Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study

Prevalence of Dental Caries in Schoolchildren from the Galapagos Islands: ESSO-Gal Cohort Report

Objective

Dental caries remains a prevalent disease worldwide. Several epidemiological studies have shown that it affects the oral health of the pediatric population, and the Galapagos population in Ecuador is no exception. The aim of this study was to determine the prevalence of dental caries and its association, based on baseline information from the Galapagos Oral Health Study (ESSO-Gal), in children of the Galapagos Islands, Ecuador.

Methods

A cross-sectional study was conducted involving 804 children aged 2-11 years. The prevalence of dental caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria, while the presence of dental biofilm was assessed using the Silness-Löe index. Descriptive statistics, including frequency analysis and measures of central tendency and dispersion, were performed. Inferential statistical analyses were conducted to identify associations between variables. Statistical analyses were performed using the SPSS version 25.0 statistical program.

Results

The caries prevalence rates based on ICDAS II codes 1-6, 1-2, and 3-6 were 98.01%, 96.9%, and 85%, respectively. A statistically significant difference was observed among the different islands regarding the cutoff point for ICDAS II codes 3-6 (p ≤ 0.001). Participants aged 6-11 years had the highest caries prevalence.

Conclusions

The results show a high prevalence of dental caries among children in the Galapagos Islands, which increases with age. Contrary to expectations, the study did not find a significant correlation between the severity of dental caries and the presence of dental biofilm.

An interdisciplinary intervention program to prevent early childhood caries in the Dominican Republic

Objective

The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists.

Materials and methods

After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria.

Results

At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460).

Conclusion

The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.

Association of polymicrobial interactions with dental caries development and prevention

Dental caries is a common oral disease. In many cases, disruption of the ecological balance of the oral cavity can result in the occurrence of dental caries. There are many cariogenic microbiota and factors, and their identification allows us to take corresponding prevention and control measures. With the development of microbiology, the caries-causing bacteria have evolved from the traditional single Streptococcus mutans to the discovery of oral symbiotic bacteria. Thus it is necessary to systematically organized the association of polymicrobial interactions with dental caries development. In terms of ecology, caries occurs due to an ecological imbalance of the microbiota, caused by the growth and reproduction of cariogenic microbiota due to external factors or the disruption of homeostasis by one's own factors. To reduce the occurrence of dental caries effectively, and considering the latest scientific viewpoints, caries may be viewed from the perspective of ecology, and preventive measures can be taken; hence, this article systematically summarizes the prevention and treatment of dental caries from the aspects of ecological perspectives, in particular the ecological biofilm formation, bacterial quorum sensing, the main cariogenic microbiota, and preventive measures.

Unmet need in Sierra Leone: a national oral health survey of schoolchildren

OBJECTIVE

Sierra Leone (SL), in West Africa, with a population of over 7.5 million people has suffered the effects of a civil war previously, and more recently Ebola & Covid-19. Dental care is very limited, mostly in the capital Freetown and the private sector. No dental education is available in the country. The objective of this research was to investigate the oral health needs of schoolchildren at key ages, to inform future action.

MATERIALS AND METHODS

This first national oral health survey of schoolchildren at 6-, 12- and 15-years was conducted in urban and rural settings across all four regions using a multi-stage cluster sampling in line with the WHO guidelines, adapted according to contemporary survey methods to include 'International Caries Detection and Assessment System (ICDAS)'. Whilst parents were invited to complete a questionnaire for 6-year-old children, 12- and 15-year-olds self-completed a questionnaire. Data were weighted according to age and regional population and analysed using STATA v.15 and SPSS v.22.

RESULTS

A total of 1174 children participated across 22 schools from all four regions. Dental caries was prevalent (over 80% of all age-groups having clinical decay; ICDAS score ≥ 2) and largely untreated. No children had fillings and only 4% had missing teeth. Amongst 6, 12 and 15-year-olds, average decay levels at ICDAS > 3 threshold was 3.47 (primary teeth), 2.94 and 4.30 respectively. Almost, 10% (n = 119) of all children reported experiencing pain in their teeth with 7% (n = 86) children having PUFA lesions present. At least one in five children required one or more dental extractions. 'Age' was a significant predictor of dental caries experience and the odds of having dental caries experience was higher in rural areas at D_3-6MFT (p < 0.05).

CONCLUSION

The findings demonstrate a vast unmet oral health need in the children of SL. Using ICDAS as an epidemiological tool in a low-income country provides valuable insight to the pattern of oral disease to inform health service planning. Urgent action is required to address this silent epidemic.

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study

BACKGROUND

Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life.

AIM

To evaluate the ECC prevalence and its impact on OHRQoL in 3-5 years-old Mexican children according to disease severity.

DESIGN

Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression.

