Fluoride Use in Health Care Settings: Association with Children's Caries Risk.

Objective:To assess the caries risk profiles in 2- to 6-year-old Greek children using a computer-based program and to evaluate the contribution of various risk factors.Methods:The study group consisted of 814 preschool children. A questionnaire on family, demographic and socioeconomic factors, general health, oral hygiene and dietary behavior was completed by the parents. Children were examined for cavitated and white-spot lesions (WSL). Salivary mutans streptococci (MS) and buffer capacity were estimated. Caries risk profiles were assessed with Cariogram.Results:Cavitated lesions were found in 30% of the children; WSL were found in 26% of those included. MS and low buffer capacity were detected in 28% and 26% of the children, respectively. The majority (70%) displayed neglected oral hygiene. Based on the questionnaires, 83% of the children had a cariogenic diet, and 17% did not use any form of fluoride. The Cariogram revealed that 26% of the children had high caries risk, while only 9% exhibited low caries risk. The most significant caries risk variables, determined by regression analysis (R2=0.88), were insufficient fluoride exposure (ß=0.160) and the presence of WSL (ß= 0.159).Conclusions:One-fourth of the children were categorised as high caries risk. The presence of WSL and lack of fluoride exposure were the most significant caries risk determinants.

The scientific knowledge about the etiology of dental caries and the employment of models that aim at promoting health have contributed to the decline of the disease. However, the tooth decay in very young children, called tooth early in childhood (ECC) continues to be the most common chronic childhood disease. As the health-sickness process stems from several factors, what is seen is the polarization of ECC, where a small portion of the population concentrates high levels of injuries of caries. Considering the need to control the etiological factors of the disease and not its sequels, the assessment of the risk for dental caries is an essential element of clinical care for contemporary infants, children and adolescents and has received great attention in recent years. Thus, the objectives of this study were: verify the experience of caries in infants and preschool children; classify children with respect to the risk to dental caries; assess whether there was a change in caries experience and in the classification of the risk to dental caries in two moments analyzed and validate a simplified form of assessment of risk for dental caries in infants and preschool children. The design of this clinical study was observational, quantitative, descriptive analytical, cross-sectional, based on information obtained from 132 dental records of dental children aged zero to 71 months of age, of both sexes and healthy, who received dental treatment and follow-up visits between the months of February 2015 to July 2016 in clinics of pediatric dentistry, School of Dentistry of Federal University of Uberlândia. For the analysis, dental records containing at least two assessments of risk for dental caries with an interval of at least 90 days between the first and the second evaluation were included. In this study, nine risk factors were considered that formed the scale of risk identification Dental caries risk factors (DCRF-9). The data were submitted to descriptive statistical analysis and the Kruskal-Wallis test (p<0.05). The results showed that 113 (78.0%) and 86 (65.2%) children, respectively, showed no caries in the first and second evaluation and that were classified as low risk for dental caries in the first and second evaluation. There was a modification of the risk rating of 26 (19.7%) children. The sensitivity and specificity of the simplified form of assessment of risk for dental caries were 88% and 69%, respectively. The simplified form used in this study can be considered a good predictor of risk factors for dental caries, since it has high sensitivity and average/good specificity. It was possible to conclude that: most of the children had no experience of caries and were classified as low risk; there was no change in caries experience and of the risk rating of few children and that the form of risk assessment to the ECC and was able to identify the children susceptible to ECC.

The aim was to evaluate the association between circadian rhythm and the risk of caries in adolescents, as well as their dietary and toothbrushing habits. A group of 196 adolescents (15 and 16years old) were divided into two equal groups based on caries risk (case=high risk; and control=low risk). Before their dental examinations, they were asked to complete a questionnaire. The questionnaire included questions on circadian rhythm, dietary and oral self-care habits, and demographic variables. The participants were divided into three circadian types: evening types who are alert in the evening and tired in the morning; morning types who are the opposite; and neutral types who are neither particularly alert in the evening nor extremely tired in the morning. The most common sleep-cycle group type was neutral (50%). After this came evening types (37%) and finally morning types (13%). Morning and neutral types reported more frequently than evening types that they had breakfast every morning and brushed their teeth twice a day. More evening types were categorized as at high risk of caries. Circadian rhythm, breakfast habits and toothbrushing frequency were associated with a high risk of caries. The predicted probability of being at high risk of caries was almost four times higher for evening types than for morning types (OR 3.8; 95% CI 1.3-10.9). Adolescents who belonged to the evening circadian rhythm group brushed their teeth more seldom, ate breakfast less regularly and had a higher risk of caries than morning types. A patient's circadian rhythm should be considered when planning oral health education for adolescents with a high risk of caries.

