A prevalência de cárie na dentição decídua foi de 65,44% e 61,61%, considerando o CAST e o critério da OMS, respectivamente; na dentição permanente: 38,19% e 10,2%, respectivamente. A média do ceod foi de 2.4 (± 2.7) e a média do CPOD 0.16 (± 0.53). o IPV foi associado a maiores CAST máximos p < 0,005. O instrumento CAST demonstrou maior sensibilidade em identificar a presença e gravidade de lesões cariosas quando comparado ao critério OMS.

The knowledge and use of population-based methods for caries detection

Background

Since the 1980s, a wide variety of methods have been proposed to measure dental caries in the population, demonstrating a lack of consensus regarding the procedure that should be used for this purpose. The current study investigated the methods that are known and used by public oral health researchers and professors as well as the reasons that lead to the choice of a particular method.

Method

In the context of an interview, a questionnaire was administered to public oral health researchers and professors who used caries indices and worked in Salvador and Feira de Santana, Bahia, Brazil from 2005 to 2015. A quantitative and descriptive approach was applied that adopted the multiple correspondence analysis (MCA) technique to assess the associations among responses.

Results

The decayed, missing, and filled index (DMF) was the only measurement known by all respondents, and although 45 of the 47 professors/researchers were dissatisfied with this index, only six had used other methods. This index was chosen because of its comparability and ease of application. The MCA revealed response associations among older, male participants who graduated from the Federal University of Bahia (UFBA) and who continued to use this index because of its comparability and because it is the index recommended by the World Health Organization (WHO) and the Brazilian Ministry of Health (MS). Another group was also observed that consisted of younger females who graduated from the State University of Feira de Santana (UEFS) or another university and who used the DMF because it is well-known, simple, and easy to apply.

Conclusions

The DMF index was the most known and used method. Many respondents demonstrated a desire for change and were critical of the DMF; however, they did not know of and had not used newer methods for measuring dental caries. Greater importance should be placed on the problem of dental caries assessment in the population.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0612-5) contains supplementary material, which is available to authorized users.

Caries Assessment Spectrum and Treatment (CAST): A Novel Epidemiological Instrument

Caries detection is fundamental to understanding the oral health status of a population and is the basis for caries diagnosis for individual patients. Although different caries detection/diagnosis criteria are available, none of them include the total spectrum of dental caries (which ranges from a sound tooth to a tooth lost due to caries) other than the Caries Assessment Spectrum and Treatment (CAST) instrument. The CAST codes and descriptions were submitted to experienced epidemiologists from across the world for obtaining face and content validity. Its construct validity and reproducibility under field conditions were tested in child and adult populations, and showed a high level of agreement between examiners. Compared to what is usually reported in the literature, CAST provides more relevant information on caries prevalence, experience, and severity. CAST is straightforward and easy to use. A manual with valuable information about how to apply CAST and report its results has been published in order to facilitate communication among researchers, oral health planners, and medical professionals. Feedback from researchers indicates that CAST is considered an asset and that reporting results after using CAST is uncomplicated. More research about the effects of CAST in different cultures and age groups is required.

Assessment of Dental Caries Spectrum among 11 to 14-Year-Old School Going Children in India

INTRODUCTION

The quantification of dental caries is usually done by DMFT index but efforts are being made to find an alternative. Caries Assessment Spectrum and Treatment (CAST) is a recent, innovative caries assessment tool which can be used in epidemiological surveys.

AIM

To assess dental caries using CAST index among 11-14-year-old school children in Rohtak city, Haryana, India.

MATERIALS AND METHODS

A cross-sectional study was carried out among 11-14-year-old children in schools of Rohtak City using multi stage cluster sampling technique. Rohtak city was divided in to nine clusters. In the 2nd stage, one school was randomly selected from each cluster with lottery method. Finally from each selected school, every odd roll number child between age group 11-14 years, were enrolled to reach a sample of 586. Caries was recorded using the CAST index. Each child was clinically examined by a trained examiner using CAST index. Descriptive and inferential statistics were done and Chi-square test was used to find association between caries prevalence and gender. Mann-Whitney U test was used to find any difference of mean DMFT between different age groups.

RESULTS

A total of 586 children were examined. Prevalence of dental caries was 28.6%. Highest caries was observed in lower right first molar and lower left first molar (13.8% and 11.6%) respectively. Pulpal involvement in lower molars was found more than the upper molars.

CONCLUSION

CAST index presents a simple hierarchical structure of caries spectrum and is a promising index for epidemiological studies with complex quantifiability.

Comparative Evaluation of Caries Status in Primary and Permanent Molars in 7-8-year-old Schoolchildren of Shimla Using Caries Assessment Spectrum and Treatment Index

Background:

A new epidemiological index is introduced for full assessment of dental caries which is known as caries assessment spectrum and treatment (CAST). “Spectrum” is considered backbone of this index as it covers from no lesion to advanced stage progression of caries. We aimed to evaluate and compare the status of caries in primary and permanent molars of 7–8-year-old schoolchildren of Shimla using CAST index and to find if any correlation exists between the status of caries in evaluated teeth.

