Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statist-

ical met-

hods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Takano et al

2003 [54]

Japan

Non-institu-

tionalised  

from Nigata

n: 373

Age: 70+

All root 

surfaces

2

2%

WHO 

1997

No BW

4 exam-

iners

Yes

Baseline DFS,

oral hygiene 

(use of dental

floss or inter-

dental brush),

MS, LB, perio-

dontal pocket 

depth, loss of 

attachment, 

socioeconomics, 

sociodemo-

graphic general 

health, BMI

≥1, 2 or 3 

new root

DS

Proportion 

high risk: 

Not stated

(After  

2 yrs)

mean root 

DS incre-

ment=0.9

36% deve-

loped ≥1 

new root

DFS

Log reg-

ression, 

OR

Model 1: ≥1

new root DS,

sign OR

≥1 baseline 

root DS:

3.7;

≥2 prosthe-

tic crowns:

2.3;

poor oral 

hygiene: 2.1

mean loss 

of attach-

ment >3,6

mm: 2.3

Model 2: ≥2 

new root

DS, sign OR

≥1 baseline 

root DS:

3.4

≥2 prosthe-

tic crowns:

3.1

LB: 2.1

Poor oral 

hygiene: 2.8

Mean loss

of attach-

ment >3,6

mm: 3.0

BMI ≥20: 

2.2

Medium

Se, Sp not 

reported

Table 5.5 continued 

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

276

Table 5.6 Caries prediction in adults. Studies with low quality and relevance.

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Drake et al

1997 [83]

USA

Piedemont  

65+ study

n: 818

Age: 65+

All coronal 

and root 

surfaces

3

45

Coronal 

and root 

caries 

exami-

nation in 

patients’

homes  

criteria 

not stated

No BW

5 exam-

iners

Yes

Baseline coronal 

DFS, root frag-

ments, MS, LB

in saliva. Medical

history, smoking 

habits

Socioeconomy: 

Daily activities,

stress indicators, 

level of social 

support, life 

satisfaction, eco-

nomic status

≥1 new DFS

Proportion 

high risk: 

Not stated

Annual 

root DS

incidence: 

0.8 (1.6)

blacks 

(whites)

per 100 

surfaces 

at risk

(After 3

yrs) 45%

blacks, 

59 whites

develo-

ped ≥1 

new DFS

Log regres-

sion, OR,

Se and Sp

Models

DFS (mostly

D) in blacks

Number of 

teeth pre-

sent, LB, DF

root surfa-

ces, smoking: 

Se: 63%; Sp:

70%

DFS (mostly

F) in whites

Number of 

surfaces at 

risk, medical 

care, health 

index: Se: 

52%; Sp:

68%:

OR blacks:

LB: 1.6;  

Smoking 0,4;

OR whites:

number of 

coronal sur-

faces at risk: 

1.1; recent

medical care: 

2.1; impai-

red physical 

health: 1.1

Low

Large drop-

out rate. 

Incom-

plete data 

reporting. 

No discri-

mination 

between  

D and F  

at baseline

277

K A P I T E L   5   •   r I s K b E d ö M n I n g

Table 5.6 Caries prediction in adults. Studies with low quality and relevance.

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Drake et al

1997 [83]

USA

Piedemont  

65+ study

n: 818

Age: 65+

All coronal 

and root 

surfaces

3

45

Coronal 

and root 

caries 

exami-

nation in 

patients’

homes  

criteria 

not stated

No BW

5 exam-

iners

Yes

Baseline coronal 

DFS, root frag-

ments, MS, LB

in saliva. Medical

history, smoking 

habits

Socioeconomy: 

Daily activities,

stress indicators, 

level of social 

support, life 

satisfaction, eco-

nomic status

≥1 new DFS

Proportion 

high risk: 

Not stated

Annual 

root DS

incidence: 

0.8 (1.6)

blacks 

(whites)

per 100 

surfaces 

at risk

(After 3

yrs) 45%

blacks, 

59 whites

develo-

ped ≥1 

new DFS

Log regres-

sion, OR,

Se and Sp

Models

DFS (mostly

D) in blacks

Number of 

teeth pre-

sent, LB, DF

root surfa-

ces, smoking: 

Se: 63%; Sp:

70%

DFS (mostly

F) in whites

Number of 

surfaces at 

risk, medical 

care, health 

index: Se: 

52%; Sp:

68%:

OR blacks:

LB: 1.6;  

Smoking 0,4;

OR whites:

number of 

coronal sur-

faces at risk: 

1.1; recent

medical care: 

2.1; impai-

red physical 

health: 1.1

Low

Large drop-

out rate. 