The aim of this study was to evaluate the role of taste-related gene polymorphisms (CA6, TAS1R1, TAS1R3, TLR2, and TLR4) on dental caries and caries activity in adults. Individuals aged 25-44years included in the study were assigned to two groups according to the decayed-missing-filled teeth index (DMFT) as the high caries risk (DMFT ≥ 14, n = 100) and the low caries risk (DMFT ≤ 5, n = 100). TaqMan allelic discrimination assays were used for genotyping the gene variants after isolating the DNA from the buccal smears. According to the American dental association caries classification system (ADA CCS), all teeth were scored as initial, moderate or advanced caries. The variant of the gustin (CA6) in saliva was found to be associated with a high caries risk (CA6 rs17032907, P < .001). There was also a statistically significant difference in the dominant model of the same variant (CC vs. TT: P < .001, OR = 5.05, 95% CI: 2.38-10.71). The presence of genotype CC and allele C was less frequent in the advanced caries lesion group (P < .001). This study shows that the CA6 rs17032907 gene variant may be a risk factor for dental caries affecting caries activity. Clinical Trials ID: NCT04066101.

Temanggung Regency in Central Java is an area with an extensive tobacco farming, allowing its residents to have ease of access to cigarettes. In addition, it has become a tradition for locals in this area to serve any visiting guest with cigarettes. Adolescents start smoking to cope with the psychosocial crisis during their development, particularly when they try to find their identity. Smoking is, in fact, a risk factor for dental caries, so the adolescents in Temanggung have a quite high prevalence of caries. Thus, this study aimed to determine the sequence of the risk factors affecting the caries risk based on cariogram among male smokers aged 15-24 years (adolescents). This was a quantitative observational study with a cross sectional design. There were 152 subjects (n= 152) selected using a proportionate clustered random sampling out of the total population (316 adolescents). The research was carried out with a clinical examination of the oral cavity, measuring salivary secretions, examining the amount of plaque, and examining DMF-T. Scoring was done using a caliogram application. The results of this study showed that 81.3% of the adolescents had a moderate caries risk, while 18.1% of them had a high caries risk. The sequence of the risk factors affecting the caries risk based on cariogram was bacteria (22.90%), susceptibility (19.39%), dietary habits (12.09%), and other influencing conditions (7.55%).

A split-mouth randomized clinical trial was carried out to assess the effectiveness of sealants in preventing carious ICDAS (International Caries Detection and Assessment System) 3–6 lesions within a 2-year follow-up. We evaluated the effectiveness of 2 types of resin-based sealants, with and without fluoride, their retention rates, and the caries risk factors related to their outcomes. The study included 663 tooth pairs in 400 children (aged 5–15 years) considered to be at high individual caries risk (ICR) and presenting permanent molars free of caries or affected by ICDAS 1–2 lesions. In the first randomization, molars were either randomized to the treatment group receiving a dental sealant or the control group (nontreatment), and in the second randomization the sealant material to be used in the intervention group was selected. Uni- and multivariate Cox proportional hazard models were employed. At the 2-year follow-up, 483 tooth pairs were assessed: sealed molars had 83% (adjusted HR = 0.17; 95% CI: 0.15–0.20) less risk of developing ICDAS 3–6 lesions than molars without sealant. The magnitude of the protective effect was lower among teeth with ICDAS 1–2 lesions or with occlusal deep fissures than without. If the total retention rate of sealants was 70% at 2 years, sealant loss was not associated with the risk of caries (HR = 1.29, 95% CI: 0.92–1.79, p = 0.14). Sealants allow the prevention of new ICDAS 3–6 lesions or progression of noncavitated carious lesions in children at high ICR, and the effect of the sealant was similar regardless of whether it contained fluoride or not.

