Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care
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Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries pre- valence at start (dft/dfs) Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Grindefjord et al 1996 [16] Sweden 8 southern suburbs of Stockholm. 56% with immigrant background n: 692
Age: 1 and 2.5 Primary
Age 1: Caries-free Age 2.5: 7% dentine and 11% initial caries
Stepwise prediction 1–2.5; 2.5–3.5
1.5 and
1.5 and
1 37 Explained Koch 1967
modified 2 exam-
iners Yes
A total of 38 vari- ables added variables: Salivary buffer (SB), LB from tongue, gingivitis. Caries pre- valence: initial caries at age 2.5, manifest caries at age 2.5, proximal contacts molars, occlusion, cooperation at exam
0 vs ≥1 Initial and/ or manifest lesion
Proportion high risk: Not stated Log regres- sion, OR
OR 1–2.5 yrs (2.5–3.5 yrs) MS: 3.2 (3.7)’ Immigrant: 2.3 (2.6) Candy: 2.3 (1.6) SB not significant in univariate analysis. Highest OR from univariate analyses from age 2.5–3.5 Initial caries: 8.8 Manifest caries: 13.5 The possibility of identifying children at risk for caries increased from age 1 to age 3.5 Same mate- rial as 1995 [15] Se and Sp not reported Pienihäkki- nen et al 2002 [17] Finland All 2-year-olds in a municipa- lity in Finland born in 1987– 1988. Control group from prevention programme n: 226
Age: 2 Primary
3% had dmfs >0
Increment: 20% devel- oped ≥1 new dmfs
3 19
own criteria d1: Early enamel d2: Early dentine (no
cavity) d3:
Cavity No BW
(fibre optics)
5 exam- iners
Yes Incipient lesions, MS in plaque (presence or absence) Low risk: caries- free + MS=0 Intermediate risk: caries-free and MS+ High risk: caries and MS+
1. Low vs interme- diate + high risk 2. Low + interme- diate vs high risk ≥1 new d3mfs
Proportion high risk: 1. 35% 2. 9%
Se, Sp, log regression, OR Se, Sp for the routine prevention group
1. Se: 72% (95% CI 59–82); Sp: 77% (95% CI 72–82); PPV: 0.49; NPV: 0.9 2. Se: 32%; Sp: 98%, PPV: 0.85; NPV: 0.83 Accuracy: 0.76 and 0.83 High
The table continues on the next page K A R I E S – d I A G N O S T I K , R I S K B E d ö M N I N G O C H I C K E - I N vA S I v B E H A N d L I N G 226
Table 5.1 continued Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries pre- valence at start (dft/dfs) Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Pienihäkki- nen et al 2004 [18] Finland All 2-year-olds in a municipa- lity in Finland born in 1987– 1988. Control group from prevention programme n: 226
Age: 2 Primary
3% had dmfs >0
Increment: 20% dev-
eloped ≥1 new dmfs
3 19
own criteria d1: Early enamel d2: Early dentine (no
cavity) d3:
Cavity No BW
(fibre optics)
5 exam- iners
Yes Visible plaque (≥1 surface in 4 sex- tants), gingival bleeding, incipient lesions, MS in plaque, fluoride use, candies ≥1 new d
mfs Proportion high risk: MS: 33%
d 1–3
mfs: 9% candies: 54% Visible
plaque: 15%
Se, Sp, ROC, log regression, OR Model: area under ROC was highest for combined MS, d 1–3 mfs
and candies (=0.81). Visible plaque NS in the model
Se: 69%; Sp: 78% d 1–3 mfs Se: 29%; Sp: 97% Candies >1/week Se: 84%; Sp: 55% Visible plaque Se: 26%; Sp: 88% Use of fluorides (NS) Se: 53%; Sp: 58% Significant OR MS: 3.9
d 1–3
mfs: 7.3 Candies: 3.6 Visible plaque: 2.5 Modelling data. Same material as 2002 [17] Karjalainen et al 2001 [19] Finland Every 5th child from larger intervention study, Turku n: 135
Age: 3 Primary
92% caries- free
Mean dmft: 0.19
Increment: Mean new dmft: 0.8 3 9 WHO No BW
1 exam- iner
Yes Exam-
iners at the
end not stated
Mother’s education, sweet intake, tooth brushing frequency, visible plaque, gen- eral health Caries-
free vs not caries-free (including enamel
lesions) Proportion high risk: 7–29%
Relative risk
Se, Sp calcula-
ted from numerical data
Sweet intake: 1.5 (NS) Visible plaque: 0.9 (NS) Combined: 1.7 (NS) Sweet intake Se: 61%; Sp: 54% Visible plaque Se: 19%; Sp: 79% Combined Se: 72%; Sp: 47% Medium Insuffi-
