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Tôrres LHDN, Hilgert JB, Hugo FN, Sousa MDLRD, De Marchi RJ. Predictors of tooth loss in Brazilian older adults: An 8-year follow-up. Gerodontology 2022; 40:207-212. [PMID: 35474327 DOI: 10.1111/ger.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the risk factors for tooth loss after 8 years among community-dwelling older adults in a southern Brazilian city. METHODS In 2004, 388 dentate community-dwelling older adults from Carlos Barbosa, southern Brazil, were selected using simple random sampling. In 2012, the follow-up consisted of 199 (51.3%) participants. Data collection comprised an interview with data about socio-demographic, behavioural and access to services and an oral examination. The outcome variable of this study is the ratio between the sum of the teeth lost during the 8-year period of follow-up, and the sum of the teeth present in 2004, per person, modelled through binomial regression analysis. RESULTS Being older (IOR = 1.03, 95% CI: 1.00-1.06), living in a rural area (IOR = 1.56, 95% CI: 1.17-2.07), earning two or more monthly minimum wages (IOR = 1.46, 95% CI: 1.09-1.96), living alone (single, widowed or divorced; IOR = 1.36, 95% CI: 1.00-1.85), having more gingival bleeding sites (IOR = 1.01, 95% CI: 1.00-1.02) and wearing partial removable prosthesis (IOR = 2.82, 95% CI: 2.15-3.71) were risk factors for tooth loss. Approximately 48% of the participants lost one or more teeth over the 8-year follow-up period. CONCLUSION Socio-demographic, economic and clinical variables were associated with the risk for tooth loss. This might be a result of social determinants of health influencing people's access to oral health care, oral health behaviours and oral health status. Public policy aimed at older adults living in rural areas, living alone and using removable dentures may contribute to reducing the risk of tooth loss.
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Affiliation(s)
- Luísa Helena do Nascimento Tôrres
- Postgraduate Program in Dental Science, Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Juliana Balbinot Hilgert
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Renato José De Marchi
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Bidinotto AB, Martins AB, dos Santos CM, Hugo FN, Hilgert JB, Celeste RK, Padilha DM, De Marchi RJ. Four-year incidence rate and predictors of root caries among community-dwelling south Brazilian older adults. Community Dent Oral Epidemiol 2017; 46:125-131. [DOI: 10.1111/cdoe.12343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Augusto B. Bidinotto
- Postgraduate Studies Program in Epidemiology; Faculty of Medicine; Federal Universisty of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Aline B. Martins
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Camila M. dos Santos
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Fernando N. Hugo
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Center of Community Oral Health Research; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Juliana B. Hilgert
- Postgraduate Studies Program in Epidemiology; Faculty of Medicine; Federal Universisty of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Dalva Maria Padilha
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Renato José De Marchi
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
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3
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Do L, Ha D, Peres MA, Skinner J, Byun R, Spencer AJ. Effectiveness of water fluoridation in the prevention of dental caries across adult age groups. Community Dent Oral Epidemiol 2017; 45:225-232. [DOI: 10.1111/cdoe.12280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Loc Do
- Australian Research Centre for Population Oral Health (ARCPOH); School of Dentistry; Faculty of Health Science; The University of Adelaide; South Australia Australia
| | - Diep Ha
- Australian Research Centre for Population Oral Health (ARCPOH); School of Dentistry; Faculty of Health Science; The University of Adelaide; South Australia Australia
| | - Marco A. Peres
- Australian Research Centre for Population Oral Health (ARCPOH); School of Dentistry; Faculty of Health Science; The University of Adelaide; South Australia Australia
| | - John Skinner
- Centre for Oral Health Strategy; NSW Ministry of Health; Wentworthville New South Wales Australia
| | - Roy Byun
- Centre for Oral Health Strategy; NSW Ministry of Health; Wentworthville New South Wales Australia
| | - A. John Spencer
- Australian Research Centre for Population Oral Health (ARCPOH); School of Dentistry; Faculty of Health Science; The University of Adelaide; South Australia Australia
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Mancl LA, Hujoel PP, DeRouen TA. Efficiency Issues among Statistical Methods for Demonstrating Efficacy of Caries Prevention. J Dent Res 2016; 83 Spec No C:C95-8. [PMID: 15286131 DOI: 10.1177/154405910408301s19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although repeated tooth-surface-specific information is commonly collected during a longitudinal caries clinical trial, traditional methods often make limited use of the repeated measures. Newer methods of analysis, such as methods based on time-to-event and methods for longitudinal or clustered data, have the potential to increase the efficiency of the statistical analysis. We compare a range of analytical methods from the traditional analysis based only on the number of caries onsets to newer methods that incorporate time at risk and surface-specific information, such as Poisson regression methods for clustered data, with respect to the efficiency of treatment comparisons. Under most circumstances, the greatest gain in efficiency associated with time-to-event methods will be due to the ability of subjects to contribute caries onsets to the analysis until they are lost from the study. Incorporating the number of surfaces at risk, the surface time at risk, and surface-specific characteristics will typically produce only a modest gain in efficiency.