RESULTS

A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p < .05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR = 1.39, 95%CI = 1.11-1.72; p < .01), two main meals/day (OR = 2.75, 95%CI = 1.26-6.03; p = .01) and unsupervised toothbrushing (OR = 3.20, 95%CI = 1.96-5.24; p < .01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ² ₍₄₎  = 175.85, p < .01; trend across groups z = 12.63 Prob > |z| < 0.01).

CONCLUSIONS

M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

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.

Relationship between Salivary Alpha-Amylase Enzyme Activity, Anthropometric Indices, Dietary Habits, and Early Childhood Dental Caries

Objectives

Although early childhood dental caries (ECC) have the same general etiology as other types of caries, predisposing factors are not well elucidated. This study aimed to investigate the effect of salivary alpha-amylase (sAA) activity, body mass index (BMI), dietary habits, and oral hygiene on ECC.

Methods

This cross-sectional study was performed on 38 ECC-affected and 41 caries-free children, aged 36 to 72 months. Upon the parents' consent, 3 mL of non-stimulated saliva was collected from the participants to measure the level of sAA activity through spectrophotometry. Additionally, parents/caretakers completed a structured questionnaire about demographic factors, oral hygiene, and consumption of sugar-containing foods. BMI, BMI z-scores, and percentile data were calculated by using an online calculator. The independent variables were dichotomized and tested through chi-square test, followed by a stepwise logistic regression, by using SPSS software (α = 0.05).

Results

The sAA activity was significantly higher in caries-free children (P ≤ 0.001). However, the mean BMI was not significantly different between the two groups (P=0.49). Brushing and other measured dietary habits were significantly associated with the development of ECC (P ≤ 0.001). According to the results of the logistic regression, sAA activity was shown to be a predictor for ECC development (Odds ratio (95% confidence interval): 0.9 (0.95-0.98)).

Conclusion

Children with inherently lower levels of sAA activity were more susceptible to dental caries. Improper nutritional habits and poor oral health care could exacerbate the risk of ECC.

Are oral health conditions associated with schoolchildren's performance and school attendance in the Kingdom of Bahrain? A life-course perspective

BACKGROUND

The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children.

AIM

To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life-course approach.

DESIGN

A cross-sectional study was conducted with 466 schoolchildren aged 7-8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at-birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression.

RESULTS

The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96-0.99). Children with caries-treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15-1.74). Disease Control and PreventionNone of the dental conditions were significantly associated with children's school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08-6.42).

CONCLUSION

Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance.

Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: a cross sectional study

This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Caries Prevalence and Severity for 12-Year-Old Children in Latvia

Objectives

To study caries prevalence/severity in 12-year-old children in Latvia and potential risk indicators.

Methods

A cross-sectional oral-health national survey of 12-year-old children was conducted in 2016. A nationally representative stratified-cluster probabilistic sample of 2,138 pupils in 92 schools was selected. Children were examined by seven calibrated examiners (kappa inter-examiner, intra-examiner scores of 0.71–0.77, 0.81–0.97, respectively) at school. Enamel-non-cavitated decay (D₁), enamel cavitation (D₃), dentine cavitation (D₅), missing (M) or filled (F) status at the tooth (T)/surface (S) levels were evaluated, and decayed, missing, and filled (DMF) index scores for severity, along with the Significant Caries Index (SiC), were calculated. An associated caries factor questionnaire was completed by participants.

Results

The prevalence of caries was 98.5% for D₁MFT, 79.7% for D₃MFT, and 71.9% for D₅MFT. The means (standard deviations) for severity were 9.2 (5.3) for D₁MFT, 3.3 (3.0) for D₃MFT, and 2.4 (2.4) for D₅MFT, and 5.6 (2.1) for the SiC. Indicators associated with a lower risk of caries (D5MFT) were irregular dental visits (prevalence odds ratio POR = 0.45, 95% confidence interval (CI): 0.36, 0.56) and irregular use of mouthwashes (POR = 0.73, 95% CI: 0.60, 0.89).

Conclusions

We found a high caries prevalence and severity in 12 year-old children in Latvia. Although the WHO target for 2010 (D₅MFT ≤ 3) is met, the values for caries prevalence (D₅MFT > 0 = 71.9%) and severity (D₅MFT = 2.5) in 12-year-old Latvian children are higher than the European averages (D₅MFT > 0 = 52%, D₅MFT = 1.1).

Caries prevalence and caries experience (ICDAS II criteria) of 5-, 12- and 15-year-old Greek children in relation to socio-demographic risk indicators. Trends at the national level in a period of a decade

PURPOSE

To study the caries status of 5, 12 and 15-year-old Greek children, assess how disease parameters are related to socio-demographic indicators and identify relevant trends at the national level.

