Detection of Approximal Caries in 5-Year-Old Swedish Children

Abstract

The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. Two hundred and sixty-seven consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs (decayed, missing and filled surfaces) value (canines and molars), the number of occlusal dmfs, the frequency of intake of between-meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs value without bitewing examination was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33% at least one enamel lesion that were detected from bitewing examination only. The gain from adding bitewing examination to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist’s overall judgement with an average precision of 73%; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33% of the 5-year-olds, representing a low caries prevalence population, benefited from bitewing examination. The ability to identify these children from the predictors was, however, limited.

Diet Intake and Caries Prevalence in Four-Year-Old Children Living in a Low-Prevalence Country

“…sucrose [Sheiham, 2001;Zero, 2004]. However, like several other studies [Garcia-Closas et al, 1997;Anderson et al, 2005], the present study failed to show a correlation between caries experience and reported intake frequency or amount of sugar-containing products. There are several possible explanations for the lack of association between sugar intake and caries experience in the present study group.…”

“…Still many epidemiological studies fail to show that the variation in caries prevalence is explained by variations in frequency or amount of sugar intake [Garcia-Closas et al, 1997;Anderson et al, 2005]. This may reflect that disease resistance is enhanced by fluoride or possibly other protective components, such as certain foods or food supplements [Zero, 2004].…”

Detection of Approximal Caries by Clinical and Radiographic Examination in 9-Year-Old Swedish Children

“…The rationale behind these guidelines is to avoid arbitrary radiographs and thereby reduce unnecessary exposure to X-rays, which is particularly important in children [Smith, 1992]. In 5-year-olds, the diagnostic yield from adding radiography to visual/tactile examination has been investigated in several studies [Raadal and Espelid, 1992;Sköld et al, 1997;Boman et al, 1999;Espelid et al, 2001;Anderson et al, 2005]. For example, 33-55% of Swedish and Norwegian 5-year-olds, respectively, benefited from bitewing examination even though they were considered to belong to low-caries prevalence populations [Raadal et al, 2000;…”

Author's reply:In vitrocomparison of digital and conventional bitewing radiographs

“…6 Nevertheless, it has been advocated that 5-year-old children should be exposed to bitewing radiography for examination of approximal surfaces. 7,8 By using these portable digital X-ray machines, children can be diagnosed radiographically and clinically in their dental units. Also, these portable digital X-ray machines can be used while children are treated under general anaesthesia or sedation.…”