cient data reporting. Only relative risk reported 227 K A P I T E L 5 • r I s K b E d ö M n I n g Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries pre- valence at start (dft/dfs) Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Pienihäkki- nen et al 2004 [18] Finland All 2-year-olds in a municipa- lity in Finland born in 1987– 1988. Control group from prevention programme n: 226
Age: 2 Primary
3% had dmfs >0
Increment: 20% dev-
eloped ≥1 new dmfs
3 19
own criteria d1: Early enamel d2: Early dentine (no
cavity) d3:
Cavity No BW
(fibre optics)
5 exam- iners
Yes Visible plaque (≥1 surface in 4 sex- tants), gingival bleeding, incipient lesions, MS in plaque, fluoride use, candies ≥1 new d
mfs Proportion high risk: MS: 33%
d 1–3
mfs: 9% candies: 54% Visible
plaque: 15%
Se, Sp, ROC, log regression, OR Model: area under ROC was highest for combined MS, d 1–3 mfs
and candies (=0.81). Visible plaque NS in the model
Se: 69%; Sp: 78% d 1–3 mfs Se: 29%; Sp: 97% Candies >1/week Se: 84%; Sp: 55% Visible plaque Se: 26%; Sp: 88% Use of fluorides (NS) Se: 53%; Sp: 58% Significant OR MS: 3.9
d 1–3
mfs: 7.3 Candies: 3.6 Visible plaque: 2.5 Modelling data. Same material as 2002 [17] Karjalainen et al 2001 [19] Finland Every 5th child from larger intervention study, Turku n: 135
Age: 3 Primary
92% caries- free
Mean dmft: 0.19
Increment: Mean new dmft: 0.8 3 9 WHO No BW
1 exam- iner
Yes Exam-
iners at the
end not stated
Mother’s education, sweet intake, tooth brushing frequency, visible plaque, gen- eral health Caries-
free vs not caries-free (including enamel
lesions) Proportion high risk: 7–29%
Relative risk
Se, Sp calcula-
ted from numerical data
Sweet intake: 1.5 (NS) Visible plaque: 0.9 (NS) Combined: 1.7 (NS) Sweet intake Se: 61%; Sp: 54% Visible plaque Se: 19%; Sp: 79% Combined Se: 72%; Sp: 47% Medium Insuffi-
cient data reporting. Only relative risk reported The table continues on the next page K A R I E S – d I A G N O S T I K , R I S K B E d ö M N I N G O C H I C K E - I N vA S I v B E H A N d L I N G 228
Table 5.1 continued Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries pre- valence at start (dft/dfs) Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Skeie et al 2006 [31] Norway
3 public dental clinics in Bergen, Norway n: 186
Age: 5 Permanent dmfs: 2.1 d1–5mfs: 4.4 48% caries- free
Increment Mean D1–
5MFS: 3.5 5 14 Explained Espelid
1990 BW d1–5mfs = including enamel lesions
5 exam- iners
Yes Caries experience at start 2nd primary and all primary molars ≥1 DFS
mesial sur- face of 1st permanent molar or incisors; or D1–5MFS
>1 SD above mean
Proportion high risk: 40% Se, Sp,
PPV, NPV, ROC
>2 d1–5mfs primary 2nd molars best pre- dictor: Se: 76% (95% CI 61–86); Sp: 72% (95% CI 66–76). ROC 0.75–0.76 for 2nd or all primary molars respectively Medium Important confounders not included Wendt et al 1996 [27] Sweden Random
selection from all children in a well-defined area
n: 289 Age: 1
Primary Caries-free Increment: 29% develo- ped ≥1 dmfs 2 11% Explained Modified Koch 1967
BW when
needed 1 exam-
iner Not
stated MS in saliva (pre- sence or absence), visible plaque (buccal surfaces of upper incisors), dietary habits (including no sugar at night), oral hygiene habits ≥1 new
caries lesion Proportion high risk: Not stated Log reg- ression, OR
No visible plaque: 3.6 Good oral hygiene age 2: 2.9 liquid when thirsty: 2.3
No sugar containing liquid at night: 23.7 Soft drinks <2/week at age 2: 2.4 MS at age 1 or 2 not related to caries age 3 Medium
Se, Sp not reported. Incom- plete data reporting BW = Bitewing; dfs = Decayed, filled surfaces (primary teeth); DFS = Decayed, filled surfaces (permanent teeth); dmfs = Decayed, missing, filled surfaces (primary teeth); dmft = Decayed, missing, filled teeth (primary teeth); LB = Lactobacilli; MS = Mutans streptococci; NPV = Negative predictive value; NS = Not significant; OR = Odds ratio; PPV = Positive predictive value; ROC = Receiver operating characteristic; SD = Standard deviation; Se = Sensitivity; Sp = Specificity; WHO = World Health Organization
