Tobacco use and caries increment in young adults: a prospective observational study.

OBJECTIVE: Tobacco use has a negative influence on general and oral health but data concerning caries are mainly derived from epidemiological and cross-sectional studies. The aim of this study was to investigate smoking and use of smokeless tobacco (Swedish snus) as determinants of dental caries increment in young adults over 3 years. The baseline cohort consisted of 1295 19-year-olds registered at eight Public Dental Clinics representing socioeconomic strata. After 3 years, 982 of the patients could be reexamined (drop-out rate 24.2%). Caries was scored as decayed and filled surfaces according the WHO criteria and the individual caries increment was recorded by counting the number of surfaces that changed from "sound" to "decayed/filled" over the study period. Information on habitual tobacco use (smoking, snuffing) was collected from a structured questionnaire at baseline. RESULTS: The baseline prevalence of smoking and use of Swedish snus was 22.3% and 6.3% respectively. Smoking, but not snuffing, displayed a statistically significant relationship with caries increment over 3 years. For smoking, the relative risk was 1.5 (95% CI 1.2-1.7) and the number needed to harm 6.8 (95% CI 4.5-14.2). Thus, habitual smoking is a risk factor for caries in young adults and the findings reinforce arguments that dental health professionals should incorporate anti-smoking activities in their preventive strategies.

Relationship between risk assessment and payment models in Swedish Public Dental Service: a prospective study.

BACKGROUND: To a) compare risk categories in patients selecting a capitation payment (CP) model with those in fee-for-service (FFS), b) determine the 3-year caries increment in the two groups, and c) compare the amount of delivered preventive care in the two groups. METHODS: A comprehensive risk assessment was carried out in 1295 young adults attending eight Public Dental Clinics in the Scania region and 75% could be re-examined after 3 years; 615 had selected the CP model and 310 the traditional FFS. Caries was scored according to WHO and data concerning preventive care was extracted from the dental records. RESULTS: More patients in the low risk category preferred the CP model (74% vs. 26%) while >80% with high risk selected FFS. The baseline caries level was significantly higher in the FFS group as well as the 3-year caries increment (1.6 vs. 0.8 DFS: p < 0.05). The amount of additional preventive care delivered to each patient was generally lower in the FFS model; it was most frequent among patients with "some" risk in the CP model (83.8%) while the lowest delivery rates were found among low risk patients in the FFS system (32.4%). CONCLUSIONS: Young adults in public dental care with low risk preferred the prepaid model while those in the higher risk categories selected fee-for-service. As more additional preventive care was delivered to patients in the subscribed care, oral health planners and decision makers should be aware of the fact that capitation payment models may enhance inequalities in dental health over time.

Caries risk assessment in young adults: a 3 year validation of the Cariogram model.

BACKGROUND: To validate baseline caries risk classifications according to the Cariogram model with the actual caries development over a 3-year period in a group of young adults living in Sweden. METHODS: The study group consisted of 1,295 19-year-old patients that completed a comprehensive clinical baseline examination, including radiographs and salivary tests. An individual caries risk profile was computed and the patient was placed in one of five risk categories. After 3 years, 982 patients (75.8%) were re-examined and caries increment for each patient was calculated. The outcome was expressed as sensitivity, specificity and predictive values and compared with a risk assessment scheme used in Public Dental Service. RESULTS: The drop-outs displayed more risk factors and a significantly higher caries burden at baseline compared with those that remained in the project (p < 0.05). There was a strong association between the Cariogram risk categories and the 3-year caries increment on cavity level but the predictive values were modest. The high or very high caries risk categories yielded high specificities (>90%) but poor sensitivities. The low risk groups displayed higher sensitivities on expense of impaired specificities. No combinations proved clinically useful values according to Yuoden's index. CONCLUSIONS: Within the limitations of the present study, the computer-based Cariogram did not perform better than a caries risk assessment scheme based on past caries experience and caries progression, over a 3-year period in young adults.

Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram--a comparative study.

OBJECTIVES: To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. MATERIALS AND METHODS: All 19-year-old patients registered at eight public dental clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. RESULTS: The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as 'some risk', while 16.7% were assessed as being of 'high' or 'very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The agreement between the two models was found acceptable (77.5%) for those assessed as low risk, while discrepancies were disclosed among those classified with higher risks. CONCLUSIONS: Although the proportion of subjects assessed with high or very high risk was similar using the PDS guidelines and the Cariogram model, the agreement between the models was fair. An acceptable agreement was only disclosed for the low risk category.

Influence of education level and experience on detection of approximal caries in digital dental radiographs. An in vitro study.

This study evaluated whether variations in education level and experience among dental staff influence the diagnostic accuracy of carious lesions on digital radiographs. Three student groups and a fourth group of general practitioners (Dentists) with more than five years of clinical experience participated in this study.The student groups were (i) dental students in their final (tenth) semester (DS-10), (ii) dental students in the sixth semester (DS-6) who just finished dental radiology training, and (iii) dental hygiene students (DHS) in their final (fourth) semester. Seven observers from each group participated. Standard radiographs of 100 extracted teeth (premolars and molars) were taken. The 28 observers evaluated the images for approximal carious lesions on a standard monitor. All evaluations were made in ambient light below 50 lux. Receiver operating characteristic curves were plotted to assess results. The standard criterion for healthy or carious lesions was a histological examination of sliced teeth. Kappa statistics evaluated intra-observer agreement. For carious lesions that had extended into the dentine, significant differences were found between (i) Dentists and all other groups, (ii) Dentists and DS-10 (p < 0.01), and (iii) Dentists and DS-6 and DHS (p < 0.001). Differences between DS-10 and DHS (p < or = 0.05) were also significant. In this study, education level and experience clearly influenced the diagnostic accuracy of approximal carious lesions that had extended into the dentine on digital radiographs.

