Prevalence of White Spot Caries Lesions in Primary Teeth in Preschool Children: Systematic Review and Meta-analysis.

BACKGROUND: The first clinically detectable stage of caries lesion is a non-cavitated white spot lesion (WSL). The detection of early stages of caries lesions allows non-invasive management by fluoride usage, oral hygiene and diet control. There is a lack of information in the literature regarding the prevalence of these caries lesions in preschool children, which is important especially for public health strategies. OBJECTIVE: The aim of this study was to conduct a systematic review with meta-analysis to verify the WSLs prevalence in primary teeth of preschool children. METHODS: A literature search with MEDLINE/PubMed, Scopus, Web of Science, and Open Gray databases was conducted. Included studies fulfilled the eligibility criteria. Meta-analyses were performed using random effects model, for prevalence of pooled WSLs and subgroups analyses. RESULTS: The search strategy identified 4922 potentially relevant articles, with final inclusion of 16 studies. The pooled prevalence of WSLs in primary teeth was 14.0% (95% CI: 8.0-24.0), without publication bias (p=0.2668). For subgroup analyses, an increase in WSLs prevalence for children of low-income economy (24.0%; 95% CI: 20.0-28.0), for age >31 months (22.0%; 95% CI: 12.0-37.0), for validated visual criteria assessment (20.0%; 95% CI: 11.0-33.0), and for tactile assessment with ball-ended probe (26.0%; 95% CI: 11-50.0) were detected. CONCLUSION: It is suggested that the prevalence of WSLs in primary teeth of preschool children increases in countries with low income economy, with age greater than 31 months or texture assessment with visual validated criteria or ball-ended probe. PROSPERO Registration: Protocol number #CDR42017078434.

Performance of light-emitting diode device in detecting occlusal caries in the primary molars.

This in vitro study aimed to compare the performance of a light-emitting diode (LED) device (Midwest Caries I.D.: MID), International Caries Detection and Assessment System (ICDAS) visual criteria, and fluorescence-based devices (DIAGNOdent: LF; DIAGNOdent pen: LFpen; and Quantitative Light-induced Fluorescence: QLF) in detecting occlusal caries in the primary molars. Eighty-eight primary molars with sound occlusal surfaces or carious lesions at different stages were assessed twice, with a 1-week interval in between, by one examiner using all three methods. Subsequently, the teeth were sectioned and lesion depth was verified using stereomicroscopy as a gold standard. Sensitivity, specificity, and accuracy were calculated at D1 (all carious lesions-enamel and dentin) and D3 (dentin lesions) thresholds. Correlation with histological analysis was evaluated using Spearman's rank correlation coefficients (rho). Weighted Kappa and intraclass-correlation (ICC) coefficients were calculated to assess intra-examiner reproducibility. At D1 threshold, ICDAS and LFpen showed higher sensitivity than the other methods, whereas ICDAS, LF, and QLF showed higher specificity (p < 0.05), and MID showed lower accuracy. At D3 threshold, ICDAS, LFpen, and QLF showed higher sensitivity than MID, whereas ICDAS, LF, and MID showed higher specificity (p < 0.05). All methods, except MID, showed statistically similar accuracy values (p < 0.05). Correlations with histopathological analysis varied from 0.15 (MID) to 0.57 (ICDAS). Intra-examiner reproducibility varied from 0.30 (MID) to 0.92 (ICDAS, LF, and QLF). The MID device exhibited a poor performance in detecting occlusal carious lesions in the primary molars, and ICDAS visual criteria exhibited greater accuracy than LF, LFpen, and QLF devices.