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Khan SY, Schroth RJ, Cruz de Jesus V, Lee VHK, Rothney J, Dong CS, Javed F, Yerex K, Bertone M, El Azrak M, Menon A. A systematic review of caries risk in children <6 years of age. Int J Paediatr Dent 2024; 34:410-431. [PMID: 38071403 DOI: 10.1111/ipd.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 06/14/2024]
Abstract
BACKGROUND For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION This study provides updated evidence of risk factors for ECC that could be included in CRA tools.
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Affiliation(s)
- Saima Yunus Khan
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Inc., Winnipeg, Manitoba, Canada
| | - Vivianne Cruz de Jesus
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Victor H K Lee
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia S Dong
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Faraha Javed
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Katherine Yerex
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Bertone
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed El Azrak
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anil Menon
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Dey P, Ogwo C, Tellez M. Comparison of traditional regression modeling vs. AI modeling for the prediction of dental caries: a secondary data analysis. FRONTIERS IN ORAL HEALTH 2024; 5:1322733. [PMID: 38854398 PMCID: PMC11156996 DOI: 10.3389/froh.2024.1322733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction There are substantial gaps in our understanding of dental caries in primary and permanent dentition and various predictors using newer modeling methods such as Machine Learning (ML) algorithms and Artificial Intelligence (AI). The objective of this study is to compare the accuracy, precision, and differences between the caries predictive capability of AI vs. traditional multivariable regression techniques. Methods The study was conducted using secondary data stored in the Temple University Kornberg School of Dentistry electronic health records system (axiUm) of pediatric patients aged 6-16 years who were patients on record at the Pediatric Dentistry Clinic. The outcome variables considered in the study were the decayed-missing-filled teeth (DMFT) and the decayed-extracted-filled teeth (deft) scores. The predictors included age, sex, insurance, fluoride exposure, having a dental home, consumption of sugary meals, family caries experience, having special needs, visible plaque, medications reducing salivary flow, and overall assessment questions. Results The average DMFT score was 0.85 ± 2.15, while the average deft scores were 0.81 ± 2.15. For childhood dental caries, XGBoost was the best performing ML algorithm with accuracy, sensitivity. and Kappa as 81%, 84%, and 61%, respectively, followed by Support Vector Machine and Lasso Regression algorithms, both with 84% specificity. The most important variables for prediction found were age and visible plaque. Conclusions The machine learning model outperformed the traditional statistical model in the prediction of childhood dental caries. Data from a more diverse population will help improve the quality of caries prediction for permanent dentition where the traditional statistical method outperformed the machine learning model.
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Affiliation(s)
- Priya Dey
- Maurice H Kornberg School of Dentistry, Oral Health Sciences, Temple University, Philadelphia, PA, United States
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3
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Schroth RJ, Kyoon-Achan G, Levesque J, Sturym M, DeMaré D, Mittermuller BA, Lee J, Lee VHK. A mixed methods approach to obtaining health care provider feedback for the development of a Canadian pediatric dental caries risk assessment tool for children <6 years. FRONTIERS IN ORAL HEALTH 2023; 4:1074621. [PMID: 37065421 PMCID: PMC10090371 DOI: 10.3389/froh.2023.1074621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionEarly childhood caries (ECC) is a chronic but preventable disease affecting young children worldwide. Many young children face access to care barriers to early preventive dental visits for a variety of reasons, which can increase their risk for ECC. Non-dental primary health care providers are well positioned to assist in assessing a child's risk for ECC by performing caries risk assessment (CRA). The purpose of this project was to report on primary health care provider and stakeholder feedback in order to refine a drafted CRA tool for Canadian children <6 years of age intended for use by non-dental primary health care providers.MethodsIn this mixed methods project, we conducted six focus groups with primarily non-dental primary health care providers followed by a short paper-based survey to quantify preferences and feedback. Data were thematically and descriptively analyzed.ResultsParticipants’ feedback on the drafted CRA tool included the need for it to be relatively quick to complete, easy and practical to score, easy to implement into practitioners’ clinic schedules, and to include anticipatory guidance information to share with parents and caregivers. All participants (100%) welcomed a CRA tool. Many (85.4%) liked a layout that could be added to tools they already utilize. Most (73.2%) wanted the tool to be in colour, and many (90.2%) wanted the tool to include pictures.ConclusionNon-dental primary health care providers informed the final development and layout of the newly released Canadian CRA tool. Their feedback resulted in a user-friendly CRA tool with provider-patient dynamics and preferences.
