Dental caries risk assessment: A practical tool to improve oral health in the Philippines?

@#The purpose of a dental caries risk assessment (CRA) is to assign appropriate preventive measures for high-risk individuals in order to reduce caries risk. For a dental professional, it can set the direction for treatment planning while aiding in patient motivation by pointing out modifiable risk factors and indicators influencing dental caries development. In the Philippines and other developing areas, decayed, missing, and filled teeth have been consistently high over many years. Given that the recognized CRA tools have been created in developed countries with registered low caries prevalence, validation of these tools outside their countries of origin will confirm their relevance in settings where disease conditions and health behaviors are different.

A cross-sectional cariogram-based comparison of caries risk profile in children with various levels of intellectual disability

Aim: To compare the caries risk profile in children with mild, moderate, and severe intellectual disability (ID) using cariogram. Materials and Methods: A cross-sectional study was conducted to compare caries risk profile using cariogram among 150 children aged 6–18 years, with various levels of ID (50 each in Mild ID, Moderate ID, and Severe ID groups), attending special schools in Bengaluru city. The risk assessment consisted of: a questionnaire, an interview, estimation of oral hygiene, saliva sampling, microbial evaluation and clinical examination. Statistical analysis of the results obtained was performed using Chi-square/Fischer's exact test, Kruskal–Wallis test and Mann–Whitney test. Results: The overall comparison showed significant differences between the groups across all parameters except diet (P = 0.131), fluoride exposure (P = 1), salivary flow rate (P = 0.3), and buffer capacity (P = 1). Caries risk was high among children with severe intellectually disability while the actual chance to avoid caries was found to be high in the Mild ID group. Bacteria was one of the dominant caries risk sectors followed by susceptibility, circumstances, and diet. Conclusion: Cariogram can be used as an effective tool in assessing caries prediction, thus aiding in identifying different risk groups in a community so that appropriate preventive measures can be implemented to overcome the caries risk.

Evaluation of caries risk reduction following preventive programs in orthodontic patients, using Cariogram computer model: A quasi-experimental trial

ABSTRACT Objective: This study evaluated the effectiveness of preventive strategies on caries risk reduction in patients undergoing orthodontic treatment, using the Cariogram program. Methods: In this quasi-experimental study, samples were selected using a convenience quota sampling technique, in a public dental school. At first, caries risk profile was determined for each subject using the Cariogram before brackets bonding. The sample size consisted of 36 patients. The intervention group (n = 18) received preventive programs, and the control group (n = 18) was trained based on the routine oral health education by means of pamphlets. Then, Cariogram parameters were calculated for patients in both groups after six months. Results: The age range of participants was from 12 to 29 years. The mean percentage of the "Actual chance of avoiding new cavities" section in the intervention group increased from 45.72 ± 21.64 to 62.50 ± 17.64. However, the mean percentage of other parameters - such as "Diet", "Bacteria" and "Susceptibility" - decreased after six months (p< 0.001). Besides, the differences in the mean percentage between intervention and control group at the end of the study period (T1) related to the Cariogram parameters were statistically significant (p< 0.001). Accordingly, the mean percentage of 'Actual chance of avoiding new cavities'' parameter in the intervention group (62.50) was statistically higher than in the control group (42.44) (p< 0.001). Conclusion: Implementing different preventive approaches is able to reduce the caries risk in patients undergoing fixed orthodontic treatment, which can be clearly demonstrated using Cariogram program.

RESUMO Objetivo: O presente estudo usou o software Cariogram para avaliar a eficácia de estratégias preventivas para redução do risco de cáries em pacientes sob tratamento ortodôntico. Métodos: Nesse estudo quase-experimental, as amostras foram selecionadas por meio de uma técnica de amostragem por cota de conveniência, em uma faculdade pública de Odontologia. Inicialmente, o perfil de risco de cárie foi determinado para cada indivíduo usando o Cariogram antes da colagem dos braquetes. A amostra consistiu de 36 pacientes: o grupo experimental (n = 18) recebeu programas preventivos, e o grupo controle (n = 18) recebeu orientações sobre a saúde bucal por meio de folhetos. Após seis meses, os parâmetros obtidos por meio do Cariogram foram calculados novamente para os pacientes de ambos os grupos. Resultados: A faixa etária dos participantes foi de 12 a 29 anos. A porcentagem média da seção "Probabilidade real de prevenir novas cáries" no grupo experimental aumentou de 45,72 ± 21,64 para 62,50 ± 17,64. Por outro lado, a porcentagem média de outros parâmetros - como "Dieta", "Bactérias" e "Suscetibilidade" - diminuiu após seis meses (p< 0,001). Além disso, as diferenças nas porcentagens médias entre o grupo experimental e o grupo controle ao fim do estudo (T1), relacionadas aos parâmetros do Cariogram, foram estatisticamente significativas (p< 0,001). Assim, a porcentagem média do parâmetro "Probabilidade real de prevenir novas cáries" no grupo experimental (62,50) foi estatisticamente maior do que no grupo controle (42,44) (p< 0,001). Conclusão: A implementação de diferentes abordagens preventivas pode reduzir o risco de cárie em pacientes sob tratamento ortodôntico com aparelhos fixos, o que pode ser observado claramente por meio do software Cariogram.