METHODS

A stratified cluster sample of 3702 children in total was randomly selected and examined clinically for caries (ICDAS II criteria). Caries experience was outlined by adapting ICDAS_0-6 criteria to the d/D component of the WHO dmf/DMF index configuration. Percentages (%) of caries experience-free children, of children with initial caries (ICDAS_1-2), and the mean d_1-2t/D_1-2T, d_3-6mft/D_3-6MFT and d_3-6mfs/D_3-6MFS indices were calculated. The probability of presenting with d_1-2t/D_1-2T ≥ 1 was assessed by binary logistic regression analysis, whereas negative binomial regression models examined the effect of socio-demographic parameters on d_3-6mfs/D_3-6MFS indices (level of significance: p ≤ 0.05).

RESULTS

60.1%, 48.1%, and 34.7% of the 5, 12, and 15-year-old children, respectively, had no caries experience at the defect level (d_3-6mft/D_3-6MFT = 0). Initial lesions (ICDAS_1-2) were detected in 17.7%, 19.3% and 17.4% of the 5, 12 and 15-year-olds, accordingly. Mean d_1-2t/D_1-2T was 0.93, 1.70, and 2.51, whereas mean d_3-6mft/D_3-6MFT was 1.48, 1.61, and 2.46 for the 5, 12, and 15-year-olds, respectively. Children with higher educated parents and 15-year-old urban residents exhibited significantly less caries experience at the defect level. Initial caries lesions presented a significantly higher probability of being detected in urban-residing 5- and 15-year-olds, while no consistent trend could be identified for parental education level. Caries prevalence and experience levels declined for all age groups in ten years.

CONCLUSION

Although the dental health of Greek children has improved disparities remain, calling for organised primary and secondary preventive interventions.

Caries experience between primary teeth at 3-5 years of age and future caries in the permanent first molars

Background/purpose

Past caries experience remains the most powerful predictor of future caries. This study was aimed at exploring the possible relationship between the caries statuses at 3–5 and 8–10 years of age and examining the predictive power of caries experience at 3–5 years of age for the caries pattern at 8–10 years of age.

Materials and methods

A total of 76 children (43 boys and 33 girls) were included in this study from 2012 to 2018. The first caries examination, performed in 2012, was completed when participants underwent dental rehabilitation under general anesthesia at 3–5 years of age. Tooth decay was recorded based on the International Caries Detection and Assessment System criteria. The caries examination was repeated in the clinic in 2018 when the participants were 8–10 years old. Associations between the permanent and primary teeth were analyzed using the Mann–Whitney U test. The receiver operating characteristic curve analysis was performed to determine the predictive accuracy of the primary dentition.

Results

A significant dmfs score of the primary second molar was found between groups of free dentin caries and dentin caries of the permanent first molars (p = 0.002). The calculated areas under the receiver operating characteristic curve for the dmfs score of the primary second molar was 0.74.

Conclusion

Caries in the primary second molars is a clinically useful predictor at 3–5 years of age for future dentin caries development on surfaces of the first permanent molars in the following 5 years.

Genes and SNPs in the pathway of immune response and caries risk: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to pool the data on Single Nucleotide Polymorphisms (SNPs) in immune response genes associated with dental caries. Nineteen studies were included in the review and 18 in the meta-analysis. Twenty-two SNPs were evaluated, which are linked to six different genes (MBL2, LFT, MASP2, DEFB1, FCN2 and MUC5B). Most SNPs (81.8%) are related to the possible functional impact on protein coding. The MBL2 gene was associated with caries experience in the analysis of the homozygote (OR = 2.12 CI95%[1.12-3.99]) and heterozygote (OR = 2.22 CI95%[1.44-3.44]) genotypes. The MUC5B gene was associated according to an analysis of the heterozygous genotype (OR = 1.83 CI95%[1.08-3.09]). Thus, SNPs related to immune response genes are linked to the phenotype of caries experience. Although the meta-analysis showed that the genes MBL2 and MUC5B were associated with caries, these results should be interpreted with caution due to the quality of the evidence.

Effects of Cariogenic Bacteria and Sealant Evaluated by International Caries Detection Assessment System

Aim:

Evaluation of tooth surface level effect of cariogenic bacteria and sealant.

Background:

International Caries Detection Assessment System (ICADS) is a clinical scoring system that can assess the non-cavitated early stage of dental caries by surface level. Scores used in ICDAS are ordinary and each tooth within one individual is not statistically independent.

Objective:

In this study, by applying mixed effect modeling, the effect of cariogenic bacteria and fissure sealant for tooth surface-level caries progression was analyzed.