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Affiliation(s)
- Robert J. Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Shared Health Inc., Winnipeg, MB, Canada
- Correspondence: Robert J. Schroth
| | - Grace Kyoon-Achan
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Josh Levesque
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Melina Sturym
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Daniella DeMaré
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Betty-Anne Mittermuller
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Juyoung Lee
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Victor Ho Kong Lee
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Pithpornchaiyakul S, Naorungroj S, Pupong K, Hunsrisakhun J. Using Chatbot as an Alternative Approach for In-Person Tooth Brushing Training During the COVID-19 Pandemic. J Med Internet Res 2022; 24:e39218. [PMID: 36179147 PMCID: PMC9591704 DOI: 10.2196/39218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background It is recommended that caregivers receive oral health education and in-person training to improve toothbrushing for young children. To strengthen oral health education before COVID-19, the 21-Day FunDee chatbot with in-person toothbrushing training for caregivers was used. During the pandemic, practical experience was difficult to implement. Therefore, the 30-Day FunDee chatbot was created to extend the coverage of chatbots from 21 days to 30 days by incorporating more videos on toothbrushing demonstrations and dialogue. This was a secondary data comparison of 2 chatbots in similar rural areas of Pattani province: Maikan district (Study I) and Maelan district (Study II). Objective This study aimed to evaluate the effectiveness and usability of 2 chatbots, 21-Day FunDee (Study I) and 30-Day FunDee (Study II), based on the protection motivation theory (PMT). This study explored the feasibility of using the 30-Day FunDee chatbot to increase toothbrushing behaviors for caregivers in oral hygiene care for children aged 6 months to 36 months without in-person training during the COVID-19 pandemic. Methods A pre-post design was used in both studies. The effectiveness was evaluated among caregivers in terms of oral hygiene practices, knowledge, and oral health care perceptions based on PMT. In Study I, participants received in-person training and a 21-day chatbot course during October 2018 to February 2019. In Study II, participants received only daily chatbot programming for 30 days during December 2021 to February 2022. Data were gathered at baseline of each study and at 30 days and 60 days after the start of Study I and Study II, respectively. After completing their interventions, the chatbot's usability was assessed using open-ended questions. Study I evaluated the plaque score, whereas Study II included an in-depth interview. The 2 studies were compared to determine the feasibility of using the 30-Day FunDee chatbot as an alternative to in-person training. Results There were 71 pairs of participants: 37 in Study I and 34 in Study II. Both chatbots significantly improved overall knowledge (Study I: P<.001; Study II: P=.001), overall oral health care perceptions based on PMT (Study I: P<.001; Study II: P<.001), and toothbrushing for children by caregivers (Study I: P=.02; Study II: P=.04). Only Study I had statistically significant differences in toothbrushing at least twice a day (P=.002) and perceived vulnerability (P=.003). The highest overall chatbot satisfaction was 9.2 (SD 0.9) in Study I and 8.6 (SD 1.2) in Study II. In Study I, plaque levels differed significantly (P<.001). Conclusions This was the first study using a chatbot in oral health education. We established the effectiveness and usability of 2 chatbot programs for promoting oral hygiene care of young children by caregivers. The 30-Day FunDee chatbot showed the possibility of improving toothbrushing skills without requiring in-person training. Trial Registration Thai Clinical Trials Registry TCTR20191223005; http://www.thaiclinicaltrials.org/show/TCTR20191223005 and TCTR20210927004; https://www.thaiclinicaltrials.org/show/TCTR20210927004
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Affiliation(s)
- Samerchit Pithpornchaiyakul
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Prince of Songkla University, Hatyai, Songkhla, TH.,Improvement of Oral Health Care Research Unit, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, TH
| | - Supawadee Naorungroj
- Department of Conservative Dentistry, Faculty of Dentistry, Prince of Songkla University,, Hatyai, Songkhla, TH
| | | | - Jaranya Hunsrisakhun
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Prince of Songkla University, Hatyai, Songkhla, TH.,Improvement of Oral Health Care Research Unit, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, TH
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5
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Featherstone JDB, Crystal YO, Alston P, Chaffee BW, Doméjean S, Rechmann P, Zhan L, Ramos-Gomez F. Evidence-Based Caries Management for All Ages-Practical Guidelines. FRONTIERS IN ORAL HEALTH 2022; 2:657518. [PMID: 35048005 PMCID: PMC8757692 DOI: 10.3389/froh.2021.657518] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0–6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level. Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0–6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals. Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.
