Do combinations of clinical parameters related to caries activity status predict progression more accurately than individual parameters?

Abstract

Few studies have addressed the predictive power of the clinical parameters used in assessing caries lesion activity. This study assessed the predictive validity of evaluating clinical parameters that are related to caries lesion activity status, individually and combined, in a long-term analysis. The occlusal surfaces of primary molars (1361 surfaces) were examined in 205 children according to the following clinical features: potential for plaque stagnation, colour, luster, cavitation, texture, and clinical depth. Cavities with frankly exposed dentine were excluded from this sample. After 1 year, 148 children (828 surfaces) were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as an outcome to verify the predictive power of the initially assessed clinical parameters. Different combinations of two or more parameters were also tested to check for any association with caries progression. Multilevel Poisson regression analyses were performed and the relative risk for each parameter/combination tested was calculated by considering a confidence interval of 95%. Forty percent of the reassessed surfaces presented caries progression after 1 year. Despite their surface integrity, dentine caries lesions were approximately 10-fold more likely and enamel lesions were approximately three-fold more likely to progress than sound surfaces. Similarly, cavitated lesions showed the highest risk of progression compared to sound/non-cavitated lesions. When only non-cavitated surfaces were considered, roughness proved to be a risk factor for caries progression. In conclusion, the lesions presenting clinical involvement of the dentine and even those cavitations clinically involving only the enamel had a higher risk of progression compared to sound or non-cavitated surfaces. For these lesions, the evaluation of other conjoint parameters seems unnecessary. Nevertheless, surface roughness can be a useful feature in predicting the risk of non-cavitated caries lesion progression.