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 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 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 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 232
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 Levy et al 2003 [65] All children from 8 Iowa hospitals 1992–1995 n: 291
Age: Birth Primary
23% had caries at ages 4–6 4–6
Not stated
(54%, calcula-
ted from Marshall 2003) Warren
2002 No BW
2 exam- iners
Yes Fluoride in water, diet: Various sugar- containing drinks, water, milk, gender dfs=0 vs dfs >0 Proportion high risk: Not stated Log reg- ression, OR, AUC
Brushings/day from age 3–4: 0.70 Water consumption from age 3–4: 0.57 Milk consumption during 3rd year: 0.69 Sugared beverage vs milk consumption during 1st year: 1.7 AUC: 0.69 Low
Large drop-out. No Se, Sp Li et al
2002 [66] China
Random sample from village outside Beijing start 1992 n: 362
Age: Mean 3.5 Permanent dmft at start:
5.5–6.7 8 (11.7 at end)
28 WHO
No BW 2 exam-
iners Yes
Baseline caries, dif- ferent tooth types, any molar, all molars ≥1 DFT
Proportion high risk: About 1/3 Se, Sp, RR dmft ≥10: RR 3.5
Se: 48%; Sp: 78%; PPV: 0.51, accuracy: 0.66
Low Too long follow- up time. Important confounders not inclu- ded little bias from treatment however! Marshall et al 2003 [67] USA
Cohort fol- lowed from birth – Iowa Fluoride study n: 396 Age: Birth Primary dft not
stated 5 38 Not explained Pitts 1988,
1997 No BW
Exam- iners not stated No
regular beverages from powder Any dentine caries
Proportion high risk: Not stated Log reg-
ression, OR
1–5 yrs combined Age at dental exam: 3.2 Regular soda pop, high intake: 2.2 Regular beverages from powder, high intake: 2.0 Low Diagnostic procedures unclear, important confounders not included
233 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 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 Levy et al 2003 [65] All children from 8 Iowa hospitals 1992–1995 n: 291
Age: Birth Primary
23% had caries at ages 4–6 4–6
Not stated
(54%, calcula-
ted from Marshall 2003) Warren
2002 No BW
2 exam- iners
Yes Fluoride in water, diet: Various sugar- containing drinks, water, milk, gender dfs=0 vs dfs >0 Proportion high risk: Not stated Log reg- ression, OR, AUC
Brushings/day from age 3–4: 0.70 Water consumption from age 3–4: 0.57 Milk consumption during 3rd year: 0.69 Sugared beverage vs milk consumption during 1st year: 1.7 AUC: 0.69 Low
Large drop-out. No Se, Sp Li et al
2002 [66] China
Random sample from village outside Beijing start 1992 n: 362
Age: Mean 3.5 Permanent dmft at start:
5.5–6.7 8 (11.7 at end)
28 WHO
No BW 2 exam-
iners Yes
Baseline caries, dif- ferent tooth types, any molar, all molars ≥1 DFT
Proportion high risk: About 1/3 Se, Sp, RR dmft ≥10: RR 3.5
Se: 48%; Sp: 78%; PPV: 0.51, accuracy: 0.66
Low Too long follow- up time. Important confounders not inclu- ded little bias from treatment however! Marshall et al 2003 [67] USA
Cohort fol- lowed from birth – Iowa Fluoride study n: 396 Age: Birth Primary dft not
stated 5 38 Not explained Pitts 1988,
1997 No BW
Exam- iners not stated No
regular beverages from powder Any dentine caries
Proportion high risk: Not stated Log reg-
ression, OR
1–5 yrs combined Age at dental exam: 3.2 Regular soda pop, high intake: 2.2 Regular beverages from powder, high intake: 2.0 Low Diagnostic procedures unclear, important confounders not included
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 234
Table 5.2 continued 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 Mattila et al 2005 [68] Finland
Random sample of larger popula- tion: Mothers expecting their first baby n: 550 Age: Before birth Primary
and perma- nent
dft not stated
7 13–15
Collected retrospec- tively from records
WHO 1987
No BW (fibre
optic) Several