Karies gigi pada anak usia sekolah merupakan masalah kesehatan yang sering terjadi, tetapi kurang mendapat penanganan yang optimal. Salah satu faktor yang dapat mempengaruhi terjadinya karies gigi, yaitu makanan kariogenik yang bersifat manis dan lengket. Tujuan penelitian ini, yaitu untuk mengetahui hubungan antara konsumsi makanan kariogenik dan risiko kejadian karies gigi pada anak usia sekolah. Metode penelitian ini menggunakan desain deskriptif analitik dengan pendekatan cross sectional. Sampel pada penelitian ini sebanyak 163 anak usia sekolah yang dipilih dengan teknik random sampling. Teknik analisis yang digunakan pada penelitian ini, yaitu chisquare. Hasil menunjukkan bahwa tingkat konsumsi makanan kariogenik yang tinggi sebanyak 55,8% responden, sedangkan tingkat konsumsi makanan kariogenik rendah sebanyak 44,2% responden dan responden yang berisiko tinggi karies gigi sebanyak 76,7% responden, sedangkan responden yang berisiko rendah karies gigi sebanyak 23,3% responden. Hasil analisis penelitian menunjukan bahwa ada hubungan antara konsumsi makanan kariogenik dengen risiko kejadian karies gigi dengan nilai (p value &lt; 0,05). Hasil penelitian menyarankan tenaga kesehatan untuk mencegah kejadian karies gigi dengan menurunkan tingkat konsumsi makanan kariogenik. &#x0D; &#x0D;

A reduced cariogram model is a simplified version of the original cariogram which simplifies the analysis by focusing on fewer parameters, making it easy to use in clinical and research settings. One of the key components in “cariogram model” is the buffering capacity of saliva, which plays a pivotal role in maintaining oral pH balance. To investigate the role of “salivary buffer capacity” for caries predictive ability of “reduced cariogram model” in adults.A sample of 90 patients were included in this study. The cariogram variables were collected through a questionnaire, clinical and salivary examinations. The outcome measure was computed as a ‘‘chance to avoid caries in the near future,’’ which was expressed in percentage. The eight cariogram variables computed were caries experience, related diseases, diet frequency, plaque amount, fluoride program, saliva secretion, saliva buffer capacity, and clinical judgment. The data were calculated in two ways: “cariogram with eight variables” and “cariogram with seven variables”, excluding saliva buffer capacityThe patients were then allocated into three caries risk categories according to their chance of avoiding caries in the near future, as follows: 0–40% chance to avoid caries =high caries risk, 41–60% chance to avoid caries = medium caries risk, and 61–100% chance to avoid caries = low caries risk in both models i.e “cariogram with eight variables” and “cariogram with seven variables”. Comparison between the two was done. When eight variables were considered the p value was 0.150 and when only seven variables were considered the p value was 0.001 which is statistically significant indicating the saliva buffer capacity has an influence in the caries risk assessment of an individual.: Saliva buffer capacity had a significant role in altering the caries risk of an individual in a “reduced cariogram model”.

Caries risk assessment (CRA) is an important step in preventive and therapeutic management of caries in children. This study assessed the sensitivity and specificity of a new Canadian Caries Risk Assessment Tool (<6 years) for preschoolers to predict caries development. In this prospective cohort study, CRA was performed at baseline and 12 months among 190 children aged <6 years from 3 clinics in Manitoba, Canada. CRA included information on child's fluoride exposure, teeth cleaning, diet, socio-economic status, and oral examinations. Sensitivity and specificity were calculated, and logistic regression for new caries at follow-up was performed. The sensitivity and specificity for baseline CRA rating and development of new caries at follow-up were 87.2% and 42.7%, respectively. Presence of visible caries and/or past evidence of dental treatment for caries at baseline was the strongest independent indicator of new caries by follow-up (OR = 6.49; CI = 3.28, 12.85; p < 0.001). Children with high caries risk (score ≥3) were more likely to develop new caries by follow-up (OR = 4.58; 95% CI = 2.07, 10.11). The combined sensitivity and specificity score is comparable to findings from other studies examining CRA. Results support the increased weighting of the score for the presence of visible caries and/or evidence of dental treatment for caries at baseline. Results from this study provide evidence for the CRA tool's predictability. The Canadian Caries Risk Assessment Tool for preschoolers has high sensitivity to identify children with high caries risk, and modest specificity to identify children with low caries risk. However, future population-based studies with primary care providers are recommended.

