Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care
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- Table 5.4
- Statist- ical met- hods Results* Sensitivity and specificity Study
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quality and relevance Comments Hänsel
Petersson et al
2002 [39] Sweden
50% of target population in a small city, Halland and surrounding rural areas n: 392 Age: 10–11 Permanent, all surfaces Mean DMFT: 0.9 Increment: New DMFS groups (border): 20: 2.6 40: 2.6
60: 1.5 80: 0.5
100: 0.3 2 11 (17 % of inten- tion-to-
treat) Not
stated BW Defined: Only dentine
caries 1 exam-
iner Intra
exam DMFT at baseline, plaque, diet, LB, MS in saliva, fluoride exposure, salivary secretion, buffer, general health ≥1 new DFS Proportion high risk: Not stated Log
regression OR, cario- gram
Se: 9%; Sp: 99.6%; PPV: 0.92; NPV: 0.71
80% chance to avoid caries Se: 73%; Sp: 60%; PPV: 0.45; NPV: 0.83 Low
Incom- plete data reporting. Bias from treatment possible. Effect of different predictors cannot be evaluated Lith et al 1992 [74] Sweden
Samples from 2 communities: 1.2 ppm fluor (1 group) 2. random sample of half with 0.2 ppm (0 group) n: 102+127 Age: 13
Permanent Mean
D en MFS: 2.5 Mean
DMFS: 0.6 Increment: 53% developed ≥1 new approximal dentine lesion
5 Not
stated Own
criteria BW only
2 exam- iners
Yes Past caries expe- rience: ≥0, ≥1, ≥2, ≥3 approximal DFS ≥1 new approximal dentine lesion
Proportion high risk: Not stated Accuracy
ROC curves
A z (area under the linear ROC curve All, 0 and fluor groups 13–18: 0.84, 0.82, 0.83 13–15: 0.81, 0.78, 0.81 Low
Retrospec- tive? Incom- plete data reporting 259 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.4 continued Author Year, reference Country Sample, n Age (years) 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 met- hods Results* Sensitivity and specificity Study quality and relevance Comments Hänsel
Petersson et al
2002 [39] Sweden
50% of target population in a small city, Halland and surrounding rural areas n: 392 Age: 10–11 Permanent, all surfaces Mean DMFT: 0.9 Increment: New DMFS groups (border): 20: 2.6 40: 2.6
60: 1.5 80: 0.5
100: 0.3 2 11 (17 % of inten- tion-to-
treat) Not
stated BW Defined: Only dentine
caries 1 exam-
iner Intra
exam DMFT at baseline, plaque, diet, LB, MS in saliva, fluoride exposure, salivary secretion, buffer, general health ≥1 new DFS Proportion high risk: Not stated Log
regression OR, cario- gram
Se: 9%; Sp: 99.6%; PPV: 0.92; NPV: 0.71
80% chance to avoid caries Se: 73%; Sp: 60%; PPV: 0.45; NPV: 0.83 Low
Incom- plete data reporting. Bias from treatment possible. Effect of different predictors cannot be evaluated Lith et al 1992 [74] Sweden
Samples from 2 communities: 1.2 ppm fluor (1 group) 2. random sample of half with 0.2 ppm (0 group) n: 102+127 Age: 13
Permanent Mean
D en MFS: 2.5 Mean
DMFS: 0.6 Increment: 53% developed ≥1 new approximal dentine lesion
5 Not
stated Own
criteria BW only
2 exam- iners
Yes Past caries expe- rience: ≥0, ≥1, ≥2, ≥3 approximal DFS ≥1 new approximal dentine lesion
Proportion high risk: Not stated Accuracy
ROC curves
A z (area under the linear ROC curve All, 0 and fluor groups 13–18: 0.84, 0.82, 0.83 13–15: 0.81, 0.78, 0.81 Low
Retrospec- tive? 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 260
Table 5.4 continued Author Year, reference Country Sample, n Age (years) 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 met- hods Results* Sensitivity and specificity Study quality and relevance Comments Mattiasson- Robertson et al