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Affiliation(s)
- John D B Featherstone
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Yasmi O Crystal
- Pediatric Dentistry Department, College of Dentistry, New York University, New York, NY, United States.,Comprehensive Pediatric Dentistry, Bound Brook, NJ, United States
| | - Pamela Alston
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Sophie Doméjean
- Department of Operative Dentistry and Endodontics, UFR d'Odontologie de Clermont-Ferrand, Clermont-Ferrand, France.,EA 4847, Clermont-Ferrand, France.,Université Clermont Auvergne, Clermont-Ferrand, France.,Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Ling Zhan
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Francisco Ramos-Gomez
- Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
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6
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Agouropoulos A, Birpou E, Twetman S, Kavvadia K. Caries risk assessment with the 'Bangkok checklist' in preschool children: A prospective cohort study. Int J Paediatr Dent 2022; 32:82-89. [PMID: 33768727 DOI: 10.1111/ipd.12794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/07/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caries risk assessment in preschool children is poorly validated in prospective studies. AIM To validate the Bangkok checklist (BCL) in predicting caries development in a cohort of preschool children from low and moderate socioeconomic areas and compare it with two established risk assessment tools. DESIGN We followed 146 preschool children, aged 2-5 years for 2 years. At baseline, the caries risk category (low, moderate, high) was determined with three checklists: (a) BCL, (b) American Academy of Pediatric Dentistry form (CRAF), and (c) Caries Management By Risk Assessment (CAMBRA). Data were collected from questionnaires and clinical examinations. Caries increment was recorded by counting the number of surfaces that changed from sound to decayed. We used Kendall's tau, Poisson regression models and ROC analysis to assess the predictive ability of the different checklists. RESULTS Over 50% of the children developed new caries on a yearly basis. The BCL assigned the majority of the children (87%) into the high-risk category. Sensitivity was 88% but specificity was low (16%). Accuracy of BCL was similar to CRAF but inferior to CAMBRA. CONCLUSIONS Bangkok checklist had a very limited performance in accurately predicting future early childhood caries in this population.
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Affiliation(s)
- Andreas Agouropoulos
- Department of Paediatric Dentistry, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Birpou
- Department of Paediatric Dentistry, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katerina Kavvadia
- Division of Paediatric Dentistry, University of Louisville School of Dentistry, Louisville, KY, USA
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Schroth RJ, Rothney J, Sturym M, Dabiri D, Dabiri D, Dong CC, Grant CG, Kennedy T, Sihra R. A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers. Int J Paediatr Dent 2021; 31:767-791. [PMID: 33497015 DOI: 10.1111/ipd.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries. AIM To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings. DESIGN Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE. RESULTS Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance. CONCLUSIONS This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.