Incom-

plete data 

reporting. 

No discri-

mination 

between  

D and F  

at baseline

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

278

Table 5.6 continued

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Ettinger et al

1990 [84]

USA

Patients 

scheduled for 

partial denture 

at University 

of Iowa

1975–1985

n: 254

Age: 59 (mean)

Abutment 

teeth

1–12

29

Root

caries

own  

criteria

No BW

No of 

exam-

iners 

unclear

Yes

Over denture

9 independ-

ent groups of 

variables: age, 

sex, medical 

problems, use 

of drugs, drug 

effects, fluor-

ide use, type of 

fluoride, brushing 

habits, periodon-

tal status

≥1 new DS

on over 

denture 

abutment 

teeth

Proportion 

high risk: 

Not stated

Incidence:

6.5% of

abutment 

teeth per 

year

Log regres-

sion, Se, Sp

Model: low

frequency of 

brushing, no 

fluoride at 

home, severe 

periodontal 

problems 

in mand-

ible, drugs 

with neural

side-effects, 

cardiovascu-

lar disease, 

Se: 8%; Sp:

99%

Low

Sampling 

bias. Incom-

plete data 

reporting

Hawkins et al

1997 [85]

Canada

Independently

living in four 

Ontario  

locations

n: 699

Age: 50+

All coronal 

and root 

surfaces

3

30

Coronal:

“conser-

vative 

approach”,

not 

further 

specified

No BW

2 exam-

iners

Yes

Sociodemo-

graphic, general 

health, psycho-

social, health 

behaviour, oral 

self care, dental 

visiting, baseline 

caries, preval-

ence, wearing

partial denture, 

mean periodontal 

attachment loss

≥1 coronal 

DFS or

mean net 

increment

Proportion 

high risk: 

69%

(After 3

yrs)

Mean net

coronal 

DFS

incre-

ment/

100 sur-

faces at 

risk: 2.1

57%

deve-

loped 

≥1 new

coronal 

DFS

Log regres-

sion, OR,

Se and Sp

Significant OR

in model

High school 

education: 

0.5

Married: 0.6

Baseline 

attachment 

loss: 0.8

Baseline 

no of teeth 

(>20): 1.1  

Se: 80%;  

Sp: 46%;

accuracy: 

0.66

Low

Incom-

plete data 

reporting. 

Coronal 

caries only

279

K A P I T E L   5   •   r I s K b E d ö M n I n g

Table 5.6 continued

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Ettinger et al

1990 [84]

USA

Patients 

scheduled for 

partial denture 

at University 

of Iowa

1975–1985

n: 254

Age: 59 (mean)

Abutment 

teeth

1–12

29

Root

caries

own  

criteria

No BW

No of 

exam-

iners 

unclear

Yes

Over denture

9 independ-

ent groups of 

variables: age, 

sex, medical 

problems, use 

of drugs, drug 

effects, fluor-

ide use, type of 

fluoride, brushing 

habits, periodon-

tal status

≥1 new DS

on over 

denture 

abutment 

teeth

Proportion 

high risk: 

Not stated

Incidence:

6.5% of

abutment 

teeth per 

year

Log regres-

sion, Se, Sp

Model: low

frequency of 

brushing, no 

fluoride at 

home, severe 

periodontal 

problems 

in mand-

ible, drugs 

with neural

side-effects, 

cardiovascu-

lar disease, 

Se: 8%; Sp:

99%

Low

Sampling 

bias. Incom-

plete data 

reporting

Hawkins et al

1997 [85]

