Assessment of caries diagnostic thresholds of DMFT, ICDAS II and CAST in the estimation of caries prevalence rate in first permanent molars in early permanent dentition-a cross-sectional study.

BACKGROUND: The actual burden of dental caries prevalence varies with the caries assessment tool used. Therefore, the present study evaluated the caries diagnostic potentials of Decayed, Missing and Filled Teeth (DMFT); International Caries Detection and Assessment System (ICDAS) II and Caries Assessment Spectrum and Treatment (CAST) indices in estimating the caries prevalence rate of first permanent molar (FPM) in Saudi male children aged 7-9 years. METHODS: This descriptive, cross-sectional study included 390 children by multistage stratified cluster sampling method in Al-Jouf Province, Saudi Arabia. The prevalence rates of FPM caries were determined by DMFT, ICDAS II and CAST indices at various diagnostic cut-off points. Intra- and inter-examiner reliability was determined. RESULTS: The prevalence rates of FPM caries determined by DMFT (decayed), ICDAS II (codes 1-6) and CAST (codes 3-7) were 64.4% (61.6-67.2), 71.5% (69.2-73.2) and 71.0% (68.7-73.3), respectively. The prevalence rates of FPM caries determined by ICDAS II at various diagnostic cut-offs were as follows: 'sound' (code '0'), 28.5% (26.3-30.8); 'enamel caries' (codes 1-3), 57.2% (54.7-59.7) and 'dentinal caries' (codes 4-6), 14.3% (12.6-16.1). Similarly, the prevalence rates estimated by CAST at different diagnostic cut-off points were: 'healthy' (scores 0-2), 28.1% (25.9-30.4); 'premorbid' (score 3, enamel carious), 56.5% (54.0-59.0); 'morbid' (scores 4-5, cavitated carious dentin), 7.9% (6.6-9.3); 'severe morbidity' (scores 6-7, pulp exposure/fistula/abscess), 6.6% (5.4-8.1) and 'mortality' (score 8, lost), 0.8% (0.4-1.4). CONCLUSION: Enamel caries lesions were found in more than half of the FPMs investigated in the current study. CAST index is preferable because it detects the complete spectrum of caries. ICDAS II at codes 1-6 and CAST at codes 3-7 projected similar caries prevalence rates in FPMs.

Assessment of Caries Spectrum of First Permanent Molars in 7- to 8-Year-Old School Children in Northern Saudi Arabia: A Cross-Sectional Study

Abstract Objective: To estimate caries spectrum in first permanent molars (FPMs) of 7- to 8-year-old children in Saudi Arabia using Caries Assessment Spectrum and Treatment (CAST) index, and examine the correlation between distributions of CAST codes among contralateral and opposite arches. Material and Methods: A cross-sectional survey was conducted of 7- to 8-year-old Saudi school children in Sakaka, Aljouf, Saudi Arabia. A total of 385 children were examined. CAST codes were determined for FPMs, and their distribution was analyzed using Spearman's rank correlation coefficient. Statistical significance was set as p<0.05. Intra-examiner reliability was determined using the unweighted kappa coefficient. Results: The results indicated most of the FPMs were scored as code 3 (enamel lesions) such as upper contralateral FPM 44.40% for right, 53.50% for left, respectively, and lower contralateral molars were 61.30% for right and 64.90% for left, respectively. It was also observed that upper FPMs had scored code 0 (sound teeth) more than that of lower FPMs. Serious morbidity (codes 6 and 7) and mortality (code 8) showed a low prevalence in FPMs. Strong correlations were observed between upper contralateral FPMs (r=0.586) and lower contralateral FPMs (r=0.567, p<0.001). Conclusion: A high prevalence of enamel caries lesions (code 3) was observed in FPMs; in addition, a strong correlation was present between upper contralateral FPMs and between lower contralateral FPMs.