Validity of the New Caries Activity Test using Real-Time Polymerase Chain Reaction / 대한소아치과학회지

Periogen is a new caries activity test using real-time polymerase chain reaction. The aim of this study was to assess the validity of Periogen by evaluating the correlation with dmft, dmfts indices and comparing with Cariview and caries risk assessment tool (CAT).83 children under 6 participated in this study. Dmft, dmfts indices and CAT were collected through an examination of oral health status. Plaque samples for Periogen and Cariview were collected and manipulated according to the manufactures' instructions.The correlation coefficient of Periogen, Cariview and CAT with the dmfts index were 0.38, 0.56 and 0.66 in each (p < 0.01). The sensitivity of Periogen, Cariview and CAT were 43%, 76% and 95% and specificity were 80%, 72% and 74% respectively. Area under curve under the receiver operating characteristic curves in each method indicated 0.69, 0.81 and 0.85.CAT and Cariview were more effective in evaluation the risk of dental caries than Periogen so far. To be used Periogen clinically, more improvements for higher validity were needed.

Caries Management of High-Risk Children by Caries Risk Assessment / 치위생과학회지

The purpose of this study was to classify risk groups according to Caries Risk Assessment (CRA) and to investigate the effect of caries prevention program after 1 year of caries prevention intervention program in 6-year-old infants with high caries risk. The subjects were selected based on responses to CRA questionnaires. At the first visit, oral examination, Cariview, bacteria and saliva flow test were performed. The caries risk group was classified accordingly. The subjects were given fluoride application and oral health education every four months and evaluated the same as the first visit after 1 year. As a result of classifying the risk level according to CRA, more than 80% of the subjects were in the high or extreme high risk. The dft index was increased in all risk groups after the intervention. There was a significant difference between the before and after intervention (p < 0.05). The Cariview score showed a slight decrease after the intervention in the moderate and high risk groups. As a result of the evaluation of bacteria test, Streptococcus mutans were decreased to ≥10⁵ CFU/ml saliva after intervention in all groups. Lactobacilli were decreased after intervention in high risk and extreme high risk groups. As a result of saliva flow, there was significant difference between caries risk groups before and after intervention (p < 0.05). In conclusion, regular caries management has been shown to influence caries risk factors in high-caries risk children. Also, it is necessary to find out periodical dental risk management system which is suitable for domestic situation through the related studies.

Strategy and practice of the healthy cosmetic management for patients with high dental caries susceptibility / 华西口腔医学杂志

A new clinic conception, healthy cosmetic management (HCM), was innovated introduced into diagnose and treatment of patients with high caries risk. The priority of HCM should be given to aesthetic restoration of teeth, taking consideration of the conserving of tissue and pulp of teeth and the balance between health and aesthetics, which may reach to the goal of the individual clinic treatment. HCM includes five steps: 1) caries risk assessment; 2) detection of initial caries; 3) digital aesthetic design; 4) minimally invasive therapy; 5) behavior management of caries and doctor-patient communication pattern. In this article, HCM is introduced into two aspects: process management and clinical protocols, followed by the combination of the clinical practice.

Evaluation of Chair-Side Assays in High Microbiological Caries-Risk Subjects

The aim of this study was to evaluate the commercial chair-side assays Saliva-Check Mutans and ClinproTM Cario L-PopTM in high microbiological caries-risk dental students compared with conventional semi-quantitative colony counting culture-based technique as the reference method. Saliva samples from 93 subjects of both sexes aged 18-26 years were seeded (Köhler and Bratthall method) on plates containing SB-20M culture medium method and 12 subjects with high caries risk were selected. These 12 individuals were subjected to determination of caries risk using two commercial rapid detection chair-side assays (Saliva-Check Mutans and ClinproTM Cario L-PopTM) according to the manufacturers' instructions. The results were analyzed by the Kappa correlation test using SAS statistical software. There was a perfect agreement (Kappa=1) among the three caries risk evaluation methods - chair-side assays and semi-quantitative CFU count (control) - in all subjects. The results suggest that the commercial chair-side assays evaluated in this study may be practical and useful to identify high microbiological caries-risk subjects.

Resumo O objetivo do estudo foi avaliar os testes comerciais de consultório Saliva-Check Mutans e ClinproTM Cario L-PopTM, em estudantes de Odontologia de alto risco à cárie, comparado à técnica convencional semi-quantitativa baseada em contagem de colônias, como método de referência. Amostras de saliva de 93 estudantes de ambos os sexos, entre 18 e 26 anos de idade, foram semeadas em placas contendo meio de cultura SB-20M e 12 pacientes de alto risco à cárie foram selecionados. Estes 12 indivíduos foram submetidos à determinação de risco à cárie por dois testes comerciais de rápida detecção (Saliva-Check Mutans e ClinproTM Cario L-PopTM), seguindo as instruções dos fabricantes. Os resultados foram analisados pelo teste de correlação Kappa, por meio do software estatístico SAS. Houve uma concordância perfeita (Kappa=1) entre os três métodos de avaliação de risco á cárie - testes comerciais e contagem semi-quantitativa de UFC (controle) - em todos os pacientes. O resultado sugere que os testes comerciais de consultório avaliados neste estudo podem ser práticos e úteis para identificar indivíduos de alto risco microbiológico à cárie.