University of North Carolina caries risk assessment study. III. Multiple factors in caries prevalence

Serum Levels of Vitamin D and Dental Caries in 7-Year-Old Children in Porto Metropolitan Area

Vitamin D deficiency has been associated with significant changes in dental structures. In children, it can induce enamel and dentin defects, which have been identified as risk factors for caries. This study aimed to assess the association between low serum 25-hydroxyvitamin D (25(OH) D) levels (<30 ng/mL) and the prevalence of caries in the permanent teeth and mixed dentition of 7-year-old children. A sample of 335 children from the population-based birth cohort Generation XXI (Porto, Portugal) was included. Data on children’s demographic and social conditions, health status, dental health behaviours, dental examination including erupted permanent first molars, and blood samples available for vitamin D analysis were collected. Dental outcomes included the presence of caries, including non-cavitated lesions (d_1–6mft/D_1–6MFT > 0), and advanced caries (d_3–6mft/D_3–6MF > 0). Serum 25(OH) D was measured using a competitive electrochemiluminescence immunoassay protein-binding assay. Bivariate analysis and multivariate logistic regression were used. Advanced caries in permanent teeth was significantly associated with children’s vitamin D levels <30 ng/mL, gastrointestinal disorders, higher daily intake of cariogenic food, and having had a dental appointment at ≤7 years old. Optimal childhood levels of vitamin D may be considered an additional preventive measure for dental caries in the permanent dentition.

Regular dental checkup and snack-soda drink consumption of preschool children are associated with early childhood caries in Korean caregiver/preschool children dyads

OBJECTIVES

Early childhood caries (ECC) is a common oral disease among young Korean children. The purpose of this study was to examine the relationship of ECC with preschool children's oral health behavior and caregivers' oral health in Ulsan, Korea.

METHODS

In 2006, cross-sectional survey of 1214 children under 6 years old and their care givers were surveyed. Two dentists examined according to the WHO criteria. Outcome variable was ECC, and explanatory variables were preschool children's oral health behavior and caregivers' oral health. The chi-square test and multiple log-binomial regression models were performed.

RESULTS

The prevalence of simple ECC was 47.5% and that of severe ECC was 34.8%. In bivariate analysis, ECC prevalence was increased according to children's age, caregiver's age, and type of housing. In multiple log-binomial regression models, preschool children's irregular oral checkup [prevalence ratio (PR): 1.7 for simple ECC and 1.8 for severe ECC] and frequent snack and soda drinking (PR: 1.2 for simple ECC, and 1.6 for severe ECC) were significant factors.

CONCLUSIONS

This study demonstrates that the prevalence of ECC was high among Korean children. Early intervention programs for preschool children's oral health behavior should be developed based on the risk factors identified in this study.

Caries experience of chinese children with cleft lip and palate

Objective : This study evaluated the caries experience in the primary teeth of children with and without cleft lip and palate (CLP). Design : Observational study. Setting : Dental hospital clinic. Patients : The sample consisted of 132 pairs of Chinese children with and without CLP matched by gender, age, ethnicity, and socioeconomic status. Their ages were between 2 and 7 years. Methods : The children were dichotomized into 2- to 4-year-old (n  =  71) and 5- to 7-year-old groups (n  =  61). The oral examination was performed by one trained and calibrated dentist, and the caries experience was determined using the dmft (decay missing filled teeth) index. Results : For the 2- to 4-year-old group, the dmft values were 1.5 for the cleft group and 1.6 for the non-CLP group, but the difference was not statistically significant. For the 5- to 7-year-old group, the dmft indices were 5.2 for the cleft group compared with 2.9 for the control group; this difference was statistically significant (p  =  .0006). The caries rate for the various tooth types in the 5- to 7-year-old group was higher in the CLP group than in the non-CLP group; the most marked difference was for the lateral incisors, mandibular molars, and maxillary left first molars (p  =  .0001). Conclusions : The 5- to 7-year-old children with CLP had a higher caries experience in the primary dentition than the children without CLP.

Building Caries Risk Assessment Models for Children

Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a “one-year caries increment”, screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. Abbreviations: decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).

Clinical, salivary, and bacterial markers for caries risk assessment in schoolchildren: a 4-year follow-up

BACKGROUND

In Mexico, there is a high prevalence of dental caries and large groups of children still show extensive untreated dental damage.

AIM

This study aims to evaluate, in a cohort of 6-year-old Mexican children, the relationship between caries increment at 4 years and the following caries risk markers: fissure morphology, caries experience, salivary flow rate, Snyder test results, and mutans and lactobacilli counts.