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Affiliation(s)
- L A Mancl
- Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
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5
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Johnson MF. The Role of Risk Factors in the Identification of Appropriate Subjects for Caries Clinical Trials: Design Considerations. J Dent Res 2016; 83 Spec No C:C116-8. [PMID: 15286136 DOI: 10.1177/154405910408301s24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In seeking new and more effective therapies to delay or prevent caries development, investigators must design clinical trials focused on high-risk populations with a predictable incidence of caries over a limited period of time. In children and adolescents, the strongest predictors of caries incidence appear to be baseline levels of caries activity (present caries, e.g., dmfs, DMFT, caries lesions in first molars). Other predictors of caries risk typically include oral hygiene level, counts of cariogenic micro-organisms in plaque and saliva, fluoride history, sucrose intake, and parent's socio-economic level. This paper will briefly review existing literature to address the most useful and relevant prognostic factors for predicting future caries onset. The relative merits of identifying high-risk subjects based on these factors, either singly or in combination, will be explored in terms of statistical efficiency. Particular attention will focus on the advantages of covariate adjustment in the context of survival-based methods for the analysis of caries data. Further, with the advent of more sophisticated diagnostic procedures ( e.g., quantitative light fluorescence) to screen and monitor study subjects for caries activity, there is the potential for earlier states of lesion initiation and progression (or regression) to be detected, with, therefore, improved experimental sensitivity to treatment effects. The validity of risk assessment and outcome measurement on the basis of these new diagnostic tools vs. more conventional methods will be examined.
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Affiliation(s)
- M F Johnson
- PharmaNet, Inc., 504 Carnegie Center, Princeton, NJ 08540, USA.
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6
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De Marchi RJ, dos Santos CM, Martins AB, Hugo FN, Hilgert JB, Padilha DM. Four-year incidence and predictors of coronal caries in south Brazilian elderly. Community Dent Oral Epidemiol 2015; 43:452-60. [DOI: 10.1111/cdoe.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Renato José De Marchi
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Camila Mello dos Santos
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Aline Blaya Martins
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Faculty of Dentistry; Center of Community Oral Health Research; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Juliana Balbinot Hilgert
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Epidemiology; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | - Dalva Maria Padilha
- Department of Preventive and Social Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
- Postgraduate Studies Program in Dentistry; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
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7
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Lee HJ, Kim JB, Jin BH, Paik DI, Bae KH. Risk factors for dental caries in childhood: a five-year survival analysis. Community Dent Oral Epidemiol 2014; 43:163-71. [DOI: 10.1111/cdoe.12136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Hyo-Jin Lee
- Department of Preventive and Public Health Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Dental Research Institute; School of Dentistry; Seoul National University; Seoul Korea
| | - Jin-Bom Kim
- Department of Preventive and Community Dentistry; School of Dentistry; Pusan National University; Yangsan Korea
| | - Bo-Hyoung Jin
- Department of Preventive and Public Health Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Dental Research Institute; School of Dentistry; Seoul National University; Seoul Korea
| | - Dai-Il Paik
- Department of Preventive and Public Health Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Dental Research Institute; School of Dentistry; Seoul National University; Seoul Korea
| | - Kwang-Hak Bae
- Department of Preventive and Public Health Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Dental Research Institute; School of Dentistry; Seoul National University; Seoul Korea
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Cagetti MG, Carta G, Cocco F, Sale S, Congiu G, Mura A, Strohmenger L, Lingström P, Campus G. Effect of Fluoridated Sealants on Adjacent Tooth Surfaces: A 30-mo Randomized Clinical Trial. J Dent Res 2014; 93:59S-65S. [PMID: 24846910 DOI: 10.1177/0022034514535808] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D1 - D3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p = .03) in the GIC and fluoride-RB groups (p = .04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.86; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.67, 0.89; p = .005) for fluoride-RB vs. RB [Corrected]. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth (clinical trial registration NCT01588210).