The aim of the current study was to investigate the relationship between dietary intake, type of feeding during infancy, other lifestyle and sociodemographic factors, and dental caries. A cross-sectional study. The study was carried out on children younger than 16 years of age who visited Primary Health Care Centers. The study was carried out over a period from October 2010 to June 2011 in Qatar. A random sample of 1752 children aged 6-15 years old who visited the Primary Health Care Centers was approached, and parents of 1284 children provided their consent and fulfilled the inclusion criteria (corresponding to a response rate of 73%). The study was based on a questionnaire that included variables such as sociodemographic information, lifestyle, family history, and feeding patterns during infancy, information on oral hygiene practices, and clinical examination. The status of dental caries was recorded on the basis of the WHO criteria. The prevalence of dental caries [decayed, missed, or filled tooth (DMFT)] in the permanent dentition among children was 73% [95% confidence interval (CI): 71-75%], with a mean DMFT value of 4.5 (SD: 4.2). The numbers of children consuming sea food, cod liver oil, and vitamin-D-fortified milk less than once a week were significantly higher in the dental caries group compared with those without caries (11.7 vs. 8.3%; P=0.05, 92.4 vs. 87.5%; P=0.005, and 10.6 vs. 6.3%; P=0.011, respectively). Multivariable logistic regression analysis showed that being female [adjusted odds ratio (OR): 1.41; 95% CI: 1.07-1.84], having a BMI greater than the 95th percentile versus less than the 85th percentile (adjusted OR: 2.12; 95% CI: 1.17-3.84), a monthly household income of at least 10 000 QAR (adjusted OR: 2.61; 95% CI: 1.69-4.02), consumption of cod liver oil less than once a week (adjusted OR: 2.13; 95% CI: 1.35-3.37), 1-year increase in age (adjusted OR: 1.05; 95% CI: 1.01-1.11), being formula fed during infancy (adjusted OR: 2.27; 95% CI: 1.59-3.21), and frequency of tooth brushing once a day or less (adjusted OR: 1.36; 95% CI: 1.01-1.83) were associated independently with the risk of dental caries among children in Qatar. Being female, overweight or obese, and monthly household income higher than US$2747 (≥10,000 QAR) were independent risk factors for dental caries. However, consumption of cod liver oil (at least once a week) and frequency of tooth brushing (more than once a day) were protective against dental caries. Health awareness and education on frequent tooth brushing, adequate nutrition, and obesity prevention should be promoted to avoid dental caries among children.

After 2 hours of training in infant oral health, the pediatric primary care providers in this study achieved an adequate level of accuracy in identifying children with cavitated carious lesions. Additional training and research would be needed to optimize pediatric primary care providers' identification of carious teeth if that were the goal of screening. However, the purpose of screening by nondental personnel generally is to accurately identify those in need of referral, which does not require a tooth-by-tooth identification of cavities. Additional research is also needed to determine how to improve dental referrals by pediatric primary care providers. Results of our study suggest that dental screenings can easily be incorporated into a busy pediatrics practice and that pediatric primary care providers can significantly contribute to the overall oral health of young children by the identification of those children who need to be seen by a dentist.

The correlation between breastfeeding and the development of caries in children remains unclear. Previous studies have found a correlation between prolonged breastfeeding and the risk of caries. However, the associations observed were primarily based on non-European populations, and important confounding factors, such as socio-economic position and diet, were not taken into account. The Generation R study re-examined the relationship between breastfeeding and oral health. The results of this Dutch cohort study confirmed the previously observed associations between prolonged breastfeeding and the increased risk of dental caries, even after adjustments had been made for indicators of socio-economic position, ethnic background and sugar intake. Future studies are encouraged to further explore possible explanations for the observed correlations. Healthcare professionals should be more aware of this and advise patients about the potential risk of prolonged breastfeeding on the development of caries by applying current recommendations regarding breastfeeding, oral hygiene and frequency of feeding.