DESIGN

To predict new caries lesions in 110 schoolchildren, clinical, salivary, and bacteriological caries risk markers were used, including fissure morphology, caries experience, salivary flow rate, Snyder test, and Streptococcus mutans and lactobacilli counts. To determine the validity of these markers, the baseline data were compared with the caries increment after 4 years.

RESULTS

The risk model's capacity to predict caries was moderate (specificity 79.6% and sensitivity 78.6%). Caries experience (P = 0.0001), Snyder test (P = 0.002), and fissure morphology (P = 0.024) had the strongest association with caries increment. Salivary flow rate, lactobacilli, and S. mutans counts did not contribute significantly to the prediction of caries lesions in these children.

CONCLUSION

In addition to the initial caries experience, tooth morphology and Snyder test proved to be useful predictors for caries. These three risk markers may be particularly useful in targeting caries prevention efforts in developing countries.

Association between infant breastfeeding and early childhood caries in the United States

OBJECTIVE

Despite limited epidemiologic evidence, concern has been raised that breastfeeding and its duration may increase the risk of early childhood caries. The objective of this study was to assess the potential association of breastfeeding and other factors with the risk for early childhood caries among young children in the United States.

METHODS

Data about oral health, infant feeding, and other child and family characteristics among children 2 to 5 years of age (N = 1576) were extracted from the 1999-2002 National Health and Nutrition Examination Survey. The association of breastfeeding and its duration, as well as other factors that previous research has found associated with early childhood caries, was examined in bivariate analyses and by multivariable logistic and Poisson regression analyses.

RESULTS

After adjusting for potential confounders significant in bivariate analyses, breastfeeding and its duration were not associated with the risk for early childhood caries. Independent associations with increased risk for early childhood caries were older child age, poverty, being Mexican American, a dental visit within the last year, and maternal prenatal smoking. Poverty and being Mexican American also were independently associated with severe early childhood caries, whereas characteristics that were independently associated with greater decayed and filled surfaces on primary teeth surfaces were poverty, a dental visit within the last year, 5 years of age, and maternal smoking.

CONCLUSIONS

These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth. In contrast, they identify poverty, Mexican American ethnic status, and maternal smoking as independent risk factors for early childhood caries, which highlights the need to target poor and Mexican American children and those whose mothers smoke for early preventive dental visits.

Dental caries risk in the U.S. Air Force

BACKGROUND

This study describes the dental caries risk in the active duty U.S. Air Force population from October 2000 through September 2004.

METHODS

The authors used data collected from two Air Force databases (personnel and dental files) by cross-referencing Social Security numbers from both databases with date.

RESULTS

During the study period, the percentages of people at high and moderate risk of developing caries decreased by 31 percent and 12 percent, respectively, while the percentage of people at low risk of developing caries increased by 9 percent. Among Air Force members who were enrolled continuously during the study period, the percentages at high and moderate risk of developing caries decreased by 57 percent and 18 percent, respectively, while the percentage at low risk of developing caries increased by 14 percent. The authors observed improvement in caries risk in 83 percent and 73 percent of the people at high and moderate caries risk, respectively, for those continuously enrolled. High caries risk was related inversely to age, rank, education and years in service. Also, tobacco users had an elevated risk of developing caries.

CONCLUSIONS

The Air Force Dental Service has made great strides in improving the oral health of the Air Force population. The results of this study suggest that caries risk is decreasing in the Air Force population, but oral health disparities still exist and require further evaluation.

CLINICAL IMPLICATIONS

This investigation suggests that a caries risk assessment can be conducted successfully, and caries risk can be reduced by using a comprehensive population-based prevention program. This caries risk assessment also can identify factors associated with dental caries disparities in a large-scale population.

Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: anin vivocomparison

The aim of this clinical study was to compare the outcome of quantitative laser/light-induced fluorescence (QLF) and visual inspection (VI) for the detection of initial caries lesions on all maxillary and mandibular smooth surfaces in caries-risk adolescents. The subjects were 34 students, mean age 15 yr. A total of 879 buccal and 882 lingual surfaces were air-dried and visually examined at a magnification of x3.5. Fluorescence images of each smooth surface were captured with QLF\clin equipment, and QLF software 2.00 was used to display, store, and analyse the images. Fluorescence loss (deltaF; %) and area of the lesion (A; mm2), and fluorescence loss integrated over the lesion area (deltaQ; deltaF x A; % x mm2), were determined. The presence or absence of initial caries lesions was scored using both VI and QLF. A total of 87.2% of all smooth surfaces were scored as sound or initially carious when assessed by VI + QLF in combination: 4.9% were detected by VI alone and 7.9% by QLF alone. The parameters DeltaF, A, and DeltaQ differed significantly between lesions registered with VI + QLF and QLF alone. It was concluded that (i) QLF seems to be a sensitive method that is suitable for the detection of visually undetected initial caries lesions; and (ii) that the clinical use of QLF is limited by several confounding factors in caries-risk adolescents.