Methods:

Three hundred and one schoolchildren with age group of 7–8 years were selected from schools in Shimla. CAST codes were determined for primary molars and first permanent molars. The distribution of CAST codes in the examined molars is correlated with the help of Spearman's rank correlation coefficient. The level of statistical significance was established at P < 0.05. The intraexaminer reliability was determined by the unweighted kappa coefficient.

Results:

Caries was assessed in 6.3%–12.3% of the permanent molars in contrast to primary molars, in which caries was near about 50%. The correlation was stronger for first and second deciduous molars for the right side of the mouth than the left side (r = 0.293 and 0.257 in the maxilla and 0.503 and 0.319 in the mandible [P < 0.001], respectively, while correlation for teeth in opposite jaws was moderate [r = 0.20–0.47]). The intraexaminer reliability was examined (k = 0.90 for the primary and 0.85 for permanent molars).

Conclusion:

The correlation between primary and permanent molars regarding the caries status in primary molars is weak while strongest correlation was present on the right side of the mouth for first and second deciduous molars. The study also showed the applicability of the CAST index in epidemiological surveys.

Assessing caries status according to the CAST instrument and WHO criterion in epidemiological studies

Background

The Caries Assessment Spectrum and Treatment (CAST) is a new epidemiological instrument for detection and treatment of dental caries. Worldwide, the WHO criterion constitutes the epidemiological tool most commonly used for caries detection. The objective of the present study is to determine the levels of similarity and difference between the CAST instrument and WHO criterion on the basis of caries prevalence, dmf/DMF counts, examination time and reporting of results.

Methods

An epidemiological survey was carried out in Brazil among 6-11-year-old schoolchildren. Time of examinations was recorded. dmft, dmfs, DMFT and DMFS counts and dental caries prevalence were obtained according to the WHO criterion and the CAST instrument, as well the correlation coefficient between the two instruments.

Results

Four hundred nineteen children were examined. dmft and dmfs counts were 1.92 and 5.31 (CAST), 1.99 and 5.34 (WHO) with correlation coefficients (r) of 0.95 and 0.93, respectively. DMFT and DMFS counts were 0.20 and 0.33 (CAST), 0.19 and 0.30 (WHO), with r = 0.78 and r =0.72, respectively. Kappa coefficient values for intra-examiner consistency were CAST = 0.91-0.92; WHO = 0.95-0.96 and those for inter-examiner consistency were CAST = 0.90-0.96; WHO = 0.94-1.00. Mean time spent on applying CAST and WHO were 66.3 and 64.7 sec, respectively p = 0.26. The prevalence of dental caries using CAST (codes 2, 5-8) and the WHO criterion for the primary dentition were 63.0% and 65.9%, respectively, and for the permanent dentition they were 12.7% and 12.8%, respectively.

Conclusions

The CAST instrument provided similar prevalence of dental caries values and dmf/DMF counts as the WHO criterion in this age group. Time spent on examining children was identical for both caries assessment methods. Presentation of results from use of the CAST instrument, in comparison to WHO criterion, allowed a more detailed reporting of stages of dental caries, which will be useful for oral health planners.

Dental caries in primary and permanent molars in 7-8-year-old schoolchildren evaluated with Caries Assessment Spectrum and Treatment (CAST) index

BACKGROUND

No reports on a caries pattern covering the full spectrum of the disease could be found in the literature. The aim of this study was to evaluate caries in primary and first permanent molars of 7-8-year-old Polish children by the Caries Assessment Spectrum and Treatment (CAST) index and to find whether there was any correlation between the caries stages in such teeth.

METHODS

The study covered 284 7-8-year-old children from randomly selected schools in the Bialystok District, Poland. The prevalence of CAST categories was evaluated with regard to the first and second primary, and first permanent, molars. The Spearman's rank correlation coefficient was used to explore the correlation of the distribution of CAST codes among the evaluated teeth. The level of statistical significance was established at p < 0.05. The intra-examiner reliability was determined by the unweighted kappa coefficient.

RESULTS

With regard to the permanent molars, caries was observed in 14.8% to 17.3% of the molar and most lesions were scored at the non-cavitation level. Caries in primary molars was most often recorded at the stage of cavitated dentine lesion. Teeth with pulpal involvement, sepsis and extracted due to caries were found to be more prevalent in first, and then in second primary molars. A strong correlation was found between the status of teeth from the right and left sides of the oral cavity. The correlation of the status of first and second primary teeth was stronger for the left than for the right side of the mouth, r was 0.627 and 0.472 in maxilla and 0.513 and 0.483 in mandible (p < 0.001), respectively. For the neighbouring primary and permanent molars the correlation was assessed to be weak. With regard to the teeth situated in opposite jaws the study revealed that the correlations were moderate - r between 0.33 and 0.49. The intra-examiner reliability was established at 0.96 for the primary dentition and at 0.878 for permanent molars.

CONCLUSION

The strongest correlation found in the evaluated population concerned the distribution of caries in primary molars on the left side of the mouth. The study proved the usefulness of the CAST index in epidemiological surveys.