Methods:

Ninety-eight patients who had been regularly visited the dental hospital for the regular check-ups were enrolled in this study. Among them, patients who visited at baseline, after one and two years, were included for the analysis. Fifty-two patients were dropped out. The study population consisted of 25 boys and 21girls and their mean ages were 9.3 +/- 2.1. Salivary levels of cariogenic bacteria were measured by qPCR. Mixed effect modeling with repeated measures was applied for the analysis.

Results:

Salivary levels ofS. mutansandLactobacilliwere affected by the progression of the ICDAS score. Maxillary teeth, molars and buccal and occlusal surfaces were tended to progress. Maxillary tooth, molar tooth and buccal, approximal, and occlusal surface were tended to be affected by both cariogenic bacteria.

Conclusion:

By applying mixed effect modeling, highly-detailed surface-level analysis can be available.

Oral health and obesity in the SAYCARE study: reliability and internal validity of diagnostic methods

OBJECTIVE

The aim of this pilot study was to address the reliability, internal validity and viability of oral health methods used in the South American Youth/Child cARdiovascular and Environmental study.

METHODS

South American Youth/Child cARdiovascular and Environmental study was a multicentre feasibility observational study and conducted in seven South American cities. The training sessions were performed in two steps before data collection: the first verified the inter-rater reproducibility between the examiners of the six centres in relation to the gold standard, and the second one verified the inter-rater reproducibility between the examiners at each centre in relation to the main rater. The diagnostic methods used were International Caries Detection and Assessment System II and Pulpal Involvement, Ulceration, Fistula and Abscess for dental caries and Periodontal Screening and Recording and Index Plaque for periodontal disease. Anthropometric variables were measured and used to calculate the body mass index and were classified according to the cut-off points defined by the International Obesity Task Force. Cohen's kappa coefficient and proportions of agreement were calculated to report inter-rater and intra-rater reliability in the calibration process and pilot study.

RESULTS

The inter-rater weight kappa ranged from 0.78 to 0.88 and proportion of agreement from 96.07% to 98.10% for the International Caries Detection and Assessment System II and for the Periodontal Screening and Recording, 0.68 to 0.95 and 94.40% to 98.33%, respectively, in the calibration process. At the pilot study, a total of 490 children (40.8% overweight and 12.9% obese) and 364 adolescents (23.4% overweight and 4.3% obese) were examined. The prevalence of dental caries was 66% in children and 78% in adolescents, and gingival bleeding was 49% and 58.20%, respectively.

CONCLUSION

The results demonstrated good reliability and internal validity after the examiners were trained, as well as the feasibility of using the methods chosen for this multicentre study.

Caries reporting in studies that used the International Caries Detection and Assessment System: A scoping review

OBJECTIVE

To explore how caries was reported in studies that employed the International Caries Detection and Assessment System (ICDAS).

METHODS

A systematic database search up to August 2017 was carried out using PubMed, Ovid MEDLINE, Cochrane library and ISI Web of Science electronic databases. Only studies that used the ICDAS for dental caries examinations were included. Studies were excluded if the examination was done only for the validation or the calibration of the ICDAS and/or if the examination was not done for the whole dentition. Measures used to report caries were considered.

RESULTS

A total of 126 papers met the inclusion criteria. Forty-four different synthesis measures were used to report caries. Most of the studies used a combination of multiple measures to report patient's caries level. These reporting measures cluster into four main groups: the number of individual ICDAS scores (ie, total counts of every score); the number of decayed surfaces/teeth (ie, total counts of combined caries scores for surfaces or teeth); measures of caries experience (ie, total counts of combined caries scores, filled and/or missing surfaces or teeth); and measures of central tendency and dispersion. The number of decayed surfaces and individual ICDAS scores were the most commonly used measures. Three studies used mean ICDAS score (ie, total ICDAS scores divided by the number of teeth), two used mean ICDAS score of carious teeth (ie, total ICDAS scores divided by the number of carious teeth) and two used the maximum ICDAS score (ie, highest ICDAS score recorded). The total ICDAS score was used only once. Many studies synthesized from the ICDAS the number of decayed, missing and filled teeth/surfaces (dmft/DMFT, dmfs/DMFS) as a measure of caries experience.

CONCLUSIONS

There are variations among studies in the utilization of the system to summarize caries. Most studies presented caries data using the categorical characteristics of the ICDAS.

