Pulpal involvement-roots-sepsis index: a new method for describing the clinical consequences of untreated dental caries

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

INTRODUCTION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

Background

Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time.

Methods

In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate.

Discussion

The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.

Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01674-1.

Clinical Consequences of Dental Caries, Parents' Perception of Child's Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children

This cross-sectional study aimed to assess the occurrence of the consequences of dental caries and factors affecting dental service utilization in a population of 7-year-old children. The research included oral examination of 7-year-old schoolchildren and socio-medical study of their parents/legal caregivers. It was carried out in five primary schools of two provinces, i.e., Greater Poland and Lubusz. Dental examination was performed in accordance with World Health Organization (WHO) recommendations. The socio-medical study consisted of questionnaires with close-ended questions concerning socioeconomic characteristics of the family, reasons and time of the last visit at the dental office, consequences of child’s oral health problems, parents’ attitude towards dental visits, and parental opinion about their child’s teeth. Factors affecting utilization of dental services were statistically analyzed using univariate logistic regression assuming p < 0.05. The pufa index of examined children ranged from 0 to 7 (mean 0.80 ± 1.49), while the dmf index ranged from 0 to 14 (3.86 ± 3.32). Low financial burden of oral health expenditures and university education of at least one of the parents significantly increased the chance of visiting a dentist despite lack of pain (OR = 3.0 and 2.5, respectively). In spite of the availability of free dental care for children, socioeconomic factors still determine the utilization of dental services in Poland. Poor oral health status of examined population and negligence of regular dental check-ups emphasize a need to strengthen oral health literacy of parents and children, promoting proper attitudes towards dental care.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Evaluation of Pulpal Involvement, Ulceration, Fistula, and Abscess Index and Periapical Index in Screening for Endodontic Disease: Reliability and Accuracy

INTRODUCTION

The pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases.

METHODS

A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test.

RESULTS

A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05).

CONCLUSIONS

The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.

Toothbrushing behavior in children - an observational study of toothbrushing performance in 12 year olds

Background

Many countries offer systematic group prevention programs in kindergarten and school in order to promote children’s oral health. Little is known, however, about the actual toothbrushing abilities of children when group prevention programs end.

Methods

In Germany, all children take advantage from a nationwide group prevention program (called “Gruppenprophylaxe”) lasting from kindergarten up to sixth grade (12 years of age). Standardized recommendations are given concerning brushing systematics and brushing movements. N = 174 children at the age of 12 were thus randomly selected from two German towns and were asked to perform toothbrushing to the best of their abilities in front of a mirror which also served as a camera. Brushing behavior was analyzed by video analysis.

Results

Children brushed their teeth for an average of 200 s ± 80.48 s (mean ± SD). Still, more than 55% missed at least one sextant when brushing inner surfaces, 16% missed them all. Only 7.5% of the children brushed both inner and outer surfaces by the intended movements (vertical movements on the inner surfaces and circular movements on the outer surfaces) for at least 90% of the respective brushing time. Instead, horizontal brushing was very common on the lateral surfaces.

Conclusions

The present analysis indicates that children have low efficiency to adopt the tooth-brushing recommendations given in prevention programs. This is surprising as great endeavors are made to help children internalize the recommendations. Future research is needed to better understand which factors impede adoption of toothbrushing recommendations in children and which efforts are necessary to improve their toothbrushing abilities.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0755-z) contains supplementary material, which is available to authorized users.

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

Background:

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

Methods:

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

Results:

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

Conclusion:

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

Impact of untreated dental caries and its clinical consequences on the oral health-related quality of life of schoolchildren aged 8-10 years

OBJECTIVE

This study aims to evaluate the impact of untreated dental caries and its clinical consequences on the quality of life of Brazilian schoolchildren aged 8-10 years.

METHODS

A randomly selected sample of 587 children underwent a clinical oral examination for the assessment of untreated dental caries and clinical consequences. The WHO criteria (decayed component of the decayed, missing, and filled teeth--D-DMFT in permanent teeth or d-dfmt in primary teeth) and the PUFA index, which records the presence of severely decayed permanent (upper case) and primary (lower case) teeth with visible pulpal involvement (P/p), as well as ulceration caused by dislocated tooth fragments (U/u), fistula (F/f), and abscesses (A/a), were used for the oral examination. Oral health-related quality of life (OHRQoL) was evaluated using the Child's Perception Questionnaire (CPQ8-10). Poisson regression was employed to test unadjusted and adjusted associations between untreated dental caries/clinical consequences and OHRQoL.

RESULTS

The prevalence of untreated dental caries was 64.6% (D/d component of DMFT/dmft > 0) and 17.9% of children exhibited clinical consequences of caries (PUFA/pufa index >0). In the adjusted models, untreated caries was significantly associated with the total CPQ8-10 score and all subscale scores. The clinical consequences of dental caries (PUFA/pufa index >0) were significantly associated with the total CPQ8-10 as well as the oral symptoms and functional limitations' subscales.

CONCLUSION

Untreated dental caries and its clinical consequences exerted a negative impact on the OHRQoL of the schoolchildren analyzed.

Clinical Consequences of Untreated Dental Caries Evaluated with the Pulpal Involvement-Roots-Sepsis Index in the Primary Dentition of School Children from the Raipur and Durg Districts, Chhattisgarh State, India

Objective: To evaluate the prevalence of the clinical consequences of untreated dental caries in primary dentition among 6- to 8-year-old children using the prs [pulpal involvement (p), roots (r) and sepsis (s)] index and record the distribution of prs among boys and girls. Subjects and Methods: The study included a sample of 371 children aged 6-8 years with at least one carious primary molar tooth, who had been randomly selected from schools in the districts of Raipur and Durg, Chhattisgarh State, India. We recorded the presence of decayed, extracted and filled (i.e. def) teeth. The prevalence of the consequences of untreated dental caries was evaluated using the prs index. The data were statistically analyzed to express the prevalence of prs among boys and girls and the distribution of individual prs codes in the sample population. Results: The prevalence of carious lesions was very high (87%) and teeth with clinical consequences of untreated dental caries were found in 49.3% of the children. The prs distribution in children who were 8 years old (40.9%) was higher than in the 6-year-old children (25.6%). In the group of 8-year-olds, the occurrence of prs was greater among the boys whereas in the 6- and 7-year-old group, it was greater among the girls. Conclusion: The prs index is a valuable tool for measuring the clinical consequences of untreated dental caries. It could be useful for epidemiological studies and provide relevant information regarding treatment needs. © 2014 S. Karger AG, Basel.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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