Caries Risk Assessment in School Children Using Reduced Cariogram Model

Predictive validity of the reduced Cariogram model for caries increment in non-cavitated and cavitated lesions: cohort study

BACKGROUND

The aim of this study is to assess the caries prediction of the reduced Cariogram by comparing baseline caries risk profiles with non-cavitated and cavitated lesions over periods of six, twelve, and 18 months.

METHODS

From May 2016 to October 2017, seven schools in Bhakkar, Pakistan, participated in a cohort study. First base line examination was conducted followed by examinations at 6, 12 and 18 months. Children intraoral examinations were performed on portable dental chair with in school premises by a trained examiner. A modified ICDAS index was used to measure caries at baseline and at follow-up examinations after 6, 12, and 18-months. A receiver operating curve (ROC) analysis was performed to evaluate its effectiveness for predicting dental caries increment.

RESULTS

About 40% of children had a low-risk status, 30.5% medium risk, and 29.7% high risk, at baseline risk assessment. At 18 months, 73% of high-risk children, 59% of medium-risk children, and 41% of low-risk children showed a caries increment. For the reduced Cariogram model, the area under the curve on the 6, 12 and 18 months follow-up was 0.63, 0.65 and 0.70 respectively.

CONCLUSIONS

Our findings indicates that a reduced Cariogram can predict the progression of caries in both cavitated and non-cavitated lesions and model exhibits a level of discriminatory ability. While it might not achieve a very high accuracy, it suggests that the model is able to predict caries increment effectively than random guessing.

Survival Rate of Atraumatic Restorative Treatment Restorations in Primary Posterior Teeth in Children with High Risk of Caries in the Republic of Kosovo-1-Year Follow-up

OBJECTIVE

 Atraumatic restorative treatment (ART) may be beneficial for disadvantaged populations with no or limited access to dental services. This study aimed to evaluate the survival rate of single-surface ART restorations in primary posterior teeth in children with high caries risk.

MATERIALS AND METHODS

 This study was conducted in six rural areas of the Republic of Kosovo, and 100 children aged 3 to 8 years participated in the study. Information was obtained from each parent/guardian regarding their children, such as sociodemographic characteristics, general health, dental history, dietary habits, oral hygiene, and fluoride exposure. The reduced Cariogram was used to estimate the risk of caries in the participants based on the seven factors specified in the program, and all the provided information were collected and entered in a computer program of the Cariogram. A pediatric dentist, accompanied by two assistants, performed 100 ART restorations in school settings using high-viscosity glass-ionomer cement (Fuji IX) following the nine steps of the ART procedure. The restorations were evaluated at 3, 6, 9, and 12 months using the ART restoration criteria.

STATISTICAL ANALYSIS

 Percentages, mean value, standard deviation, mean interquartile range, and difference test between arithmetic mean values were used to analyze the research results.

RESULTS

 Review of the average of reduced Cariogram showed that the majority of children, 72%, were at high risk of developing caries, with only 28% having a good chance of avoiding caries in the future. A total of 77% of the children in the study had never visited dentists before due to poor economic conditions and the lack of dentists in the area. The success rates of ART restorations performed in single-surface cavities in primary teeth were very encouraging, with more than 97% success rates after a 1-year follow-up period.

CONCLUSION

 Our results demonstrate that ART is efficient, affordable, and practical for the treatment of single-surface cavities in primary posterior teeth. Owing to its low price and atraumatic nature, ART can potentially help disadvantaged children in Kosovo access dental care.

Establishing risk-based recall interval for caries management among 11-12-year-old Pakistani children

Background

This study aims to investigate the rate of caries increment among 11-12-year-old Pakistani children over 18 months using modified International Caries Detection and Assessment Systems II (ICDAS) and subsequently establish an appropriate dental recall interval for our targeted population according to their caries risk intensity.

Methods

A prospective longitudinal study was conducted in Bhakkar, Punjab, Pakistan. The 226 children from seven schools of Bhakkar with the highest student enrolment were conveniently selected. Caries risk assessment was performed using a computer-based reduced Cariogram program. Caries increment among cavitated lesions was measured by modified Beck's method or adjusted caries increment. Two ICDAS II cutoffs were created for the analysis of cavitated lesion (ICDAS code 3–6) and cavitated plus non-cavitated lesion (ICDAS code A-6).

Results

At the risk assessment stage, 39.8% of the children were classified as low risk, 30.5% as medium risk, and 29.7% as high risk. Caries increment at both cutoff points increased with caries risk at all follow-ups. The highest caries increment was recorded at the third follow-up among high-risk children at cutoff 3–6 (1.95 ± 3.18) and A-6 (4.01 ± 4.31). However, the lowest caries increment was recorded at the third follow-up among low-risk children at cutoff 3–6 (0.18 ± 1.42) and A-6 (1.11 ± 3.33).

Conclusion

Based on the study findings for Pakistani children with cavitated lesions, the recommended risk-based recall interval for caries management is 18 months for those with low and medium caries risk and six months for those with high caries risk. On the other hand, recommendations for risk-based recall intervals for caries management in non-cavitated and cavitated lesions are six months for low-risk, moderate risk and high-risk for Pakistani 11-12-year-old children.

Caries risk profile of preschool children in the City of Niš

Introduction: Primary caries prevention from the earliest childhood has multiple significance. Its efficacy is largely conditioned by the knowledge of the caries risk profile of the subpopulation at risk, as an important prerequisite for developing effective strategies and measures for disease prevention and control. Aim: To assess the caries risk profile of preschool children in the City of Niš using a reduced computer Cariogram ® model. Material and methods: To realize the set objectives, a cross-sectional study was conducted, which included preschool children, aged 36-48 months, with permanent residence in the City of Niš since birth. The collection of data was done by interviewing mothers, and by the clinical examination of subjects. The caries risk profile of the subjects was performed using a reduced Cariogram ® model. Results: The study included 276 subjects of preschool age, mean age 41.28 ± 4.40 months. The highest percentage of subjects has a moderate caries risk, with an average of 50% chance of avoiding a new carious lesion in the future. In the assessed caries risk profile of children, the most vulnerable sectors are "susceptibility" (18%) and "bacteria" (14%), related to the use of fluoride by children of this age and their oral hygiene. The highest percentage of subjects belongs to the moderate caries risk group. Conclusion: According to the conducted study, insufficient exposure of teeth to fluoride and inadequate oral hygiene may be considered significant caries risk factors in preschool children, which should be considered when choosing measures and strategies for disease prevention and control. Also, it is necessary to reconsider the time of diagnostic examinations to reduce the prevalence of caries and its negative consequences at this age to a minimum.