Caries risk profiles in schoolchildren over 2 years assessed by Cariogram.

BACKGROUND: Caries risk assessment is an important tool in clinical decision making. AIM: To evaluate longitudinal changes in caries risk profiles in a group of schoolchildren in relation to caries development. DESIGN: The Cariogram model was used to create caries risk profiles and to identify risk factors in 438 children being 10-11 years at baseline. The assessment was repeated after 2 years and the caries increment was recorded. The frequency of unfavourable risk factors were compared between those considered at the lowest and the highest risk. RESULTS: Fifty percent of the children remained in the same risk category after 2 years. One third of the children were assessed in a higher-risk category while 18.4% showed a lower risk. Those with increased risk compared with baseline developed significantly more caries than those with an unchanged risk category. The most frequent unfavourable risk factors among those with high risk at baseline were high-salivary mutans streptococci and lactobacilli counts as well as frequent meals. CONCLUSION: Half of the children showed a changed risk category after 2 years, for better or for worse, which suggests that regular risk assessments are needed in order to make appropriate decisions on targeted preventive care and recall intervals.

Caries risk assessment in school children using a reduced Cariogram model without saliva tests.

BACKGROUND: To investigate the caries predictive ability of a reduced Cariogram model without salivary tests in schoolchildren. METHODS: The study group consisted of 392 school children, 10-11 years of age, who volunteered after informed consent. A caries risk assessment was made at baseline with aid of the computer-based Cariogram model and expressed as "the chance of avoiding caries" and the children were divided into five risk groups. The caries increment (DeltaDMFS) was extracted from the dental records and bitewing radiographs after 2 years. The reduced Cariogram was processed by omitting the variables "salivary mutans streptococci", "secretion rate" and "buffer capacity" one by one and finally all three. Differences between the total and reduced models were expressed as area under the ROC-curve. RESULTS: The baseline caries prevalence in the study population was 40% (mean DMFS 0.87 +/- 1.35) and the mean 2-year caries increment was 0.51 +/- 1.06. Both Cariogram models displayed a statistically relationship with caries development (p < 0.05); more caries was found among those assessed with high risk compared to those with low risk. The combined sensitivity and specificity decreased after exclusion of the salivary tests and a statistically significant reduction of the area under the ROC-curve was displayed compared with the total Cariogram (p < 0.05). Among the salivary variables, omission of the mutans streptococci enumeration impaired the predictive ability the most. CONCLUSIONS: The accuracy of caries prediction in school children was significantly impaired when the Cariogram model was applied without enumeration of salivary tests.

Comparing caries risk factors and risk profiles between children and elderly.

The aim of this study was to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors. The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the 'percent chance of avoiding caries' in the future. The data used originated from two separate longitudinal studies illustrating the Cariogram's capacity to assess caries risk. One study comprised about 400 children; the other included about 150 elderly. At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and after two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26% belonged to the highest caries risk group versus 3 % of the children. The mean DFS increment per year for the total group of children was 0.4 +/- 0.8 (SD) and 1.2 +/- 1.9 for the elderly. Individual factors contributing significantly to the higher risk profiles for the adults were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Over all, the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

Assessing caries risk--using the Cariogram model.

In trying to make a comprehensive caries risk profile for an individual, one faces a situation that several factors need to be considered and weighted together. Summarising these factors could be a complex process and to facilitate the practical application, a computer-based risk assessment model for caries, the Cariogram, was developed. The Cariogram program operates basically in such a way that information on a number of factors are collected about the patient, transferred to 'scores' and these scores then entered into the program. According to its built-in algorithm, the program evaluates the data and presents the summarised result expressed as one figure, a pie-diagram, illustrating the 'Chance of avoiding cavities' in the future. This thesis deals with the evaluation of the Cariogram model and, as a first step, it was important to investigate if the program was in line with how colleagues, dental students and dental hygienists would evaluate a set of cases. The first two studies (Paper I and II) confirmed that the 'opinion' on the risk profile of the risk assessment program was in line with the opinions of the majority of the responders in these groups. In the third study (Paper III), the Cariogram's assessments were tested against the "reality" for the first time. The model was used to assess risk for caries among children and to evaluate the program by comparing the caries risk assessments of the risk model with the actual caries increment of the children over a two-year period. The hypothesis was that the Cariogram should be able to sort the children into caries risk groups according to the actual caries increment and the results confirmed the theory. It was also demonstrated that the Cariogram assessed caries increment more accurately than any included single factor model. Following the evaluation of the program on the children, the aim of the fourth study (Paper IV) was to evaluate the model for risk assessment in a group of elderly individuals. Comparing the caries risk assessment of the program with the actual caries increment over a five-year period showed that the program was able to arrange this group of elderly individuals into risk groups that reflected the actual caries incidence. The aim of the fifth study was to compare the risk profiles of the children with the risk profiles of the elderly. The evaluation of caries risk among the children showed that 3% was considered having very high caries risk, while 50% appeared in the low risk group. The corresponding values for the group of elderly individuals were 26% and 2%. Overall, the risk for caries, as assessed by the Cariogram, was twice as high for the elderly as for the children (V). The present thesis also tries to explore the concept of risk, the terminology and definitions related to risk, risk management and risk assessment in dentistry.