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Affiliation(s)
- Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melina Sturym
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Darya Dabiri
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Donya Dabiri
- University of Toledo Medical Center, University of Toledo, Toledo, OH, USA
| | - Cecilia C Dong
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cameron G Grant
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tara Kennedy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Rena Sihra
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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8
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A methodological study to assess the measurement properties (reliability and validity) of a caries risk assessment tool for young children. J Dent 2020; 95:103324. [DOI: 10.1016/j.jdent.2020.103324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
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9
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Inquimbert C, Bourgeois D, Giraudeau N, Tramini P, Viennot S, Dussart C, Carrouel F. Microbiota of interdental space of adolescents according to Risk of Caries: A cross-sectional study protocol. Contemp Clin Trials Commun 2019; 16:100444. [PMID: 31709310 PMCID: PMC6833308 DOI: 10.1016/j.conctc.2019.100444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/21/2019] [Accepted: 08/21/2019] [Indexed: 11/21/2022] Open
Abstract
Dental caries is a major oral disease resulting from a complex interaction between the commensal microbiota, host susceptibility (heredity, immunity, diseases, etc.) and environmental factors (diet, dental hygiene, etc.). To predict the patient's risk of new carious lesions or progression of existing lesions, the Caries Risk Assessment (CRA) takes account of clinical, biological and behavioural factors. Thus, the CRA can predict whether the patient is at high or low risk of developing caries. The practitioner can thus set up a follow-up adapted to the risk of the patient. However, although bacteria are the main etiological factor of carious lesions, the CRA does not consider bacterial quantification or just focus on the level of S. mutans in the saliva. As the majority of cavities are interproximal in adolescence, the aim of this trial is to identify and quantify the interdental microbiota of adolescents aged from 15 to 17 years with low or high carious risk. So, the quantification of new biomarkers associated with carious lesion could be added to the CRA to improve it.
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Affiliation(s)
- Camille Inquimbert
- Systemic Healthcare Laboratory EA4129, Faculty of Medicine Laennec, University Lyon 1, University of Lyon, Lyon, France
- Department of Public Health, Faculty of Oral Medicine, University of Montpellier, Montpellier, France
| | - Denis Bourgeois
- Systemic Healthcare Laboratory EA4129, Faculty of Medicine Laennec, University Lyon 1, University of Lyon, Lyon, France
| | - Nicolas Giraudeau
- Department of Public Health, Faculty of Oral Medicine, University of Montpellier, Montpellier, France
| | - Paul Tramini
- Department of Public Health, Faculty of Oral Medicine, University of Montpellier, Montpellier, France
| | - Stéphane Viennot
- Systemic Healthcare Laboratory EA4129, Faculty of Medicine Laennec, University Lyon 1, University of Lyon, Lyon, France
| | - Claude Dussart
- Systemic Healthcare Laboratory EA4129, Faculty of Medicine Laennec, University Lyon 1, University of Lyon, Lyon, France
| | - Florence Carrouel
- Systemic Healthcare Laboratory EA4129, Faculty of Medicine Laennec, University Lyon 1, University of Lyon, Lyon, France
- Department of Fundamental and Clinical Biological Sciences, Faculty of Oral Medicine, University Lyon 1, University of Lyon, Lyon, France
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10
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Ghazal TS, Childers NK, Levy SM. Models to Predict Future Permanent Tooth Caries Incidence in Children Using Primary Teeth Caries Experience. Pediatr Dent 2019; 41:472-476. [PMID: 31882034 PMCID: PMC6936327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: To assess permanent tooth caries incidence (ΔDMFS) among a cohort of African American children using the presence of any caries experience(decayed, missing, and filled surfaces-dmfs) in primary teeth and the presence of untreated primary tooth caries (ds) in two separate models. Methods: Data from a prospective study was used to apply two models with different clinical for predicting DMFS from ages six through 12 years. The first model used dmfs, and the second model used ds as predictors (both at age six years). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed. Results: The first model resulted in sensitivity from 81.8 percent to 100 percent, specificity from 35.6 percent to 42.6, PPV from 5.8 percent to 38.1 percent, and NPV from 90.0 percent to 100 percent. In the second model, the predictive values were from 33.3 percent to 55.6 percent, 62.7 percent to 72.7 percent, 3.4 percent to 45.5 percent, and 80 percent to 95.9 percent, respectively. Conclusions: The proposed models for permanent tooth caries incidence prediction are easy, not time consuming, and clinically applicable; if validated, they have the potential to change the current paradigm for caries risk assessment.