1993 [75] Sweden
Representative schools in two areas with dif- ferent F
n: 655 Age: 12
Permanent Mean
DMFS: 1.5 (low F), 2.2 (high F) Increment: New DMFS high F (low F): 1.4 (1.2) New
approximal enamel
lesions: 3.7 (2.5) 3 6
1967 BW Several exam- iners
(ordinary dentist)
No Past caries expe- rience: DMFS, approximal enamel lesions, MS in saliva and combined >3 new D
MFS, or >3 or >5 new approximal lesions Proportion high risk: 21% (high F) 38% (low F) Se, Sp,
PPV, NPV Best for past caries experience >3 new D en MFS Low F
Se: 60%; Sp: 78% High F
Se: 32%; Sp: 91% Low F better than high F. MS did not contribute to pre- diction Low
Retrospec- tive? (very low attrition) Mattila et al 2001 [76] Finland
Representa- tive of target population n: 1 070
Age: 7 Permanent 59% caries- free at age 7 mean DFT not
stated Increment Mean new DMFT: 2.3 3 35–46
Not stated
No BW (fibre
optics) Several
exam- iners
(ordinary dentist)
Sociodemographic factors, parents pre- vious dental health, dietary, oral hygiene habits (caries status at age 7 not used as predictor) Caries
increment cut-off not stated Proportion high risk: Not stated OR Mother’s previous caries, ≥3 carious teeth/yr: OR 2.6 Child’s bedtime ≥9 pm: OR 1.9 Sweet >1/week age 3: OR 2.1–2.7 Low Large
attrition ter Pelkwijk et al 1990 [33] Netherlands Children from 2 towns. Inclu- sion unclear, representative of target popu- lation n: 286
Age: 7 Permanent 72% caries- free mean dft or DMFT not stated Increment caries-free age 9: 41%, caries-free age 12:
36% 2 and
4 Not given Backer Dirks
1957 BW Senior exam- iners
n=? Expe-
rienced, calibrated No dmft age 7: 0, ≥1, ≥2, ≥3, ≥4, ≥5, ≥6 Caries
increment caries pre- valence DMFS >0
Proportion high risk: About 50% Se, Sp,
PPV, NPV, accuracy, ROC ≥ DMFT ≥4 or 5 7–9 (7–11) Se: 68–69%; Sp: 66–72%
Se: 68–73%; Sp: 72–77% Better values for caries experience than for caries increment Low
Incom- plete data reporting
261 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.4 continued Author Year, reference Country Sample, n Age (years) 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 met- hods Results* Sensitivity and specificity Study quality and relevance Comments Mattiasson- Robertson et al
1993 [75] Sweden
Representative schools in two areas with dif- ferent F
n: 655 Age: 12
Permanent Mean
DMFS: 1.5 (low F), 2.2 (high F) Increment: New DMFS high F (low F): 1.4 (1.2) New
approximal enamel
lesions: 3.7 (2.5) 3 6
1967 BW Several exam- iners
(ordinary dentist)
No Past caries expe- rience: DMFS, approximal enamel lesions, MS in saliva and combined >3 new D
MFS, or >3 or >5 new approximal lesions Proportion high risk: 21% (high F) 38% (low F) Se, Sp,
PPV, NPV Best for past caries experience >3 new D en MFS Low F
Se: 60%; Sp: 78% High F
Se: 32%; Sp: 91% Low F better than high F. MS did not contribute to pre- diction Low
Retrospec- tive? (very low attrition) Mattila et al 2001 [76] Finland
Representa- tive of target population n: 1 070
Age: 7 Permanent 59% caries- free at age 7 mean DFT not
stated Increment Mean new DMFT: 2.3 3 35–46
Not stated
No BW (fibre
optics) Several
exam- iners
(ordinary dentist)
Sociodemographic factors, parents pre- vious dental health, dietary, oral hygiene habits (caries status at age 7 not used as predictor) Caries