Interpreting Poisson Regression Models in Dental Caries Studies

Oral epidemiology involves studying and investigating the distribution and determinants of dental-related diseases in a specified population group to inform decisions in the management of health problems. In oral epidemiology studies, the hypothesis is typically followed by a cogent study design and data collection. Appropriate statistical analysis is essential to demonstrate the scientific association between the independent factors and the target variable. Analysis also helps to develop and build a statistical model. Poisson regression and its extensions have gained more attention in caries epidemiology than other working models such as logistic regression. This review discusses the fundamental principles and basic knowledge of Poisson regression models. It also introduces the use of a robust variance estimator with a focus on the "robust" interpretation of the model. In addition, extensions of regression models, including the zero-inflated model, hurdle model, and negative binomial model, and their interpretation in caries studies are reviewed. Principles of model fitting, including goodness-of-fit measures, are also discussed. Clinicians and researchers should pay attention to the statistical context of the models used and interpret the models to improve the oral and general health of the communities in which they live.

Impact of different detection criteria on caries estimates and risk assessment

AIM

This study aimed to compare the prevalence and extent of dental caries according to the standard World Health Organization (WHO), modified WHO and International Caries Detection and Assessment System (ICDAS) criteria among 12-year-old Brazilian schoolchildren and to assess the impact of these detection criteria on the assessment of sociodemographic risk indicators for dental caries.

METHODS

This cross-sectional survey used a multistage probability sampling strategy to select a representative sample of 12-year-old schoolchildren. After tooth cleaning and drying, a single examiner recorded the presence of non-cavitated and cavitated caries lesions. A questionnaire gathered demographic and socio-economic information. Three proposed thresholds for caries detection were used: standard WHO criteria (only cavitated lesions); modified WHO criteria (active non-cavitated lesions and cavitated lesions); and ICDAS (all non-cavitated and cavitated lesions). Prevalence ratios (PR), rate ratios (RR) and 95% confidence intervals (95% CI) were estimated using survey Poisson regression analysis.

RESULTS

In total, 1,528 of 1,837 eligible schoolchildren participated. Caries prevalence (standard WHO, 55.23%; modified WHO, 63.33%; ICDAS, 79.82%) and decayed, missing and filled teeth (DMFT) index (standard WHO, 1.39; modified WHO, 1.95; ICDAS, 3.78) increased as the detection criteria became more sensitive. Compared with the standard WHO criteria, ICDAS had a greater impact on caries estimates, mainly in schoolchildren of higher socio-economic background. All socio-economic variables were significantly associated with dental caries, irrespective of the detection criteria.

CONCLUSION

The inclusion of non-cavitated lesions impacted estimates of prevalence and extent of dental caries, mainly when ICDAS was used. No impact was observed on the association between caries and socio-economic variables.

In Vitro Evaluation of Enamel Microhardness after Application of Two Types of Fluoride Varnish

INTRODUCTION

Use of fluoride compounds is one of the most effective ways of preventing decay and among these varnishes have high acceptance among different fluoride products.

AIM

Hence, the aim of this research was to evaluate the micro-hardness of tooth enamel after the usage of two different commercial products of fluoride varnish.

MATERIALS AND METHODS

This in vitro experimental study was performed on 51 extracted premolar teeth. The teeth were divided randomly into three 17-membered groups. The first group received Duraflor varnish, the second group received Ariadent Iranian varnish while the third group received no treatment. Micro hardness of tooth enamel was measured utilizing Vickers method before and after the use of fluoride varnish. ANOVA, Tukey, and Wilcoxon statistical tests were utilized for statistical analysis of data.

RESULTS

The comparison of mean change in micro hardness before and after the use of fluoride showed that increase in micro hardness in Duraflor varnish and Ariadent varnish group was significant when compared to control group (p<0.05) but no significant statistical difference was observed in terms of mean of micro hardness after intervention between two groups of Duraflor varnish and Ariadent varnish (p>0.05).

CONCLUSION

According to the findings, the use of fluoride significantly increased the enamel micro hardness which did not show a significant difference between two groups of Duraflor varnish and Ariadent varnish.

Caries progression as a risk factor for increase in the negative impact on OHRQOL-a longitudinal study

OBJECTIVES

The aim of this study is to evaluate the association between caries lesions progression and oral health-related quality of life (OHRQoL) among Brazilian preschools, after 2 years.

MATERIALS AND METHODS

At baseline, 163 children (3-4 years old) enrolled in 12 public primary care services in Porto Alegre/RS-Brazil were evaluated. After 2 years, 119 children were re-evaluated. Calibrated examiners employing the ICDAS criteria conducted clinical examinations. A socio-demographic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale were applied to the parents of the children at baseline and 2-year follow-up. Data analysis was performed using a hierarchical approach based in a conceptual framework testing by Poisson regression.

RESULTS

The number of surfaces that progressed from baseline to 2-year follow-up was associated with an increased negative impact on OHRQoL.

CONCLUSIONS

Caries progression increased the negative impact on OHRQoL.

CLINICAL RELEVANCE

The progression of caries lesions could negative impact on OHRQoL in Brazilian preschoolers.