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Affiliation(s)
- M G Cagetti
- WHO Collaborating Centre of Milan for Epidemiology and Community Dentistry, University of Milan, San Paolo Hospital, Milan, Italy
| | - G Carta
- Department of Surgery, Microsurgery, and Medical Science, School of Dentistry, University of Sassari, Italy
| | - F Cocco
- WHO Collaborating Centre of Milan for Epidemiology and Community Dentistry, University of Milan, San Paolo Hospital, Milan, Italy Department of Chemistry, University of Sassari, Italy
| | - S Sale
- Department of Surgery, Microsurgery, and Medical Science, School of Dentistry, University of Sassari, Italy
| | - G Congiu
- Department of Surgery, Microsurgery, and Medical Science, School of Dentistry, University of Sassari, Italy
| | - A Mura
- Department of Surgery, Microsurgery, and Medical Science, School of Dentistry, University of Sassari, Italy
| | - L Strohmenger
- WHO Collaborating Centre of Milan for Epidemiology and Community Dentistry, University of Milan, San Paolo Hospital, Milan, Italy
| | - P Lingström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - G Campus
- WHO Collaborating Centre of Milan for Epidemiology and Community Dentistry, University of Milan, San Paolo Hospital, Milan, Italy Department of Surgery, Microsurgery, and Medical Science, School of Dentistry, University of Sassari, Italy
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9
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Liang J, Wu B, Plassman B, Bennett J, Beck J. Racial disparities in trajectories of dental caries experience. Community Dent Oral Epidemiol 2013; 41:517-25. [PMID: 23465078 PMCID: PMC4324468 DOI: 10.1111/cdoe.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study charted the trajectories of dental caries, including decayed teeth, missing teeth and filled teeth among older Americans over a 5-year period. In particular, it focused on racial differences in the levels of and rates of change in dental caries experience. METHODS Data came from the Piedmont Dental Study. The sample included 810 older Americans who were dentate at the baseline with up to 4 repeated observations between 1988 and 1994. Hierarchical linear models were employed in depicting intrapersonal and interpersonal differences in dental caries experience. RESULTS Different measures of caries outcomes exhibited distinct trajectories. On average, the number of decayed teeth decreased over time, whereas missing teeth increased. In contrast, the number of filled teeth remained stable during a 5-year period. Relative to their white counterparts, older black Americans had more decayed teeth and missing teeth but fewer filled teeth. Blacks and whites differed in the levels of dental caries but not in their rates of change except for missing teeth. Even when demographic and socioeconomic attributes were adjusted, racial variations in dental caries experience remained significant. CONCLUSIONS Although significantly correlated, various dental caries outcomes move along different paths over time. In view of the persistent racial disparities in dental caries trajectories, future interventions to minimize such variations among older Americans in the levels of and the rates of change in dental caries experience are clearly warranted.
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Masood M, Yusof N, Hassan MIA, Jaafar N. Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study. BMC Public Health 2012; 12:989. [PMID: 23158416 PMCID: PMC3524020 DOI: 10.1186/1471-2458-12-989] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 10/04/2012] [Indexed: 11/08/2022] Open
Abstract
Background This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children. Methods This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries. Results The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT) component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P<0.001). Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural) (OR=1.80, P<0.001). However, it was not significantly associated with gender and ethnicity. The incidence density of caries, affected persons (IDp) observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt) in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation. Conclusion The majority of 12-year-old school children (70%) were caries-free and most of the caries were concentrated in only a small proportion (30%) of them. We found that the presence of caries in permanent teeth at the age of 6 years was a strong predictor of future caries development in this population. The strong evidence of early permanent teeth caries at six years old to predict future caries incidence at 12-year-olds, which could be obtained at almost no cost, questions the need for and cost-effectiveness of expensive technology-based commercial caries predictions kits.
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Affiliation(s)
- Mohd Masood
- Centre of Studies for Community Dentistry, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia.
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Bernabé E, Newton JT, Uutela A, Aromaa A, Suominen AL. Sense of coherence and four-year caries incidence in Finnish adults. Caries Res 2012; 46:523-9. [PMID: 22889725 DOI: 10.1159/000341219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/17/2012] [Indexed: 11/19/2022] Open
Abstract
This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.
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Affiliation(s)
- E Bernabé
- Unit of Dental Public Health, King's College London Dental Institute, London, UK.
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12
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Campus G, Cagetti MG, Sale S, Petruzzi M, Solinas G, Strohmenger L, Lingström P. Six months of high-dose xylitol in high-risk caries subjects--a 2-year randomised, clinical trial. Clin Oral Investig 2012; 17:785-91. [PMID: 22791282 PMCID: PMC3607712 DOI: 10.1007/s00784-012-0774-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 06/14/2012] [Indexed: 11/23/2022]
Abstract
Objectives The hypothesis was that the daily use of a high dose of a xylitol chewing gum for 6 months would reduce the increment of decayed permanent first molar surfaces (ΔD6S) in high-risk schoolchildren after 2 years. Methods In this randomised, clinical trial, 204 schoolchildren with a high caries risk were assigned to two experimental groups, xylitol and non-xylitol. Caries status, salivary mutans streptococci, and lactobacilli were re-evaluated 2 years later in 74 xylitol-treated and 83 non-xylitol-treated schoolchildren. Differences in mean ∆D6S between groups registered at baseline and at follow-up were evaluated using the nonparametric Mann–Whitney U test. Results Outcome was the development of detectable carious lesions initial (D1–D2) and manifest (D3) in the permanent first molars. In the xylitol group, the difference in proportion of children with decayed first permanent molars at baseline and follow-up was 1.43 % for manifest lesion and 2.86 % for initial lesions; while in the non-xylitol group was 10.26 % (p < 0.01) and 16.66 % (p < 0.01), respectively. A statistically significant difference regarding means was also observed in the non-xylitol group: the ∆D6S for manifest lesion was 0.18 (p = 0.03) and 0.67 (p = 0.02) for initial lesion. Conclusion The use of a chewing gum containing a high dose of xylitol for a period of 6 months has been shown to produce a long-term effect on caries development in high caries-risk children. Clinical relevance A school-based preventive programme based on 6 months’ administration of a high dose of xylitol via chewing gum proved to be efficacious in controlling caries increment in high-risk children.