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Affiliation(s)
- Tariq S Ghazal
- Dr. Ghazal is a pediatric dentist in private practice at the Rodeo Dental and Orthodontics, McAllen, Texas, USA;,
| | - Noel K Childers
- Dr. Childers is an adjunct professor, Department of Pediatric Dentistry, School of Dentistry, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Steven M Levy
- Dr. Levy is a professor, Department of Preventive and Community Dentistry, College of Dentistry, and Dr. Levy is a professor, Department of Epidemiology, College of Public Health, both at the University of Iowa, Iowa City, USA
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11
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Inquimbert C, Bourgeois D, Bravo M, Viennot S, Tramini P, Llodra JC, Molinari N, Dussart C, Giraudeau N, Carrouel F. The Oral Bacterial Microbiome of Interdental Surfaces in Adolescents According to Carious Risk. Microorganisms 2019; 7:E319. [PMID: 31491909 PMCID: PMC6780098 DOI: 10.3390/microorganisms7090319] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022] Open
Abstract
Adolescence is closely associated with a high risk of caries. The identification of specific bacteria in an oral microniche, the interdental space of the molars, according to carious risk can facilitate the prediction of future caries and the anticipation of the progression or stabilization of caries in adolescents. A cross-sectional clinical study according to the bacteriological criteria of interdental healthy adolescents and carious risk factors-low and high-using a real-time polymerase chain reaction technique was conducted. The presence of 26 oral pathogens from the interdental microbiota of 50 adolescents aged 15 to 17 years were qualitatively and quantitatively analyzed. Bacteria known to be cariogenic (Bifidobacterium dentium, Lactobacillus spp., Rothia dentocariosa, Streptococcus cristatus, Streptococcus mutans, Streptococcus salivarius, Streptococcus sobrinus, and Streptococcus wiggsiae) did not present differences in abundance according to carious risk. Periodontal bacteria from the red complex are positively correlated with carious risk. However, only 3 bacteria-S. sobrinus, E corrodens and T. forsythia-presented a significant increase in the highest group. Estimating the risk of caries associated with bacterial factors in interdental sites of molars in adolescents contributes to the better definition of carious risk status, periodicity and intensity of diagnostic, prevention and restorative services.
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Affiliation(s)
- Camille Inquimbert
- Laboratory "Systemic Health Care", EA4129, University Lyon 1, University of Lyon, 69008 Lyon, France.
- Department of Public Health, Faculty of Dental Medicine, University of Montpellier, 34090 Montpellier, France.
| | - Denis Bourgeois
- Laboratory "Systemic Health Care", EA4129, University Lyon 1, University of Lyon, 69008 Lyon, France.
| | - Manuel Bravo
- Department of Preventive and Community Dentistry, Faculty of Odontology, University of Granada, 18010 Granada, Spain.
| | - Stéphane Viennot
- Laboratory "Systemic Health Care", EA4129, University Lyon 1, University of Lyon, 69008 Lyon, France.
| | - Paul Tramini
- Department of Public Health, Faculty of Dental Medicine, University of Montpellier, 34090 Montpellier, France.
| | - Juan Carlos Llodra
- Department of Preventive and Community Dentistry, Faculty of Odontology, University of Granada, 18010 Granada, Spain.
| | - Nicolas Molinari
- Service DIM, CHU de Montpellier, UMR 5149 IMAG, University of Montpellier, 34090 Montpellier, France.
| | - Claude Dussart
- Laboratory "Systemic Health Care", EA4129, University Lyon 1, University of Lyon, 69008 Lyon, France.
| | - Nicolas Giraudeau
- Department of Public Health, Faculty of Dental Medicine, University of Montpellier, 34090 Montpellier, France.
| | - Florence Carrouel
- Laboratory "Systemic Health Care", EA4129, University Lyon 1, University of Lyon, 69008 Lyon, France.