increment cut-off not stated Proportion high risk: Not stated OR Mother’s previous caries, ≥3 carious teeth/yr: OR 2.6 Child’s bedtime ≥9 pm: OR 1.9 Sweet >1/week age 3: OR 2.1–2.7 Low Large
attrition ter Pelkwijk et al 1990 [33] Netherlands Children from 2 towns. Inclu- sion unclear, representative of target popu- lation n: 286
Age: 7 Permanent 72% caries- free mean dft or DMFT not stated Increment caries-free age 9: 41%, caries-free age 12:
36% 2 and
4 Not given Backer Dirks
1957 BW Senior exam- iners
n=? Expe-
rienced, calibrated No dmft age 7: 0, ≥1, ≥2, ≥3, ≥4, ≥5, ≥6 Caries
increment caries pre- valence DMFS >0
Proportion high risk: About 50% Se, Sp,
PPV, NPV, accuracy, ROC ≥ DMFT ≥4 or 5 7–9 (7–11) Se: 68–69%; Sp: 66–72%
Se: 68–73%; Sp: 72–77% Better values for caries experience than for caries increment Low
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 262
Table 5.4 continued Author Year, reference Country Sample, n Age (years) 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 met- hods Results* Sensitivity and specificity Study quality and relevance Comments Petti et al 2000 [77] Italy
3 primary schools in Rome caries-free only included (39% of total sample) n: 314
Age: 6–7 Primary
and per- manent
Mean dft: 1.6 DMFT: 0.6 Increment Mean new dmft: 0.5, Mean new DMFT: 0.2 2 3
1987 BW 3 exam- iners Yes
Repeated salivary MS 0 vs 1–3, 0–1 vs 2–3, 0–2 vs 3 positive tests
Fluoride intake, sucrose intake plaque ≥1 new dft or DFT If exfoliated at follow-up: counted as caries Only
caries-free at baseline included Se, Sp,
PPV, NPV Modest improve- ment of MS multiple tests
0 vs 1–3 positive tests Se: 50%; Sp: 80%; PPV: 0.59; NPV: 0.74
Low F, high plaque Se: 57%; Sp: 94% Low Only caries- free included. Bias from study design Pienihäkkinen 1987 [44] Finland
Institutional- ised Hungarian children 1. Xylitol group 2. F and con- trol group n: 276
Age: 7–12 Permanent Mean
D en MFS: 1.8 Increment Mean new D en
2.0 2 30 Analysed WHO
No BW (fibre
optics) 7 exam-
iners at start,
3 there- after
Yes ≥1 incipient lesion or buccal or lingual surfaces
LB>10 5 CFU/ml saliva Yeasts ≥5 CFU/ml Saliva salivary buffer capacity: pH ≤5 and combinations of these
Age ≤9: 2–3 new
DMFS Age ≥10:
4–5 new DMFS
Proportion high risk: Median value (value not stated) Se, Sp, log regression Incipient lesions (inc) Se: 52%; Sp: 87% Combinations Inc and/or LB + yeasts Se: 67%; Sp: 76% Inc and/ or LB + yeasts Se: 70%; Sp: 71% Salivary buffering Se: 63%; Sp: 69 Accuracy max 0.77 Low
Very caries- active
children; open cavities common; not applicable to populations of today
Pienihäkkinen 1987 [45] Finland Institutional- ised Hungarian children (n=350)
1. Xylitol group 2. F and con- trol group n: 276
Age: 7–12 Permanent Mean
D en MFS: 1.8 Increment Mean new D en
2.0 2 19 WHO No BW
(fibre optics)
7 exam- iners at start, 3 there-
after Yes
Salivary buffering; 2 levels: pH ≤4 and pH ≤5 ≥3 new
DMFS Proportion high risk: Varying
Se, Sp Best for pH ≤5 at age ≤9 yrs Se: 58% girls; 52% boys Sp: 64% girls; 63% boys Same
material as Pienihäkkinen 1987 [44]. Important confounders not included 263 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.4 continued Author Year, reference Country Sample, n Age (years) at start Teeth tested, Caries preval- ence at start Obs time (yrs) Drop-out Explained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor Yüklə 4,3 Mb. Dostları ilə paylaş:
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