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Affiliation(s)
- Guglielmo Campus
- Department of Surgery, Microsurgery, Medical Sciences, Dental School, University of Sassari, Viale San Pietro 43/C, 07100, Sassari, Italy.
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Stephenson J. A model for the analysis of caries occurrence in primary molar tooth surfaces. Caries Res 2012; 46:452-9. [PMID: 22739707 DOI: 10.1159/000339390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/17/2012] [Indexed: 11/19/2022] Open
Abstract
Recently methods of caries quantification in the primary dentition have moved away from summary 'whole mouth' measures at the individual level to methods based on generalised linear modelling (GLM) approaches or survival analysis approaches. However, GLM approaches based on logistic transformation fail to take into account the time-dependent process of tooth/surface survival to caries. There may also be practical difficulties associated with casting parametric survival-based approaches in a complex multilevel hierarchy and the selection of an optimal survival distribution, while non-parametric survival methods are not generally suitable for the assessment of supplementary information recorded on study participants. In the current investigation, a hybrid semi-parametric approach comprising elements of survival-based and GLM methodologies suitable for modelling of caries occurrence within fixed time periods is assessed, using an illustrative multilevel data set of caries occurrence in primary molars from a cohort study, with clustering of data assumed to occur at surface and tooth levels. Inferences of parameter significance were found to be consistent with previous parametric survival-based analyses of the same data set, with gender, socio-economic status, fluoridation status, tooth location, surface type and fluoridation status-surface type interaction significantly associated with caries occurrence. The appropriateness of the hierarchical structure facilitated by the hybrid approach was also confirmed. Hence the hybrid approach is proposed as a more appropriate alternative to primary caries modelling than non-parametric survival methods or other GLM-based models, and as a practical alternative to more rigorous survival-based methods unlikely to be fully accessible to most researchers.
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Affiliation(s)
- J Stephenson
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK.
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14
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De Marchi RJ, Hilgert JB, Hugo FN, Santos CMD, Martins AB, Padilha DM. Four-year incidence and predictors of tooth loss among older adults in a southern Brazilian city. Community Dent Oral Epidemiol 2012; 40:396-405. [DOI: 10.1111/j.1600-0528.2012.00689.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 03/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Renato José De Marchi
- Department of Preventive and Social Dentistry, Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre; Rio Grande do Sul; Brazil
| | | | | | - Camila Mello dos Santos
- Department of Preventive and Social Dentistry, Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre; Rio Grande do Sul; Brazil
| | - Aline Blaya Martins
- Department of Preventive and Social Dentistry, Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre; Rio Grande do Sul; Brazil
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Zhou Y, Yang J, Lo E, Lin H. The Contribution of Life Course Determinants to Early Childhood Caries: A 2-Year Cohort Study. Caries Res 2012; 46:87-94. [DOI: 10.1159/000335574] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 12/06/2011] [Indexed: 11/19/2022] Open
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Arantes R, Santos RV, Frazao P, Coimbra CEA. Caries, gender and socio-economic change in the Xavante Indians from Central Brazil. Ann Hum Biol 2009; 36:162-75. [PMID: 19184758 DOI: 10.1080/03014460802672844] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The oral health conditions of indigenous peoples in Amazonia are closely associated with ecological and dietary changes related to interaction with non-Indians. AIM The study investigated the incidence of caries in an indigenous community from Central Brazil focusing on gender differences. SUBJECTS AND METHODS The research was conducted among the Xavante Indians and was based on longitudinal data collected in two surveys (1999 and 2004). The study included 128 individuals, 63 (49.2%) males and 65 (50.8%) females, divided in four age brackets (6-12, 13-19, 20-34, 35-60 years of age). The DMFT (decayed, missing and filled teeth) index and incidences (difference between 1999 and 2004) were calculated for each individual. The proportion of incidence was also calculated. Differences in caries risk between gender and age brackets were compared by parametric and non-parametric tests. RESULTS There were statistically significant differences in relation to caries incidence between age brackets and gender. The greatest incidence was observed in the 20-34 age bracket, which presented 3.30 new decayed teeth, twice the risk of the 6-12 age bracket (p<0.01), chosen as reference. While females in most age groups did not show higher risk for caries when compared to males, there was a 4.04-fold risk in the 20-34 age bracket (p<0.01). CONCLUSION It is concluded that factors related to the social functions of each sex (gender issues) and differential access to information, health services, and education may help to understand the differences observed in the incidence of caries.