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12
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Gómez Clavel JF, Vences DT, Valdiviezo AC, Peña Castillo E, García Muñoz A, Trejo Iriarte CG. Correlation between caries history and laser fluorescence of sound tooth enamel in restored and unrestored dentition. J Oral Sci 2019; 61:441-446. [PMID: 31353335 DOI: 10.2334/josnusd.18-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The aim of this study was to determine the correlation between laser fluorescence (LF) values of apparently sound tooth enamel and caries history. LF measurements were recorded from six sound enamel tooth surfaces in each of 346 subjects aged 8-25 years. Caries experience was evaluated using the decayed, missing, and filled tooth (DMFT) index and the International Caries Detection and Assessment System (ICDAS). To measure differences between the unrestored and restored tooth groups, an unpaired two-sample t-test was used. To assess the relationship between LF of sound enamel and caries experience based on the DMFT and ICDAS, Pearson's correlation coefficient and linear regression analyses were used. The LF values of sound dental enamel in subjects with no history of invasive dental treatment were highly correlated with caries experience, as measured by the DMFT index (R = 0.76) and ICDAS (R = 0.7). The LF values of sound enamel in subjects with a history of previous invasive dental treatment were weakly correlated with caries experience, as measured by the DMFT index (R = 0.33), and moderately correlated with the ICDAS values (R = 0.66). The LF value of clinically healthy tooth enamel correlates with caries status based on the DMFT or ICDAS.
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Affiliation(s)
- José F Gómez Clavel
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
| | - Diana T Vences
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
| | - Allison C Valdiviezo
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
| | - Eric Peña Castillo
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
| | - Alejandro García Muñoz
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
| | - Cynthia G Trejo Iriarte
- Laboratory of Research in Education and Dentistry, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico
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13
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Abstract
A system for Caries Management by Risk Assessment (CAMBRA®) has been developed in California. The purpose of this article is to summarize the science behind the methodology, the history of the development of CAMBRA, and the outcomes of clinical application. The CAMBRA caries risk assessment (CRA) tool for ages 6 y through adult has been used at the University of California, San Francisco (UCSF), for 14 y, and outcome studies involving thousands of patients have been conducted. Three outcomes assessments, each on different patient cohorts, demonstrated a clear relationship between CAMBRA-CRA risk levels of low, moderate, high, and extreme with cavitation or lesions into dentin (by radiograph) at follow-up. This validated risk prediction tool has been updated with time and is now routinely used at UCSF and in other settings worldwide as part of normal clinical practice. The CAMBRA-CRA tool for 0- to 5-y-olds has demonstrated similar predictive validity and is in routine use. The addition of chemical therapy (antibacterial plus fluoride) to the traditional restorative treatment plan, based on caries risk status, has been shown to reduce the caries increment by about 20% to 38% in high-caries-risk adult patients. The chemical therapy used for high-risk patients is a combination of daily antibacterial therapy (0.12% w/v chlorhexidine gluconate mouth rinse) and twice-daily high-concentration fluoride toothpaste (5,000 ppm F), both for home use. These outcomes assessments provide the evidence to use these CRA tools with confidence. Caries can be managed by adding chemical therapy, based on the assessed caries risk level, coupled with necessary restorative procedures. For high- and extreme-risk patients, a combination of antibacterial and fluoride therapy is necessary. The fluoride therapy must be supplemented by antibacterial therapy to reduce the bacterial challenge, modify the biofilm, and provide prevention rather than continued caries progression.
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Affiliation(s)
- J D B Featherstone
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - B W Chaffee
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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14
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Abstract
Dental caries is a disease that results from microbiome dysbiosis with the involvement of multiple cariogenic species, including mutans streptococci (MS), lactobacilli, Scardovia wiggsiae, and several Actinomyces species that have the cariogenic traits of acid production and acid tolerance. Sugar consumption also plays an important role interacting with microbiome dysbiosis, determining the fate of caries development. In addition, the MS transmission that encompasses multiple sources can have long-term impacts on the oral microbiome and caries development in children. Intervention in MS transmission in early childhood may promote effective long-term caries prevention. Anticaries regimens aimed against the above mechanisms will be important for successful caries management. Xylitol and erythritol may serve as good components of anticaries regimens as oral microbiome modifiers, sugar substitutes, and agents to prevent MS transmission in early childhood with both oral and systemic benefits. Further studies are needed to elucidate the mechanism of the anticaries effects of xylitol and erythritol with consideration of their impacts on the microbiome and bacterial virulence, in addition to cariogenic bacteria levels as well as their benefits for overall health. On the other hand, the anticaries agent C16G2, specifically targeting Streptococcus mutans, the most common cariogenic bacterial species, has shown good safety for short-term oral topical use and promising effects in reducing S. mutans in vitro and in vivo with the promotion of oral commensal bacteria. Future study on its anticaries effect will need to include its long-term impact on the oral microbiome and effects on other important cariogenic bacteria.