Concepts of risk in dental public health

The purpose of this paper is to review the concepts of risk as we use them today in dental public health practice, and to suggest that we should broaden our view of risk. Use of terms like risk factor in the literature can be quite vague, and it is recommended that a clear definition of that and related terms be adhered to. A broader view of risk in dental research would take in the concepts of social determinants of health and population health. While some progress has been made in our understanding of these issues, better knowledge would give the public health administrator more readily available information to use in program planning. The skewed distribution of caries in the high-income countries has led to the emergence of targeted prevention programs toward those considered to be at high risk. In public health programs, targeting at the individual level is not practical: the risk assessment methods are not yet sufficiently precise, and even when individuals are identified there are practical problems with schools and with the children themselves. (For private practice, however, high-risk child patients can be identified as those with at least one approximal lesion in permanent teeth.) For public health purposes, an argument is made for geographic targeting, i.e. identification of areas of social deprivation where whole schools or school districts can be targeted. Geographic targeting is something between individual targeting and whole-population approaches. Ideally, geographic targeting would supplement population measures like water fluoridation and dental health education. Examples of geographic targeting from Ohio and New York are presented as illustrations.

Validation of a Simple Approach to Caries Risk Assessment

OBJECTIVE

This study examined the predictive validity of a simple subjective method promoted to dentists for assessing their patients' caries risk.

METHODS

Data from two large group practices that have used guideline-assisted caries risk assessment (CRA) for several years were analyzed retrospectively to determine the receipt of caries-related treatment following a CRA. Patient age and receipt of caries preventive treatment subsequent to the CRA were control variables in logistic regressions to determine the likelihood of caries-related treatment for low, moderate, and high risk groups.

RESULTS

Among 45,693 individuals in the two plans, those categorized as being at high caries risk were approximately four times as likely to receive any caries-related treatment as those categorized as being at low caries risk. Those categorized as at moderate risk were approximately twice as likely to receive any treatment. In addition, for those at elevated risk who required any treatment, the number of teeth requiring treatment was larger.

CONCLUSION

The results of this study provide the first large-scale, generalizable evidence for the validity of dentists' subjective assessment of caries risk.

Trends in preventive care: caries risk assessment and indications for sealants

BACKGROUND

In the 21st century, risk assessment models will continue to be developed. By understanding patients' susceptibility to disease, better treatment and preventive regimens can be offered. As the causative agent of dental caries is bacterial, the interaction between the susceptible host, the causative agent and the environment determine whether caries occurs--regardless of the patient's age.

CLINICAL IMPLICATIONS

This article reviews risk assessment for dental caries and the implication for developing preventive strategies. It also describes the indications and uses of sealants in the prevention of dental caries.

Assessing caries risk in children

With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions.

Dental caries in African preschool children: social factors as disease markers

OBJECTIVE

This study investigated the associations between dental caries prevalence and severity and social factors in 3- to 5-year-old African children.

METHODS

Dental caries was diagnosed in natural light using WHO criteria, minors, and explorers. Socioeconomic information was obtained by questionnaire.

RESULTS

The percentages of 3-, 4-, and 5-year-olds with any caries experience were 47 percent, 58 percent, and 63 percent, respectively. Mean dmfs scores (SD) were 2.2(3.6), 3.0(3.8), and 3.7(4.1), respectively. Family education was associated with caries prevalence (P = .03) and severity (P = .008) in a multivariable regression model.

CONCLUSION

In the indigenous African group studied, family education is a disease marker to target in future caries risk evaluations.

Direct evidence concerning the 'major role' of fluoride dentifrices in the caries decline. A 6-year analytical cohort study

The role of fluoride (F) dentifrices in caries decline was investigated by assessing the effect of variation in their use on caries scores among teenagers. The material comprised 211 subjects aged about 11 years at base line and 18 years at the last examination. Pairs of posterior bitewing radiographs were assessed by one examiner. Information concerning dental health behavior was collected by questionnaire and about treatment received from dental records. A reversal of the traditional DFS gender difference occurred during teenage years. Multivariate regression analyses showed an inverse relationship between variation in F dentifrice use and current decay (D1S) at age 18 years (P < 0.04) and with caries incidence per year (D1FS) during the whole observation period (P < 0.02). Total explained variance in 6-year deltaD1FS scores was 29.8%, of which variation in toothbrushing behavior contributed 1.8 percentage points. While confirming the multifactorial nature of dental caries, these results also provided quantitative evidence for the role of variation in F dentifrice use in caries incidence and decline.