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Affiliation(s)
- Rui Arantes
- Escola Nacional de Saude PublicaFundacao Oswaldo Cruz, Rio de Janeiro, Brazil
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Thitasomakul S, Piwat S, Thearmontree A, Chankanka O, Pithpornchaiyakul W, Madyusoh S. Risks for Early Childhood Caries Analyzed by Negative Binomial Models. J Dent Res 2009; 88:137-41. [DOI: 10.1177/0022034508328629] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Because of the high incidence of early childhood caries (ECC), a longitudinal study to identify risk factors from the prenatal period to the child’s first birthday among 9- to 18-month-old children was conducted with negative binomial modeling. Overall, 495 children had dental examinations at ages 9, 12, and 18 months. Mothers were interviewed during the 2nd trimester of pregnancy and when the children had dental examinations. The highest incidence of caries was found among children who were born to mothers with ≥ 10 decayed teeth and who never received calcium supplements during pregnancy, and children who were not fed supplementary foods at age 3 months, had sweet-tasting foods at 5 months, started snacking at 5 months, had sugary snacks, had soft drinks, and did not have their teeth brushed daily at 9 months. Thus, prenatal care and child-rearing-practices during and after birth are important risk factors for the incidence and incremental rate of ECC.
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Affiliation(s)
- S. Thitasomakul
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
| | - S. Piwat
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
| | - A. Thearmontree
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
| | - O. Chankanka
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
| | - W. Pithpornchaiyakul
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
| | - S. Madyusoh
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand; and
- Dental Division, Thepa Hospital, Thepa, Songkhla, Thailand
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Morgan MV, Adams GG, Bailey DL, Tsao CE, Fischman SL, Reynolds EC. The Anticariogenic Effect of Sugar-Free Gum Containing CPP-ACP Nanocomplexes on Approximal Caries Determined Using Digital Bitewing Radiography. Caries Res 2008; 42:171-84. [PMID: 18446025 DOI: 10.1159/000128561] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 02/14/2008] [Indexed: 11/19/2022] Open
Affiliation(s)
- M V Morgan
- Cooperative Research Centre for Oral Health Science, School of Dental Science, Bio21 Institute, University of Melbourne, Parkville, Vic., Australia
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Korhonen M, Salo S, Suni J, Larmas M. Computed online determination of life-long mean index values for carious, extracted, and/or filled permanent teeth. Acta Odontol Scand 2007; 65:214-8. [PMID: 17762983 DOI: 10.1080/00016350701321466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to develop and test a data-mining system for the online determination of mean DS, M, and FS or DMFS values per subject at different ages from electronic patient records at two health centers to see if there are north-south differences in oral health in Finland. MATERIAL AND METHODS The mean index values were determined at two health centers using the codes of dental charts and progress notes of electronic dental records during the digital era of more than 10 years in a total of 153,619 subjects of all ages. Extracted teeth, as well as sound, carious, and restored tooth surfaces, were recorded from the dental charts. Treatments were then additionally registered from progress notes of the records when performed. RESULTS The cumulative DS and FS values were similar in subjects under the age of 20 years at both health centers. In adults, caries was more abundant in northern Finland, where there was a higher number of restored surfaces (>40) registered, compared to only 30 in southern Finland at the age of 40 years. A high increase in the number of extractions began at age 45 in the north compared to age 70 in the south. These changes were clearly reflected in the DMFS index. CONCLUSIONS Online determination of health parameters is a feasible methodology. The results revealed that north-south regional differences in dental health still occur in adults in Finland, but not in subjects younger than 20 years of age.
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Slade GD, Caplan DJ. Methodological issues in longitudinal epidemiologic studies of dental caries. Community Dent Oral Epidemiol 2007. [DOI: 10.1111/j.1600-0528.1999.tb02017.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Wyatt CCL, Maupome G, Hujoel PP, MacEntee MI, Persson GR, Persson RE, Kiyak HA. Chlorhexidine and Preservation of Sound Tooth Structure in Older Adults. Caries Res 2007; 41:93-101. [PMID: 17284909 DOI: 10.1159/000098041] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 07/20/2006] [Indexed: 11/19/2022] Open
Abstract
The Trial to Enhance Elderly Teeth Health (TEETH) was designed to test the impact of regular rinsing with a 0.12% chlorhexidine (CHX) solution on tooth loss, and the causes of tooth loss (caries, periodontal disease and trauma) were also investigated. This paper reports on the effectiveness of a 0.12% CHX solution for controlling caries using a tooth surface (coronal and root) survival analysis. A total of 1,101 low income elders in Seattle (United States) and Vancouver (Canada), aged 60-75 years, were recruited for a double-blind clinical trial and assigned to either a CHX (n = 550) or a placebo (n = 551) mouth rinse. Subjects alternated between daily rinsing for 1 month, followed by weekly rinsing for 5 months. All sound coronal and root surfaces at baseline were followed annually for up to 5 years. At each follow-up examination, those tooth surfaces with caries, restored, or extracted were scored as 'carious'. The hazard ratio associated with CHX for a sound surface to become filled, decayed, or extracted was 0.87 for coronal surfaces (95% confidence interval: 0.71-1.14, p = 0.20) and 0.91 for root surfaces (95% confidence interval: 0.73-1.14, p = 0.41). These findings suggest that regular rinsing with CHX does not have a substantial effect on the preservation of sound tooth structure in older adults.