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Affiliation(s)
- L Zhan
- 1 Division of Pediatric Dentistry, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
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15
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Christian B, Armstrong R, Calache H, Carpenter L, Gibbs L, Gussy M. A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children. Int J Paediatr Dent 2018; 29:106-116. [PMID: 30412330 DOI: 10.1111/ipd.12446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear. AIM This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. DESIGN MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment. RESULTS The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. CONCLUSIONS The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bradley Christian
- Jack Brockhoff Child Health and Wellbeing Program, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
- Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Australia
| | - Rebecca Armstrong
- Jack Brockhoff Child Health and Wellbeing Program, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Hanny Calache
- Deakin Health Economics, Centre for Population Health Research, Deakin University
| | - Lauren Carpenter
- Jack Brockhoff Child Health and Wellbeing Program, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Lisa Gibbs
- Jack Brockhoff Child Health and Wellbeing Program, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Mark Gussy
- Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Australia
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16
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Abstract
Early childhood caries (ECC) is a common childhood disease with highest prevalence found in poor, socially disadvantaged, and minority groups. The main risk factors for ECC are frequent sugar consumption, lack of tooth brushing, and enamel hypoplasia. Contributory factors include environmental and psychosocial stresses that modify caregiver behaviors. Strategies for prevention include preventing mutans streptococci transmission, restricting dietary sugars, tooth brushing, topical fluoride applications, and early dental examinations. This article provides an overview of ECC based on current understanding of its cause, prevention, and management.
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Affiliation(s)
- Wan Kim Seow
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, Queensland 4006, Australia.
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17
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Chaffee BW, Featherstone JDB, Zhan L. Pediatric Caries Risk Assessment as a Predictor of Caries Outcomes. Pediatr Dent 2017; 39:219-232. [PMID: 28583247 PMCID: PMC5463572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To determine cumulative dental treatment experience in a retrospective clinical cohort, according to baseline caries risk assessment (CRA) information. METHODS Evaluated were electronic records from a university pediatric dental clinic (2009 to 2014) of new, six- to 72- month-old patients who were not treated under sedation or general anesthesia (N equals 750). The mean number of teeth restored or extracted (two-year total and omitting the first 190 days post-baseline to discount initial treatment needs) was compared by baseline CRA category and CRA items (caries risk indicators, protective items, and clinical disease indicators). RESULTS The CRA category was associated with mean treated teeth over two years (low equals 0.53, moderate equals 1.02, high/extreme equals 4.47) and post 190 days (low equals 0.51, moderate equals 0.89, high/extreme equals 2.11). Any treatment probability was greatest for high/extreme-risk children but not statistically significantly different between low- and moderate-risk. Age-standardized means were greater for all individual baseline clinical indicators and most risk indicators, but lower for most protective items (not statistically significantly for all items). Clinical indicators were the strongest outcome correlates. CONCLUSIONS In this population, baseline risk information was associated with clinical outcomes. CRA can help identify patients needing more intensive caries prevention.
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Affiliation(s)
- Benjamin W Chaffee
- Assistant professor, Department of Preventive and Restorative Dental Sciences, at University of California San Francisco, San Francisco, Calif., USA;,
| | - John D B Featherstone
- Professor and Dean, at University of California San Francisco, San Francisco, Calif., USA
| | - Ling Zhan
- Associate professor, Department of Orofacial Sciences, at University of California San Francisco, San Francisco, Calif., USA
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