The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants

This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, "Preventing Pit and Fissure Caries: A Guide to Sealant Use," as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.

Role of models in assessing new agents for caries prevention--non-fluoride systems

While fluoride is an effective anti-caries agent, the search for more effective alternative therapies continues. A wide range of non-fluoride anti-caries agents has been postulated, and this paper reviews some of the pre-clinical models that have been utilized in their evaluation and some of the pitfalls that must be avoided. Using data on the potential anti-caries efficacy of phosphopeptides obtained from casein, the caution that must be applied in extrapolating laboratory data to predict clinical performance is discussed. Evaluation strategies that focus on only one potential mode of action (e.g., inhibition of demineralization) may overestimate the true clinical efficacy which may arise from a combination of two or more effects (e.g., inhibition of demineralization and stimulation of remineralization). Although laboratory and in situ data predict anti-caries efficacy for sodium trimetaphosphate in combination with fluoride, this was not found in three-year clinical trials. A possible reason for this, the lack of suitable calibration methods, is discussed. Finally, some comments on the appropriateness of laboratory evaluation strategies are made.

Oral health in adolescents from a small French town

In France, caries are more prevalent in rural areas than in large cities. This study analyzed the relationship between number of oral health indices and some known risk factors (toothbrushing, sugar consumption, saliva components) and sociodemographic factors in adolescents from a small town. The sample included 112 children aged 12-14 in the north-east of France. School marks was found to be better linked with dental caries indices than the socio-occupational category of parents: gingival index (GI), DMFS, DMFT and caries severity (CS) significantly increased with decreasing school marks; oral plaque was related to socio-occupational of parents. The analysis using the regression method showed that the variance explained by the various factors studied was modest (between 23 and 30%) for GI, initial caries sites (IS), DS, DMFS, DMFT and CS, and was small for plaque (5%) and calculus (3%). This would be due in part to the wide dispersion of these indices. The sex had a non-significant regression coefficient for all oral health indices investigated. For GI, only mutans streptococci (MS) and plaque had a significant regression coefficient. Calculus was explained by any factor considered. Only MS had a significant part in plaque. IS was explained by MS, toothbrushing and age. For DS, only toothbrushing, MS and sweet drinks during meals had a significant part. DMFS and DMFT were explained only by MS and age. CS was explained by MS, age, salivary buffer pH, salivary flow rate, and toothbrushing.

A comparison of dental caries experience in Native American and Caucasian children in Oklahoma

OBJECTIVES

In 1989 the Oklahoma Area Indian Health Service conducted an oral health survey of children attending public schools in Oklahoma to determine the extent of caries experience in the Native American population. Results were to be used to establish program priorities, gather baseline data, and compare the oral health status of Native American children with their non-Indian peers.

METHODS

A total of 934 elementary schoolchildren 5-6 years of age were examined along with 733 high school students 15-17 years of age. The study was designed so that approximately 50 percent of the students examined were Native American.

RESULTS

The mean dmfs for the 5-6-year-olds was 5.06 for the Caucasian children and 10.35 for the Native American children, a statistically significant difference (P < .001). For the 15-17-year-olds the mean DMFS for the Caucasian students (5.99) was significantly lower (P < .001) than the mean DMFS for the Native American students (10.12).

CONCLUSIONS

The prevalence and severity of caries in these Native American students appear to be substantially higher than in their non-Indian peers residing in the same communities. Further study is needed to identify factors contributing to these demonstrated differences in caries experience.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.

Caries risk assessment in a longitudinal discrimination study

Our objective was to develop and perfect a model for the assessment of risk of dental caries onset in children. Even though dental caries prevalence in children is continuing to decline, there is still a significant minority for whom it is a problem. In this study, we sought to ascertain whether a set of variables selected in a previous cross-sectional study could be used to differentiate between caries-free six-year-olds who would or would not subsequently present with clinically-detectable caries. A total of 472 caries-free six-year-olds--286 from a fluoridated community and 186 from a fluoride-deficient community--was selected. Clinical examinations for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutants streptococci, lactobacilli, total viable flora, and fluoride, calcium, and phosphate concentrations. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of linear discriminant analyses, it was possible to predict correctly which children would develop caries within six to 12 months (sensitivity) in 82.8% of cases and which children would not develop caries during that period (specificity) in 82.4% of cases.