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Affiliation(s)
- C C L Wyatt
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
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22
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Thitasomakul S, Thearmontree A, Piwat S, Chankanka O, Pithpornchaiyakul W, Teanpaisan R, Madyusoh S. A longitudinal study of early childhood caries in 9- to 18-month-old Thai infants. Community Dent Oral Epidemiol 2006; 34:429-36. [PMID: 17092271 DOI: 10.1111/j.1600-0528.2006.00292.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the rate and pattern of early childhood caries (ECC) development and to investigate the transitional changes of the carious lesions during a follow-up period of 3-9 months. METHODS A longitudinal observational community-based survey of 599 children, 9-18 months old. The children's dental examinations were first carried out at the age of 9 months with re-examination at 12 and 18 months by five dentists using standardized methods. The affected rates of dental caries were determined for prevalence, incidence density for risk of caries per person (IDp) and risk by surface (IDs). Changes in dental status over time were explored from unerupted (U) to sound (S), including enamel caries (D1), dentine caries (D2) and caries involving pulp (D3) by computing transitional probabilities. RESULTS The prevalence of caries was 2.0%, 22.8% and 68.1% among 9-, 12- and 18-month olds, respectively. The IDp observed for newly affected children 9-12 and 12-18 months old was 10.32 and 15.70 persons/100 person-months, respectively. The IDs for children 9-12 months old was 2.17 newly affected surfaces/100 surface-months whereas it was 2.22 surfaces/100 surface-months for children 12-18 months old. The buccal surface of maxillary incisors was the most affected (44.9%) followed by lingual, mesial and distal surfaces, respectively. The transitional probability of caries progression ranged between 1.79% and 15.38% during the follow-up period from 9 to 12 months old. It was 3.43-39.60% from 12 to 18 months old. CONCLUSIONS An extremely high caries-affected rate was found among the study children even before the age of 18 months. The buccal surface of the maxillary incisors was the most affected. The teeth acquired caries at 3-6 months after initial eruption and carious lesions developed continuously over time.
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Affiliation(s)
- Songchai Thitasomakul
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand.
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Broadbent JM, Thomson WM. For debate: problems with the DMF index pertinent to dental caries data analysis. Community Dent Oral Epidemiol 2006; 33:400-9. [PMID: 16262607 PMCID: PMC1388190 DOI: 10.1111/j.1600-0528.2005.00259.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Decayed, Missing, Filled (DMF) index has been used for over 50 years and is well established as the key measure of caries experience in dental epidemiology. Despite its long history of use, there is debate about the most appropriate number of surfaces to include for a missing tooth. Assigning the maximum possible value for the 'M' component of DMFS (Surfaces) leads to overestimation of an individual's caries experience, and in any associated comparisons of in-caries experience, whereas assigning the minimum possible value for the 'M' component has the opposite effect. Alternative methods of assigning the number of caries-affected surfaces for an extracted tooth are considered. The net caries increment and adjusted caries increment (common methods of correction of the crude increment measure for reversals) are discussed, along with incidence density, a measure of caries extent. Problems exist with the adjusted caries increment, particularly among cohorts with low mean baseline caries experience. Development of an alternative method of estimating the relationship of 'true' and 'examiner' reversals is advocated, as well as greater utilization of incidence density in dental epidemiology.
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Affiliation(s)
- J M Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
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Chalmers JM, Carter KD, Spencer AJ. Caries incidence and increments in Adelaide nursing home residents. SPECIAL CARE IN DENTISTRY 2005; 25:96-105. [PMID: 15856916 DOI: 10.1111/j.1754-4505.2005.tb01418.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of The Adelaide Dental Study of Nursing Homes was to quantify coronal and root caries incidence and increments in residents of Adelaide nursing homes. A longitudinal design was used to conduct dental inspections, completed by calibrated dental examiners, for residents of 7 randomly selected nursing homes at both baseline and at one-year follow-up. The nursing home residents in this study were very functionally dependent, medically compromised, cognitively impaired and behaviorally difficult older adults. The coronal caries surface incidence was 64.4% and root caries surface incidence was 48.5%. There were 72.1% of residents who had coronal and/or root caries increments between baseline and one-year. The coronal and root caries increments in these residents were high (adjusted caries increment = 2.5 coronal and 1.0 root surfaces), and were many times greater than that reported from a longitudinal study of community-dwelling older adults in Adelaide. Residents with eating and nutritional problems developed high levels of new caries. Both coronal and root caries incidence and increments were high in these nursing home residents over the one-year follow-up period.