The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF) versus restorative treatment (RT) to manage cavitated caries lesions in primary teeth in a diverse population of children in Michigan. Children aged 2 to 10 y with at least 1 soft cavitated lesion (International Caries Detection and Assessment System 5 or 6) with no pain or signs/symptoms of irreversible pulpitis were recruited and randomly assigned to 2 intervention groups. One random lesion per child received 38% SDF (twice, at a 6-mo interval) or RT. All interventions and assessments were done by calibrated dentists. Primary outcome measures were clinical failure rates: minor (e.g., reversible pulpitis, active/soft lesion or progression, restoration loss or need for replacement/repair, secondary caries) and major (e.g., irreversible pulpitis, abscess, extraction). Parent, child, and provider acceptability was also assessed. Ninety-eight children were enrolled and randomized, with a mean (SD) age of 4.8 y (1.8); 46% were female and their mean dmft + DMFT was 6.3 (3.9). Sixty-nine children were assessed at 12 mo (sample was within the planned 30% attrition rate). There were significantly more teeth with minor failures (SDF = 65%, RT = 23%, P ≤ 0.001) and major failures (SDF = 13%, RT = 3%, P ≤ 0.001) in the SDF group than the RT group; 74% of SDF-treated lesions were hard at 12 mo vs. 57% at 6 mo. Providers stated that SDF was easier, faster, and more preferable than RT (P ≤ 0.001). No significant differences were found in parental satisfaction and acceptability. At 12 mo, children in the RT arm felt significantly (P < 0.05) happier with their tooth appearance and stated that their visit to the dentist hurt less. At 12 mo, SDF-treated lesions had significantly more minor and major failures than RT, suggesting that SDF-treated teeth need to be closely monitored in a population at high caries risk (ClinicalTrials.gov NCT02601833). The results of this study can be used by clinicians when deciding whether to restore or apply silver diamine fluoride to cavitated lesions in primary teeth. Information on treatment outcomes and parent, child, and provider acceptability can help guide appropriate treatment decisions and need for monitoring.

Objective:To estimate the percentage of children with low, moderate and high caries risk; and to determine the predictors of caries risk amongst 11-12 year old Pakistani school children.Methods:Subjects’ caries risk was assessed using the Cariogram programme. The survey was done among school children in Bhakkar district of Punjab, Pakistan. Caries and plaque level were assessed using the DMFT and Sillnes and Loe indices respectively, while diet content and frequency were assessed using a three-day diet diary.Results:A total of 226 children participated in this study, giving a response rate of 75%. Most subjects (39.8%) were in the low risk category with DMFT score of 0. The overall mean DMFT score was 1.49 (±0.63). Linear and multiple regressions were performed to evaluate the predictability of caries risk. Previous experience of dental caries was found to be the most relevant predictor of caries risk (40%).Conclusion:The levels of caries risk amongst Pakistani 11-12 year old school children were generally low. Past caries experience was the most significant factor in predicting future caries lesion in this sample population.

The aim of the present study was to investigate risk factors for dental caries in children with developmental disabilities who were treated at a clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 401 dental charts of individuals without dental caries or restorations in their first dental appointment. The dependent variable was the time of occurrence of new dental caries or restorations and was measured in months. Gender, age, International Code of Diseases (ICD), mother´s education, sugar consumption, use of fluoride toothpaste, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic or asthma drugs, and history of asthma were covariates. The Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental caries/restoration was equal to 107.46 months (95%CI 95.41 to 119.51), with a median of caries-free children up to 94 months. For each point increase in the scale of sucrose consumption, the increase in caries risk was 1.07 (95%CI 1.01 to 1.15). Sucrose consumption was the only risk factor for dental caries found in this group of individuals with developmental disabilities.