Differential Impacts of Caries Classification in Children and Adults: A Comparison of ICDAS and DMF-T

The aim of this study was to describe and compare findings regarding the prevalence and severity of dental caries when using ICDAS and DMFT/dmft in an epidemiological study with children and their mothers. This cross-sectional study evaluated 150 preschoolers and their mothers. Data were collected with ICDAS and then transformed into DMFT/dmft. ICDAS scores related to caries were analyzed according to three different cut-off-points: CP1 (0-healthy/1-6-caries), CP2 (0-1-healthy/2-6-caries) and CP3 (0-2-healthy/3-6-caries), representing the D/d of DMFT/dmft. ICDAS codes regarding restorations, except sealants, were considered the F/f and the code 97 as the M/m of DMFT/dmft index. Prevalence of caries and its severity with ICDAS were 92%, 84% and 31.3% in children and 97.3%, 96.6% and 80% in adults according to CP1/CP2/CP3, respectively. Admitting CP3 as the standard for data transformation of ICDAS in DMFT/dmft, it was observed that DMFT/dmft index would underestimate 60% of non-cavitated lesions in children and 16.6% in adults. The DMFT/dmft underestimated the presence of disease to disregard non-cavitated lesions for the pediatric population evaluated. The choice of which is the best index for epidemiological surveys will depend on the purpose of the research and the target population: if it is to estimate the needs of the population to determine clinical care in children and adults, the DMFT/dmft may be sufficient. However, if the objective is to have a more comprehensive diagnosis of caries at the population level in order to develop preventive strategies, to halt and reverse the disease, the detection of non-cavitated-lesions becomes important, mainly in young children.

Are distinctive risk indicators associated with different stages of caries in children? A cross-sectional study

Background

Actual caries figures emphasize the need to identify the risk indicators involved in the disease’s development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children.

Methods

A total of 390 subjects aged 6–8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours.

Results

Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated.

Conclusions

Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3865-4) contains supplementary material, which is available to authorized users.

Determinant Factors of Untreated Dental Caries and Lesion Activity in Preschool Children Using ICDAS

The aim of the present study was to investigate determinant factors associated with the presence of dental caries and lesion activity in preschool children. A population-based, cross-sectional study was carried out with 843 children of aged three to five years enrolled at public and private preschools in the city of Campina Grande, Brazil. A questionnaire addressing socio-demographic data and oral health care was self-administered by parents/caregivers. Three dentists previously calibrated examined the children for the diagnosis of dental caries and lesion activity using the International Caries Detection and Assessment System (ICDAS). Nutritional status was evaluated based on the body mass index. Logistic regression analysis for complex samples was performed (α = 5%). The prevalence of dental caries was 66.3%. Among the children with caries, 88.0% had active lesions. Dental caries was more prevalent in girls (OR = 1.53, 95%CI: 1.05–2.23), in children from families with a monthly household income ≤US$312.50 (OR = 2.38, 95%CI: 1.65–3.43) and those whose mothers had up to eight years of schooling (OR = 1.55, 95%CI: 1.07–2.23). Lesion activity was significantly associated with mother’s schooling ≤ 8 years (OR = 2.15, 95%CI: 1.15–4.00). The prevalence rates of dental caries and lesion activity were high and mainly associated with a lower socioeconomic status and mother’s schooling.

Performance of undergraduate dental students on ICDAS clinical caries detection after different learning strategies

AIM

This study aimed to evaluate the effect of a digital learning tool on undergraduate dental students' performance in detecting dental caries using ICDAS.

METHODS

An experimental digital learning tool (DLT) was created using digital photographs of sound and carious teeth. Thirty-nine students were divided into three groups (n = 13) and each assessed 12 randomly allocated patients before and after learning strategies: G1, ICDAS e-learning program; G2, ICDAS e-learning program plus DLT; G3, no learning strategy. Students (n = 32) reassessed patients 2 weeks after training.

RESULTS

Comparing before and after the learning strategies, any difference in the values of specificity and area under the ROC curve for all groups was found. Sensitivity was statistically significantly higher for G1 and G2. Comparing the groups, G2 showed a significant increase in sensitivity at the D2 and D3 thresholds. Spearman's correlations with the gold standard before and after the learning strategy were 0.60 and 0.61 for G1, 0.57 and 0.63 for G2, and 0.54 and 0.54 for G3, respectively. The Wilcoxon test showed a statistically significant difference between the values obtained before and after learning strategies for G1 and G2.

CONCLUSIONS

Use of the DLT after the ICDAS e-learning program tended to increase the sensitivity of ICDAS used by undergraduate dental students. The DLT appeared to improve dental students' ability to use ICDAS.

