Exploring the Compliance of Resilient High-Caries-Risk Patients Who Reversed Caries Severity

Background: Behavioural factors, such as compliance and regular dental attendance, have been proven to reverse caries severity. However, these factors have not been explored enough. The aim of this study was to explore the behavioural characteristics of compliant patients who had severe dental caries in primary dentition but whose dental conditions were considerably improved in mixed or permanent dentition.Methods: The 'w and W' criteria were designed to classify patients who had a worse or higher caries risk in primary and mixed or permanent dentition. Resilience, or reversal of caries severity, was thus defined as improvement based on these criteria. Interviews were performed with two groups of participants, including eight resilient children (M/F= 5/3) and their ten caregivers (M/F=2/8) in the patient group and ten paediatric dentists (M/F=6/4; clinical experience mean=26.9 years, minimum=16 years) in the dentist group. Thematic analyses were used to identify main themes.Results: Four themes were identified: (1) dental things/teeth are their priority, (2) normalising, (3) tiger parenting/conscientiousness and (4) trust. These ideas were identically described by both the patient and dentist groups.Conclusions: Resilience is the behavioural characteristic of children who outperform expectations, given their caries history and risk. Resilient patients reverse the fate of their teeth by their compliance with treatment protocols following dental guidelines, changing their dental behaviours, and thus, leading to treatment success. Dentists' suggestions are the priority and provide the norms in resilient patients' daily life. These patients find no excuses for not implementing dentists' advice, not only because they trust their dentists but also because they and their caregivers were conscientious about following dentists’ orders.

Relationship between Skeletal Maturity, BMI Percentile and Dental Caries Experience among Taster and Non-taster Children

Introduction: Ability of an individual to taste phenylthiocarbamide (PTC) substance divides the population in tasters and non-tasters. The objective of this study was to investigate the relationship between the taste ability for PTC substance with BMI percentile, skeletal maturity and dental caries experience within taster and non-taster children of age 8-12 years. Hypotheses: Tasting ability for PTC affects the BMI percentile, skeletal maturity and dental caries experience and emerge as a useful caries risk assessment tool. Evaluation of Hypotheses (Materials and Method): One hundred children of 8-12 years were randomly selected and their taste perception was assessed using PTC sensitivity test. Radiovisiography (RVG) of middle phalanx was obtained to determine the skeletal maturity by using Rajgopal and Kansal modification 2005. Anthropometric measurements were recorded to obtain BMI value and then BMI percentile was calculated using CDC Pediatric growth charts. For dental caries assessment, deft/DMFT scores were recorded. Results: The non-tasters had early skeletal maturation, higher caries experience and higher BMI percentile than the tasters. Conclusion and Clinical Relevance: PTC Sensitivity is a genetically controlled trait showing strong association with dental caries. From the results of this study we can conclude that the genetic ability of tasting PTC affects the BMI percentile, skeletal maturity and dental caries experience. Thus it can emerge as a useful caries risk assessment tool helping in planning the preventive measures and interceptive orthodontics in children.

Randomized clinical trial to evaluate two methods of caries risk assessment in schoolchildren: the CARDEC-PEL 04 study protocol

Background Caries risk assessment is an essential element for managing and preventing dental caries in children. Individual caries risk assessment can be conducted to evaluate the presence or absence of single factors, or using multivariate models, a combination of factors. The subject has been extensively studied, but no previous research has compared whether a more elaborate and individualized method of caries risk benefits the patient than more straightforward strategies. Thus, this protocol evaluates the efficacy of two risk assessment methods for caries control in children, a simplified method based on caries experience evaluation and a multivariate method described in the literature. Methods This is a randomized, double-blind, controlled, parallel-treatment trial protocol. Two groups will be tested for two forms of caries risk assessment: an individualized and detailed multivariate method based on the guidelines of the Caries Care International 4D and another simplified process, based only on caries experience in primary and/or permanent dentition, considering the presence of decayed, missing and filled teeth using the DMFT/dmft index. Participants will be children aged 8 to 11 years, followed up at 12 and 24 months. The primary outcome will be a composite outcome representing the number of tooth surfaces requiring operative intervention (account variable). In addition, the Shapiro–Wilk normality test and Student's t-test will be performed. A multivariate analysis using negative binomial regression will compare groups in the intention-to-treat population, considering a two-tailed significance level of 5%. Discussion This is the first randomized clinical trial aiming to compare dental caries-related treatment and follow-up based on a detailed, multivariate and individualized assessment of caries risk in school-age children to a simpler risk assessment strategy based on caries experience. This study will define whether there are essential benefits to the patient that justify the choice of one method over the other. Trial registration Clinicaltrials.gov registration: NCT03969628. Registered on May 31th, 2019.