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25
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Caplan DJ. Epidemiologic issues in studies of association between apical periodontitis and systemic health. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1601-1546.2004.00087.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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26
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Chalmers JM, Carter KD, Spencer AJ. Oral health of Adelaide nursing home residents: longitudinal study. Australas J Ageing 2004. [DOI: 10.1111/j.1741-6612.2004.00019.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chalmers JM, Carter KD, Spencer AJ. Caries incidence and increments in community-living older adults with and without dementia. Gerodontology 2002; 19:80-94. [PMID: 12542217 DOI: 10.1111/j.1741-2358.2002.00080.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The Oral Health of Older Adults with Dementia was instigated in the late 1990s to quantify and compare coronal and root caries incidence and increments in community-living older Australians with and without dementia. METHODS A longitudinal design was used to conduct dental inspections at baseline and one-year, for two groups of randomly selected community-living older adults--one group of 116 people with dementia and a comparison group of 116 people without dementia. RESULTS At one-year there were 103 dementia and 113 (112 dentate) non-dementia participants. Coronal and root surface caries incidence was higher for dementia participants (p < 0.05). Dementia participants had higher coronal and root caries adjusted caries increments (ADJCI) (p < 0.01). Both coronal and root ADJCI were evident in half of dementia participants, compared with one-quarter of non-dementia participants. Dementia participants with higher coronal ADJCI were those who had visited the dentist since baseline, who were taking neuroleptics with high anticholinergic adverse effects, and whose carer had high carer burden score (p < 0.01). Dementia participants with higher root ADJCI were those needing assistance with oral hygiene care and whose carers had difficulties with oral hygiene care (p < 0.05). Baseline characteristics predictive in linear regression for: (1) coronal caries increments among all participants were--dementia participants, those with cognitive testing scores indicative of moderate-severe dementia, those with private health insurance; (2) root caries increments among all participants were--dementia participants, and those who had > or = 1 decayed/filled root surface at baseline. Among dementia participants, being male was the baseline characteristic predictive in logistic regression for coronal caries increments, and having > or = 1 decayed coronal surface was the baseline characteristic predictive for root caries increments. CONCLUSIONS Coronal and root caries incidence and increments were significantly higher in the community-living older adults with dementia over the one-year follow-up period. Dementia participants had high levels of coronal and root caries increments; characteristics related to high caries increments included sex (males), dementia severity (moderate-severe), high carer burden, oral hygiene care difficulties, use of neuroleptic medication (with high anticholinergic adverse effects) and previous experience of caries.
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Affiliation(s)
- J M Chalmers
- Australian Research Centre for Population Oral Health, Dental School, The University of Adelaide, Adelaide SA 5005, Australia.
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28
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Kalwitzki M, Weiger R, Axmann-Krcmar D, Rosendahl R. Caries risk analysis: considering caries as an individual time-dependent process. Int J Paediatr Dent 2002; 12:132-42. [PMID: 11966891 DOI: 10.1046/j.1365-263x.2002.00342.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To estimate the probability that a tooth does not develop a cavitated lesion (= end-stage caries) within time periods of interest. Additionally it was of interest to assess the heterogeneity between patients, in relation to the time periods required for their teeth to develop a cavitated lesion. DESIGN A prospective study using patient data of a clinical pedodontic course. SAMPLE AND METHODS Forty-one patients who had been followed for at least 3 years were selected. Before initiation of therapy, affiliation to a specific risk group was checked. Nine individuals who had belonged to a high-risk group on test were excluded. Of 1968 teeth, 1378 were eligible for data evaluation. The statistical techniques applied originate from time-to-event analysis methods, including a parametric frailty approach providing estimates of the relative caries risk for each individual to develop a cavitated lesion. RESULTS In the selected group of patients the probability that a tooth remained free of a cavitated lesion within five years ranged from 0.89 to 0.95 applying a 95% confidence interval. In the present sample the true caries risk of the patients to develop a cavitated lesion varied considerably although such variation was not expected from the individual examinations at baseline. CONCLUSION The frailty model accounts sufficiently for the heterogeneity of each patient. The applied time-to-event methods facilitated reliable estimation of both the probability that a tooth remains free of a cavitated lesion within a certain time and the relative caries risk of an individual to develop a cavitated lesion.
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Affiliation(s)
- M Kalwitzki
- Faculty of Dentistry, Department of Conservative Dentistry, University of Tübingen, Tübingen, Germany.