Canada

Independently

living in four 

Ontario  

locations

n: 699

Age: 50+

All coronal 

and root 

surfaces

3

30

Coronal:

“conser-

vative 

approach”,

not 

further 

specified

No BW

2 exam-

iners

Yes

Sociodemo-

graphic, general 

health, psycho-

social, health 

behaviour, oral 

self care, dental 

visiting, baseline 

caries, preval-

ence, wearing

partial denture, 

mean periodontal 

attachment loss

≥1 coronal 

DFS or

mean net 

increment

Proportion 

high risk: 

69%

(After 3

yrs)

Mean net

coronal 

DFS

incre-

ment/

100 sur-

faces at 

risk: 2.1

57%

deve-

loped 

≥1 new

coronal 

DFS

Log regres-

sion, OR,

Se and Sp

Significant OR

in model

High school 

education: 

0.5

Married: 0.6

Baseline 

attachment 

loss: 0.8

Baseline 

no of teeth 

(>20): 1.1  

Se: 80%;  

Sp: 46%;

accuracy: 

0.66

Low

Incom-

plete data 

reporting. 

Coronal 

caries only

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

280

Table 5.6 continued

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Hänsel 

Petersson 

et al

2003 [86]

Sweden

Random

sample of 

55+,65+ and

75+

n: 208

Mean age: 67

Range 60–80

(at the end)

All coronal 

and root 

surfaces

5

29

Explained

Coronal: 

WHO 

(1987),

root: 

Banting 

(1980)

No BW?

1 exam-

iner

Reliability

test not 

stated

Cariogram; per-

cent chance to 

avoid caries:

0–20, 21–40,

41–60 and

61–100

≥1 new DS,

DFS, DMFT

and DFRS

(decayed and

filled root 

surfaces)

Proportion 

high risk: 

26–43%

(high to

rather high 

risk)

(After  

5 yrs)

Mean

incre-

ment: 

DMFS =

9.5

DFRS =

2.5

51% deve-

loped 

≥1 new

coronal 

DS. 61%

develo-

ped ≥1 

new root

DS

Cariogram

OR for DFRS

for 20%

group: 3.9, 

40%: 3.3 and

60%: 3.9.

≥1 new 

DS from

Cariogram

(calculated

from pub- 

lished data)

0–20%*

Se: 35%;  

Sp: 88%

61–100%

Se: 93%; 

Sp: 32%

Low

Incom-

plete data 

reporting. 

Influence

of different 

predictors 

cannot be 

evaluated

* Chance

to avoid 

root caries 

(DFRS)

cannot be 

calculated 

from the 

data

281

K A P I T E L   5   •   r I s K b E d ö M n I n g

Table 5.6 continued

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diag-

nostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Hänsel 

Petersson 

et al

2003 [86]

Sweden

Random

sample of 

55+,65+ and

75+

n: 208

Mean age: 67

Range 60–80

(at the end)

All coronal 

and root 

surfaces

5

29

Explained

Coronal: 

WHO 

(1987),

root: 

Banting 

(1980)

No BW?

1 exam-

iner

Reliability

test not 

stated

Cariogram; per-

cent chance to 

avoid caries:

0–20, 21–40,

41–60 and

61–100

≥1 new DS,

DFS, DMFT

and DFRS

(decayed and

filled root 

surfaces)

Proportion 

high risk: 

26–43%

(high to

rather high 

risk)

(After  

5 yrs)

Mean

incre-

ment: 

DMFS =

9.5

DFRS =

2.5

51% deve-

loped 

≥1 new

coronal 

DS. 61%

develo-

ped ≥1 

new root

DS

Cariogram

OR for DFRS

for 20%

group: 3.9, 

40%: 3.3 and

60%: 3.9.

≥1 new 

DS from

Cariogram

(calculated

from pub- 

lished data)

0–20%*

Se: 35%;  

Sp: 88%

61–100%

Se: 93%; 

Sp: 32%

Low

Incom-

plete data 

reporting. 

Influence

of different 

predictors 

cannot be 

evaluated

* Chance

to avoid 

root caries 

(DFRS)

cannot be 

calculated 

from the 

data

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

282

Table 5.6 continued