229 K A P I T E L 5 • r I s K b E d ö M n I n g Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries pre- valence at start (dft/dfs) Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Skeie et al 2006 [31] Norway
3 public dental clinics in Bergen, Norway n: 186
Age: 5 Permanent dmfs: 2.1 d1–5mfs: 4.4 48% caries- free
Increment Mean D1–
5MFS: 3.5 5 14 Explained Espelid
1990 BW d1–5mfs = including enamel lesions
5 exam- iners
Yes Caries experience at start 2nd primary and all primary molars ≥1 DFS
mesial sur- face of 1st permanent molar or incisors; or D1–5MFS
>1 SD above mean
Proportion high risk: 40% Se, Sp,
PPV, NPV, ROC
>2 d1–5mfs primary 2nd molars best pre- dictor: Se: 76% (95% CI 61–86); Sp: 72% (95% CI 66–76). ROC 0.75–0.76 for 2nd or all primary molars respectively Medium Important confounders not included Wendt et al 1996 [27] Sweden Random
selection from all children in a well-defined area
n: 289 Age: 1
Primary Caries-free Increment: 29% develo- ped ≥1 dmfs 2 11% Explained Modified Koch 1967
BW when
needed 1 exam-
iner Not
stated MS in saliva (pre- sence or absence), visible plaque (buccal surfaces of upper incisors), dietary habits (including no sugar at night), oral hygiene habits ≥1 new
caries lesion Proportion high risk: Not stated Log reg- ression, OR
No visible plaque: 3.6 Good oral hygiene age 2: 2.9 No sugar containing liquid when thirsty: 2.3
No sugar containing liquid at night: 23.7 Soft drinks <2/week at age 2: 2.4 MS at age 1 or 2 not related to caries age 3 Medium
Se, Sp not reported. Incom- plete data reporting K A R I E S – d I A G N O S T I K , R I S K B E d ö M N I N G O C H I C K E - I N vA S I v B E H A N d L I N G 230
Table 5.2 Caries prediction in pre-school children. Studies with low quality and relevance. Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries preval- ence at start Obs time (yrs) Drop- out (%) Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statist- ical methods Results Sensitivity and specificity Study quality and relevance Comments Alaluusua et al 1994 [20] Finland Convenience sample: mot- hers attending a public dental clinic in a small urban town, Orimattila n: 92 Age: 1.5
Primary 8% had
≥1 initial caries
lesion 1.5
22 Own
1 exam- iner
No Mothers’ DMFT, salivary MS, child’s use of nursing bottle, child’s visible plaque on all 4 labial sur- faces of upper incisors
Any dfs including ini- tial lesions Proportion high risk: 18% (visible plaque), 36% (nursing bottle) Se, Sp,
accuracy Visible plaque best predictor Se: 83%, Sp: 92% Mother’s DMFT (MS) Se: 46% (54%); Sp: 82% (75%)
Se: 85%; Sp: 72% Low Retrospect- ive, popu- lation not specified Ekman
1990 [64] Sweden
All Finnish children in Luleå born in 1974–1975 n: 70 Age: 5
Primary dmfs: 9.1 3 30
1967 BW 1 exam- iner Yes
Caries experience primary teeth, parents dental status
dft value not stated
Parent: full denture
yes/no Proportion high risk: 25 or 30%
Se, Sp, PPV, NPV
>dmfs 25% Se: 47%; Sp: 80%; PPV: 0.39; NPV: 0.85
Se: 59%; Sp: 73% Parent full denture Se: 71%; Sp: 82%; PPV: 0.75; NPV: 0.88 Low
Small sample validating criteria for caries not stated Holbrook et al 1993 [22] Iceland 10% of target population in Reykjavik n: 158 Age: 4
Primary and per-
manent dft: 2.4
dfs: 3.3 2 30 (be- tween 4 and 6)
Not ana- lysed
+55% intention- to-treat Möller & Poulsen 1973
No BW 2 exam-
iners Yes
Misuse of sugar, fluoride use, MS, LB, baseline caries (dmfs >0), antibiotic use, combinations of these variables ≥1 DMFS in permanent teeth, ≥3 dmfs total score, ≥4 dmfs/DMFS Proportion high risk: 35% Se, Sp,
PPV, NPV, log regres- sion, OR
Se: 80%; Sp: 78%; PPV: 0.76; NPV: 0.82
Se: 91%; Sp: 61%; PPV: 0.48; NPV: 0.94
Se: 24%; Sp: 93%; PPV: 0.75; NPV: 0.58
Se: 10%; Sp: 100% (NS)
Se: 45%; Sp: 93% Low Large drop- out rate 231 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.2 Caries prediction in pre-school children. Studies with low quality and relevance. Yüklə 4,3 Mb. Dostları ilə paylaş:
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