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Hannigan A, O'Mullane DM, Barry D, Schäfer F, Roberts AJ. A re-analysis of a caries clinical trial by survival analysis. J Dent Res 2001; 80:427-31. [PMID: 11332526 DOI: 10.1177/00220345010800020501] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The decline in caries prevalence, the increases in the level of fluoride exposure, and the lack of placebo control subjects have complicated caries clinical trials in recent times. There has been a substantial increase in the numbers of subjects required for the detection of statistically significant differences between dental products, and hence, the cost of these trials has grown enormously. This study uses a new statistical approach to the analysis of the data from these trials with the ultimate aim of providing a more sensitive method of analysis. The new approach uses survival analysis, where the outcome measure is the survival time of an individual tooth surface. It exploits recent developments in the analysis of clustered survival data where survival times within the same cluster or subject are correlated. To illustrate, the new method of analysis was used for the North Wales, UK, caries clinical trial. It is concluded that survival analysis uses most of the data available in a caries clinical trial, an outcome measure that is easily understood and may lead to a more sensitive method of analysis.
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Affiliation(s)
- A Hannigan
- Department of Mathematics and Statistics, University of Limerick, Ireland.
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Slade GD, Caplan DJ. Methodological issues in longitudinal epidemiologic studies of dental caries. Community Dent Oral Epidemiol 1999; 27:236-48. [PMID: 10403083 DOI: 10.1111/j.1600-0528.1998.tb02017.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
As longitudinal epidemiologic studies of dental caries address increasingly complex research questions, approaches to analysis of data from those studies have become more sophisticated. This review examines methods available for analyzing and reporting data from such studies. Traditional analytic methods utilize the DMFS increment as the outcome measure in longitudinal studies of caries. However, two other outcome measures may be needed to address some research issues: cumulative incidence, which quantifies caries risk; and incidence density, which quantifies caries rate. Four major analytic decisions have to be addressed when computing DMFS increment: examiner misclassification ("reversals"), teeth lost due to caries, findings from more than two examinations, and multiple events such as caries initiation and progression. We present a uniform approach for enumerating caries events that permits the same analytic decisions made in calculating DMFS increment to be applied to cumulative incidence and incidence density calculations. In view of the variety of analytic decisions that must be made when enumerating events in longitudinal studies of caries, authors should specify how all potential changes in caries status were handled. Furthermore, if a study uses more than one outcome measure, the same decisions for enumerating events should be used when computing those measures.
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Affiliation(s)
- G D Slade
- Department of Dental Ecology, University of North Carolina, Chapel Hill 27599-7450, USA.
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Abstract
For over a decade researchers have been looking for the formula that will allow caries prediction. The purpose of this summary is to review recent multifactorial prediction models for adults and children with the aim of identifying the most successful and consistent methods. Conclusions from this review include the following: Clinical variables, especially past caries experience, are confirmed as the most significant predictors of future caries development. The status of the most recently erupted/exposed surface is the most successful measure of past caries experience. Bacterial levels are included in the most accurate prediction models. Sociodemographic variables are most important to caries prediction models for young children and older adults.
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Affiliation(s)
- L V Powell
- Restorative Dentistry, University of Washington, Seattle 98126, USA.
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Seppä L, Kärkkäinen S, Hausen H. Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland. Community Dent Oral Epidemiol 1998; 26:256-62. [PMID: 9758426 DOI: 10.1111/j.1600-0528.1998.tb01959.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The piped water of Kuopio, Finland, was fluoridated in 1959. Owing to strong opposition by different civic groups, water fluoridation was stopped at the end of 1992. OBJECTIVES The aim of this study was to examine the consequences of the discontinuation on dental health. METHODS In 1992 and 1995, independent random samples of all children aged 6, 9, 12 and 15 years were drawn from Kuopio and Jyväskylä, a nearby low fluoride town whose distribution of demographic and socio-economic characteristics was fairly similar to Kuopio's. The total number of subjects examined was 550 in 1992 and 1198 in 1995. Caries was registered clinically and radiographically by the same two calibrated dentists in both towns. RESULTS In 1992, the mean DMFS values were lower in the fluoridated town for the two older age groups, the percentage differences for 12- and 15-year-olds being 37% and 29%, respectively. For the two younger age groups no meaningful differences could be found. In 1995, the only difference with possible clinical significance was found in the 15-year-olds in favor of the fluoridated town (18%). In 1995, a decline in caries was seen in the two older age groups in the nonfluoridated town. In spite of discontinued water fluoridation, no indication of an increasing trend of caries could be found in Kuopio. The mean numbers of fluoride varnish and sealant applications decreased sharply in both towns between 1992 and 1995. In spite of that caries declined. CONCLUSIONS These findings suggest that the decline of caries has little to do with professional preventive measures performed in dental clinics.
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Affiliation(s)
- L Seppä
- Institute of Dentistry, University of Oulu, Finland.
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