exam- iners
Yes Sociodemographic factors Parents: Age, educa- tion, marital status, dental health child’s dietary and oral hygiene factors dmft/DMFT ≥5 Only high risk studied Proportion high risk: Not stated Log reg- ression, OR
≥3 dmft/year Mother, previous caries: OR 2.6 Tooth brushing
Bedtime after 9 pm, (sweets >1/week): OR 1.9 (2.1) Age 10: poor dental health vs caries-free OR Father, young age: 2.8 Infrequent brushing: 2.9 Primary and per- manent teeth Use of sweets >1/week: OR 2.7 Low
No true prediction study. Incom-
plete data reporting Ollila et al 1998 [28] Finland 11 day-care centres in Oulu, Finland n: 152 Age: 2.5
Primary 86% caries- free at start, dfs not stated 2 17 Own No BW
Ordinary dentists
No Social class, LB, candida, use of paci- fier, nursing bottle, breast-feeding, age at follow-up >0 caries lesions
Proportion high risk: Not stated RR Use of pacifier ≥24 months: RR 3.5 Nursing bottle ≥24 months: RR 2.6 LB, candida: RR 1.6, 1.5 (NS) Low
Important confounders not included Schröder et al 1994 [23] Sweden
All children from 2 health centres. Low caries pre- valence n: 181
Age: 1.5 Primary
Caries-free 1.5
13 Explained Not stated
2 exam- iners
No MS in saliva, diet, oral hygiene Any caries not defined Proportion high risk: varying
Se, Sp, PPV, NPV
MS in saliva, diet, oral hygiene Se: 26%, 90%, 12% Sp: 88%, 15%, 92% PPV: 0.95, 0.26, 0.35 NPV: 0.46, 0.80, 0.73 Combinations: NS Low Incom-
plete data reporting 235 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.2 continued 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 Mattila et al 2005 [68] Finland
Random sample of larger popula- tion: Mothers expecting their first baby n: 550 Age: Before birth Primary
and perma- nent
dft not stated
7 13–15
Collected retrospec- tively from records
WHO 1987
No BW (fibre
optic) Several
exam- iners
Yes Sociodemographic factors Parents: Age, educa- tion, marital status, dental health child’s dietary and oral hygiene factors dmft/DMFT ≥5 Only high risk studied Proportion high risk: Not stated Log reg- ression, OR
≥3 dmft/year Mother, previous caries: OR 2.6 Tooth brushing
Bedtime after 9 pm, (sweets >1/week): OR 1.9 (2.1) Age 10: poor dental health vs caries-free OR Father, young age: 2.8 Infrequent brushing: 2.9 Primary and per- manent teeth Use of sweets >1/week: OR 2.7 Low
No true prediction study. Incom-
plete data reporting Ollila et al 1998 [28] Finland 11 day-care centres in Oulu, Finland n: 152 Age: 2.5
Primary 86% caries- free at start, dfs not stated 2 17 Own No BW
Ordinary dentists
No Social class, LB, candida, use of paci- fier, nursing bottle, breast-feeding, age at follow-up >0 caries lesions
Proportion high risk: Not stated RR Use of pacifier ≥24 months: RR 3.5 Nursing bottle ≥24 months: RR 2.6 LB, candida: RR 1.6, 1.5 (NS) Low
Important confounders not included Schröder et al 1994 [23] Sweden
All children from 2 health centres. Low caries pre- valence n: 181
Age: 1.5 Primary
Caries-free 1.5
13 Explained Not stated
2 exam- iners
No MS in saliva, diet, oral hygiene Any caries not defined Proportion high risk: varying
Se, Sp, PPV, NPV
MS in saliva, diet, oral hygiene Se: 26%, 90%, 12% Sp: 88%, 15%, 92% PPV: 0.95, 0.26, 0.35 NPV: 0.46, 0.80, 0.73 Combinations: NS Low Incom-
plete data reporting 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 236
Accuracy = Proportion correct predictions; AUC = Area under the curve; BW = Bitewing; dfs = Decayed, filled surfaces (primary teeth); dft = Decayed, filled teeth (primary teeth); DFT = Decayed, filled teeth (permanent teeth); dmfs = Decayed, missing, filled surfaces (primary teeth); DMFS = Decayed, missing, filled surfaces (permanent teeth); dmft = Decayed, missing, filled teeth (primary teeth); DMFT = Decayed, missing,
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