Detecting Short-Term Changes in the Activity of Caries Lesions with the Aid of New Technologies

This paper discusses the use of new technologies for the assessment of caries and more in particular changes in caries activity. Over the past decades, we have seen a shift from restorative treatment caries to a prevention-driven approach. Also there is a need for shorter and less expensive caries clinical trials. These demand earlier detection of lesions and the monitoring of lesion changes longitudinally in time, which has led to the development of new technologies to aid clinical visual examination. Also clinical visual inspection indices have been refined to fit this purpose. There is a constant flow of technologies emerging and disappearing. This review discusses the merits of recent developments regarding their respective uses for research purposes in testing new caries prevention strategies as well as in clinical caries management in dental private practice. Which technique to choose highly depends on the needed resolution of information.

Dental caries, fluorosis, and oral health behavior of children from Herat, Afghanistan

OBJECTIVE

Decades of conflict, poverty, and dysfunctional public services have affected people's health in Afghanistan. To estimate treatment needs and guide health initiatives, epidemiologic data are required. Such data are currently unavailable for dental health. The present study assessed caries experience, fluorosis, and oral health behavior in children from Afghanistan.

METHODS

We performed a two-stage, school-based cross-sectional study in Herat province in Afghanistan. A total of 1059 children, 369 children aged 6-7, 300 aged 12, and 390 aged 15 years, were sampled. Caries was assessed according to ICDAS, and oral hygiene, dietary habits, and parental economic and educational status evaluated. Prevalence of fluorosis was assessed, and fluoride concentrations in drinking water and in used toothpastes were measured.

RESULTS

Mean (SD) number of decayed, missing, or filled teeth was dmft = 4.88 (3.11), DMFT = 2.57 (2.16), and DMFT = 4.04 (3.03) in 6-/7-, 12-, and 15-year-olds, respectively. The majority of lesions in 6-year-olds were cavitated, while 12- and 15-year-olds showed more non- or microcavitated lesions. Most lesions, especially in young children, were untreated. Mean (range) water fluoride concentration was 0.37 (0.19-0.67) ppm. Fluoride concentrations in evaluated toothpastes did not meet internationally recommended levels. The majority of children showed no or minimal fluorosis. Having fluorosis, infrequently consuming sweets, or having a father with high education was associated with low caries experience (dmfs/DMFS < 10), with OR (95% CI) being 0.64 (0.47/0.90), 0.65 (0.44-0.95), and 0.64 (0.47/0.90), respectively.

CONCLUSIONS

Examined Afghan children had high unmet dental treatment needs and caries experience. Sufficient access to restorative treatment and prevention measures is urgently required.

A parent motivational interviewing program for dental care in children of a rural population

OBJECTIVES

To determine the effectiveness of a motivational interviewing-based educational program in reducing the number and intensity of new caries and bacterial dental plaque levels at 6 months post randomization.

STUDY DESIGN

A randomized and single blind clinical trial in 100 schoolchildren between 6-10 years of age presenting the highest risk score of caries according to the Caries Management by Risk Assessment (CAMBRA) criteria was performed. These patients were randomized to two groups: control (in which the mothers initially received an oral prevention informative session) and experimental (in which the mothers received the initial informative session, followed by individual motivational interviewing sessions during a period of 6 months). The International Caries Detection and Assessment System (ICDAS) scores and bacterial plaque were evaluated at baseline, at 6 and 12 months.

RESULTS

After 12 months, children in the experimental group had 2.12 ± 0.8 new caries versus 3.5 ± 0.9 in the control group (t=7.39; p<0.001). Caries in the experimental group was seen to be limited to the enamel, with a median intensity of 2 (range 0-3) versus 3 (0-6) in the control group (U=1594; p<0.0001). Bacterial plaque determined by the O'Leary index decreased in both groups; however, it decreased more in the experimental than in the control group (34.3 vs. 20.6; t=-3.12, p= 0.002) respectively.

CONCLUSIONS

Motivational interviewing is better than traditional educational programs in preventing caries and decreasing bacterial plaque. Key words:Health educational, motivational interviewing, caries risk.

Caries prevalence (ICDAS) in 12-year-olds from low caries prevalence areas and association with independent variables

BACKGROUND

In areas with low caries prevalence, indices are needed for caries detection, which can also be used to identify initial lesions.

AIM

The aim of this study was to assess the caries prevalence among 12-year-olds using ICDAS criteria and to investigate the influence of independent variables on the findings.

DESIGN

The study was conducted in two regions of Germany. In Region 1, children received regular school-based prophylaxis, including fluoride varnish 2×/yr. In Region 2, there was no use of fluoride varnish in schools. Information on different factors influencing the outcome variable of caries experience was collected using structured questionnaires. DF-S values were calculated at different ICDAS cut-off points. To compare the mean caries scores of the subgroups, nonparametric tests were performed. Variables associated with caries were included in a binary logistic regression analysis.