Comparative effectiveness of visual/tactile and simplified screening examinations in caries risk assessment

Central to the development of a model for identifying children at high risk to caries is a clinical evaluation to assess dental status and other conditions potentially useful in caries prediction. Traditionally, this evaluation has been based on a relatively lengthy visual/tactile examination conducted by a dentist. Replacing the dentist examination with a dental auxiliary conducted screening evaluation could lead to reduced time and costs. The 4-yr University of North Carolina Caries Risk Assessment Study involved approximately 5000 schoolchildren initially in Grades 1 and 5 living near Aiken, South Carolina, and Portland, Maine. The effectiveness of caries prediction models using visual/tactile examination data were compared with the same models using simplified screening evaluation data. Results showed sensitivity ranged from 0.57 to 0.61 for the visual/tactile and screening models by site and grade cohort. Specificity for the models ranged from 0.80 to 0.83. None of these differences in sensitivity and specificity between visual/tactile (dentist) and screening (hygienist) models was statistically significant. Findings show that for the prediction of children at high risk to dental caries the clinical evaluation may be conducted with no reduction of precision by using dental hygienist performed screening evaluations rather than dentist conducted visual/tactile examinations. While no cost data were collected, these results imply that costs to future prediction programs could be reduced by using screening evaluations.

Prevalence of non-cavitated and cavitated carious lesions in a random sample of 7-9-year-old schoolchildren in Montreal, Quebec

This report describes the prevalence of non-cavitated and cavitated carious lesions in 911 randomly selected children in grades one through three on the Island of Montreal, Quebec, Canada. The criteria for diagnosis were developed for a longitudinal epidemiological study of restorative treatment decisions by dentists practising under a provincial dental insurance program for children. The intra- and inter-examiner reliability correlation coefficients of the two examiners were excellent (Kappa > or = 0.80). The most frequent carious lesion found in the examined children were non-cavitated carious lesions (incipient) within 1.5 of the gingival line on smooth tooth surfaces, and stained or non-cavitated carious lesions on pits and fissures. Out of 911 children in the study, 19.6% had sealants. Children whose parents completed a university education had a significantly lower prevalence of non-cavitated and cavitated carious lesions and fillings, and a significantly higher mean number of sealants than children whose parents had only primary school education. Education status of the parents was a significant risk marker of children with high caries experience and these children had a significantly higher mean number of non-cavitated carious lesions. This study has found that non-cavitated carious lesions are significantly more prevalent than cavitated carious lesions in children.

The University of North Carolina caries risk assessment study: caries increments of misclassified children

The University of North Carolina caries risk assessment was conducted between 1986 and 1989 with 5000 children initially in grades 1 and 5 from low fluoride sites in South Carolina and Maine. Clinical, microbiologic, behavioral, and demographic factors served as independent variables used in logistic multiple regression models to determine the predicted caries risk classification of each child. The 3-yr DMFS increment of each child was the dependent variable, and the 20-25% of those in each cohort with the highest increment were considered the high risk group. Sensitivity and specificity values averaged 0.60 and 0.83 respectively, indicating the misclassification of substantial numbers of children. This paper reports analysis of the DMFS increments of the misclassified children. The majority of children had DMFS increments within one or two surfaces of the classification cut points. Many false negative children had increments composed entirely of filled surfaces, often of minimal extent and without evidence of previous decay. Many false positive children had increments composed of decayed surfaces and would have benefitted from being identified as high risk and assigned to a preventive program. Other false positive children had sealants placed after the baseline examination that undoubtedly reduced their true increment. It is concluded that the consequences of misclassification are not serious for most children in this study.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.

The University of North Carolina Caries Risk Assessment study: further developments in caries risk prediction

Over 4000 first and fifth grade children from the areas surrounding Aiken, South Carolina, and Portland, Maine, participated in a 4-yr study to develop caries risk assessment models. The predictors used at baseline included detailed clinical examinations, salivary microbiological tests, and sociodemographic and dental behavior data. Mean 3-yr caries increments in South Carolina were twice those in Maine. For the four risk assessment models (two grade cohorts at two sites) specificity values averaged 0.83 and sensitivity values averaged 0.60. Clinical predictors such as prior DMFS, pit and fissure morphology, and predicted caries risk status were the major contributors to the models.