Effectiveness of web application as educational media in increasing the caries risk knowledge and decreasing the caries risk score among dental students in Indonesia

Background This study evaluating the effect of web application media in increasing the caries risk knowledge and decreasing the caries risk scores among dental students. Methods A quasi-experimental design along with a purposive sampling technique was used in this study. A total of 361 undergraduate pre-clinical dental students from 15 universities in Indonesia were divided into two groups: intervention (n = 282) and control (n = 79). The students in the intervention group received a web application media with educational materials to independently check their caries risk, whereas those in the control group received the application without any educational materials. The students were instructed to use the web application at least once a week for 21 days and complete the pretest and posttest questionnaires and web application evaluation questionnaires. In addition, they were required to independently examine their initial and final caries risk. Results A significant increase in the level of knowledge was observed in the intervention group, but not in the control group, after the use of the web application. Each group showed a decrease in the caries risk score, but the difference was not statistically significant before and after the use of a web application in both groups. Conclusion These findings indicate that health promotion and education about caries risk through web application media can improve the knowledge and reduce the caries risk in dental dentistry students.

The relationship between claimed restorations and future restorations in children and adolescents: An observational follow-up study on risk categories for dental caries

Various models are available to assess caries risk in individuals. In general past caries experience is considered as the best single predictor for future caries development in populations. Likewise, recent restorations have been used to predict future restorations. We aimed to evaluate a classification model for risk categories for dental caries in children based on claims data from Dutch healthcare insurance company Zilveren Kruis. The baseline caries risk categories were derived from the number of claimed restorations in two baseline years (2010 through 2011). These categories were defined as low (no new restorations), moderate (1 new restoration), and high (2 or more new restorations). First, we analyzed the relationship between baseline caries risk categories and the number of new restorations during 3 years of follow-up (2012 through 2014). Secondly, we used negative binominal two-level analyses to determine the accuracy of our classification model in predicting new restorations during follow-up. Thirdly, we reclassified the participants after 3 years and determined the changes in the categorization. We included insurance claims data for the oral healthcare services in 28,305 children and adolescents from 334 dental practices for the period 2010–2014. At baseline, 68% of the participants were in risk category low, 13% in moderate and 19% in high. The mean number of new restorations during follow-up was 0.81 (SD 1.72) in baseline risk category low, 1.61 (SD 2.35) in moderate, and 2.65 (SD 3.32) in high. The accuracy of the multivariate model for predicting 0/>0 restorations was 50%. After 3 years, 60% of the study participants were in the same risk category, 20% were in a lower, and 21% in a higher risk category. Risk categories based on claimed restorations were related to the number of new restorations in groups. As such, they could support planning and evaluation of oral healthcare services.

Nomogram prediction of caries risk among schoolchildren age 7 years based on a cohort study in Shanghai

Objective Caries risk assessment tools are essential for identifying and providing treatment for individuals at high risk of developing caries. We aimed to develop a nomogram for the assessment and evaluation of caries risk among Chinese children. Methods We enrolled schoolchildren age 7 years from a primary school in Shanghai. Baseline information of participants was collected using a questionnaire completed by children’s caregivers. A nomogram of a novel prediction scoring model was established based on predictors detected in univariate and multivariate analyses. Predictive accuracy and discriminative ability of the nomogram were calculated using the concordance index (C index). The bootstrap method (1000 samples) was used to decrease overfitting. The net benefit of the model was validated using decision curve analysis. Results Overall, 406 children with complete information and two completed dental examinations were included in the final analysis. The nomogram based on logistic regression model coefficients demonstrated a C index of 0.766 (95% confidence interval: 0.761–0.771) for caries risk. The net benefit of the decision curve analysis was 38.6% at 55% threshold probability. Conclusion This nomogram model, derived using dietary habits, oral hygiene status, and caries experience, showed promising predictive ability to assess the caries risk among Chinese children.

Nonrestorative Management of Dental Caries

The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.

Dietary Patterns and Risk of a New Carious Lesion Postpartum: A Cohort Study

Dental caries (cavities), one of the most common infectious diseases, is caused by a number of factors. Oral microbes, dietary practices, sociodemographic factors, and dental hygiene all inform caries risk. Assessing the impact of diet is complicated as individuals eat foods in combinations, and the interactions among the foods may alter caries risk. Our study aimed to prospectively assess the association between dietary patterns and caries risk in the postpartum period, a potentially sensitive period for caries development. We analyzed in-person dental assessments and telephone food frequency questionnaires (FFQs) from 879 Caucasian women participating in the Center for Oral Health Research in Appalachia Cohort 2 (COHRA2) that were collected biannually for up to 6 y. One-week recall of food intake frequency was assessed using a Likert scale. We used principal component analysis to summarize the FFQ data; the top 2 components described 15% and 12% of the variance in FFQ data. The first component was characterized by high consumption of fruits and vegetables, while the second component was heavily influenced by desserts and crackers. We used a modified Poisson model to predict the risk of an increase in the number of decayed, missing, and filled teeth in the postpartum period by 1) dietary patterns and 2) individual foods and beverages at the previous study visit, after controlling for other known risk factors, including history of carious lesions. Eating a dietary pattern high in desserts and crackers was associated with a 20% increase in the number of decayed, missing, and filled teeth in the postpartum period (95% confidence interval, 1.03–1.39). However, this effect was attenuated among those who also consumed a dietary pattern high in fruits and vegetables. Dietary patterns should be considered when devising interventions aimed at preventing dental caries.