RESULTS

At D(1-6) FS and D(1+2) FS level, the differences between the regions were statistically significant (P = 0.005 and P = 0.01, respectively). Regression analysis identified the variables 'use of fluoridated toothpaste', 'fissure sealants', and 'ethnic origin' as factors significant to the prevention of caries at various stages.

CONCLUSION

In a population with low caries prevalence, significant differences between subgroups could only be found when initial lesions were included.

Inequality in dental caries distribution at noncavitated and cavitated thresholds in preschool children

OBJECTIVE

To evaluate the inequality in dental caries distribution according to different thresholds assessed using the International Caries Detection and Assessment System (ICDAS) and to investigate the associations of socioeconomic factors with caries lesions at both noncavitated and cavitated thresholds.

METHODS

Study subjects were recruited in Santa Maria, Brazil, during the National Day of Children's Vaccination, and 639 children aged 12-59 months were included. Fifteen calibrated examiners performed the examinations using ICDAS criteria. Inequality in dental caries distribution was measured using the Gini coefficient, and the Significant Caries Index was calculated for several thresholds of ICDAS. Poisson regression analysis was used to assess the associations of socioeconomic factors with the highest caries scores.

RESULTS

The inequality in the distribution of dental caries was lower when precavitated caries were included; the Gini coefficient decreased from 0.77 to 0.60 when noncavitated caries lesions were included in the analyses. Moreover, the inequalities were higher in the younger than in the older children for all thresholds. Socioeconomic factors were significantly (P < 0.001) associated with caries when an ICDAS score of 3 was considered as the cut-off point. Children whose mothers did not complete primary education (P < 0.001) and those with low household income (P < 0.001) were more likely to have increased dental caries.

CONCLUSION

Caries lesions were more equally distributed when noncavitated lesions were included in the dental survey. Socioeconomic factors are found to be associated with the inequalities in caries distribution in this age group.

The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation

BACKGROUND

To determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias.

METHODS

Subjects were male and female lifetime residents aged 11-13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0).

RESULTS

Data from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester.

CONCLUSIONS

Water fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages

BACKGROUND. With Dental Caries being the most common disease amongst children in the world today, there is a need to fully understand risk factors that may be related to caries prevalence and how they could be best addressed. AIM. The aim of this study was to evaluate soda, juice, sugared-beverage intake, brushing habits, and community water source availability as they relate to the prevalence of both noncavitated and cavitated caries lesions in small rural villages in Mexico. DESIGN. The International Caries Detection and Assessment System (ICDAS) was used in children from small, isolated, villages in Mexico. Risk factors were assessed via questionnaires. RESULTS. Caries prevalence in the villages was very high, ranging from 94.7% to 100% of the children studied. The mean number of surfaces with lesions per child (D1MFS + d1mfs) having scores ≥1 (noncavitated and cavitated) ranged from 15.4 ± 11.1 to 26.6 ± 15.2. Many of the children reported drinking beverages containing sugar. CONCLUSIONS. Drinking sugared beverages, poor oral hygiene habits, and lack of access to tap water were identified as risk factor for caries in this sample of residents of rural Mexico.

Measuring Dental Caries in the Mixed Dentition by ICDAS

Caries has traditionally been assessed with WHO criteria including only obvious caries lesions. ICDAS has been developed to detect also the enamel caries lesions. This study aims to study caries and the associations of the number of caries lesions between the permanent and primary molars with ICDAS in the mixed dentition of the first and second grade primary school children. The clinical examinations of 485 children were conducted by four examiners with high reproducibility (inter- and intraexaminer kappas >0.9). The mean number of caries lesions—especially dentine caries—seemed to be higher in the second primary molars than in the first permanent molars. There were significant correlations between the number of lesions on occlusal and lingual surfaces between the primary and permanent molars. Enamel caries lesions, restorations, and caries experience did not increase according to age. Therefore, caries might be increasing in this population. As a conclusion, ICDAS recording seems to give appropriate information from the occurrence of caries lesions and its correlations between the primary and permanent teeth and surfaces.

Dental caries and pulpal disease

This article reviews the diagnostic process, from the first clinically evident stages of the caries process to development of pulpal pathosis. The caries diagnostic process includes 4 interconnected components-staging caries lesion severity, assessing caries lesion activity, and risk assessments at the patient and tooth surface level - which modify treatment decisions for the patient. Pulpal pathosis is diagnosed as reversible pulpitis, irreversible pulpitis (asymptomatic), irreversible pulpitis (symptomatic), and pulp necrosis. Periapical disease is diagnosed as symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, and chronic apical abscess. Ultimately, the goal of any diagnosis should be to achieve better treatment decisions and health outcomes for the patient.