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

Statistical 

methods

Results

Sensitivity 

and speci-

ficity

Study 

quality and 

relevance

Comments

Lawrence

et al

1995 [87]

USA

Piedemont 65+

Dental Study

NC

n: 234 black, 

218 white

Age: 65+

All root 

surfaces

3

45

Explained

Coronal 

(Radike

1972),

root (Katz

1980)

modified

No BW

5 exam-

iners

Yes

Race, gender,

baseline root 

DFS, MS, LB,

periodonto-

pathogens, 

gingival reces-

sion, periodontal 

status: PPD and

attachment loss, 

sociodemo-

graphy, general 

health, attitudes, 

habits, physical 

function, depres-

sion

≥1 new root

DFS

Proportion 

high risk: 

Not stated

(After  

3 yrs)

Mean net

incre-

ment 

of root 

DFS: 0.55

(0.80)

blacks 

(whites)

29%

blacks, 

39%

whites

develo-

ped ≥1 

new root

DFS

Log regres-

sion, OR

Significant 

OR in models

Blacks

Partial den-

ture: 3.4

Root frag-

ments: 3.3

Absence of 

Prevotella 

intermedia: 

2.7

Negative 

impact on 

appearance: 

2.2

Impaired

activities: 1.7

Whites

Gingival 

recession  

>4 mm: 4.5

Average PPD

>2 mm: 3.8

Antihista-

minica: 4.0

No calcium 

suppl: 2.5

Perceiving 

more pro-

blems since 

age 40: 5.0

Retired/

unemployed: 

3.2

Low

Large drop-

out rate

283

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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

Lawrence

et al

1995 [87]

USA

Piedemont 65+

Dental Study

NC

n: 234 black, 

218 white

Age: 65+

All root 

surfaces

3

45

Explained

Coronal 

(Radike

1972),

root (Katz

1980)

modified

No BW

5 exam-

iners

Yes

Race, gender,

baseline root 

DFS, MS, LB,

periodonto-

pathogens, 

gingival reces-

sion, periodontal 

status: PPD and

attachment loss, 

sociodemo-

graphy, general 

health, attitudes, 

habits, physical 

function, depres-

sion

≥1 new root

DFS

Proportion 

high risk: 

Not stated

(After  

3 yrs)

Mean net

incre-

ment 

of root 

DFS: 0.55

(0.80)

blacks 

(whites)

29%

blacks, 

39%

whites

develo-

ped ≥1 

new root

DFS

Log regres-

sion, OR

Significant 

OR in models

Blacks

Partial den-

ture: 3.4

Root frag-

ments: 3.3

Absence of 

Prevotella 

intermedia: 

2.7

Negative 

impact on 

appearance: 

2.2

Impaired

activities: 1.7

Whites

Gingival 

recession  

>4 mm: 4.5

Average PPD

>2 mm: 3.8

Antihista-

minica: 4.0

No calcium 

suppl: 2.5

Perceiving 

more pro-

blems since 

age 40: 5.0

Retired/

unemployed: 

3.2

Low

Large drop-

out rate

The table continues on the next page

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284

Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diagnostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and specifi-

city

Study 

quality and 

relevance

Comments

Leske et al

1989 [88]

USA

Corporation 

and University, 

Long Island,

NY, F deficient 

area (<0.3 ppm)

Selected by 

age, >14 teeth,

coronal DMFS

>4 included

n: 796

Age: 20–65

(mean 40)

All root 

surfaces

3

21

DFS: own

criteria

No BW

2 exam-

iners 

calibrated

Reliability

not stated

DFS root sur-

faces at base- 

line, age

≥1 new root

DFS

Proportion 

high risk: 24%

(After  

3 yrs)

Mean root

DFS incre-

ment: 2.5

19% deve-

loped new

root DS

Root caries

increment, 

Se and Sp

Age and base-

line root DFS

All participants

Se: 68%;  

Sp: 86%

55+

Se: 82%;  

Sp: 27%

Low

Sampling 

bias. Incom-

plete data 

reporting. 

No discrimi-

nation bet-

ween D and

F at baseline

Locker

1996 [89]

Canada

2 metropolitan 

and 2 non-

metropolitan, 

independently 

living Onta-

rio, Canada. 

Selected by 

interviews

n: 493

Age: 50+

All root 

surfaces

3

29

NIH publi-

cation no 

87-2868

No BW

No of 

examiners 

unclear

Yes

Sociodemograp-

hic, general health, 

physicosocial, 

health behaviour, 

oral care (self

and dentist, oral 

health indicators, 

baseline DFS, age

All together  

32 variables

≥1 new root

DFS

Proportion 

high risk:  

Not stated

(After  

3 years)

Mean DFS

increment: 

0.6

27% deve-

loped ≥1 

new DFS

and 16%

≥1 new DS

Log regres-

sion, RR,

OR

Model: signi-

ficant RR

Smoking: 1.5

Irregular

dental visiting: 

1.8 

Wearing  

partial den-

ture: 2.4

No of teeth 

more than 

median: 2.4

≥1 root DS at

baseline: 2.3

Significant OR

Age 65+: 2.5

Dental visiting

pattern: 1.9

Baseline root 

DS: 2.2

Low

Sampling bias 

and bias from 

treatment. 

Se and Sp not 

reported

Table 5.6 continued

285

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Author

Year,  

reference

Country

Sample, n

Age (yrs)  

at start

Teeth, 

surfaces

Obs 

time 

(yrs)

Drop-out Diagnostic 

criteria

Exam-

iner (n)

Relia-

bility

Predictor  

variables

Validating 

criteria

Inciden-

ce/incre-

ment

Statistical 

methods

Results

Sensitivity 

and specifi-

city

Study 

quality and 

relevance

Comments

Leske et al

1989 [88]

USA

Corporation 

and University, 

Long Island,

NY, F deficient 

area (<0.3 ppm)

Selected by 

age, >14 teeth,

coronal DMFS

>4 included

n: 796

Age: 20–65

(mean 40)

All root 

surfaces

3

21

DFS: own

criteria

No BW

2 exam-

iners 

calibrated

Reliability

not stated

DFS root sur-

faces at base- 

line, age

≥1 new root

DFS

Proportion 

high risk: 24%

(After  

3 yrs)

Mean root

DFS incre-

ment: 2.5

19% deve-

loped new

root DS

Root caries

increment, 

Se and Sp

Age and base-

line root DFS

All participants

Se: 68%;  

Sp: 86%

55+

Se: 82%;  

Sp: 27%

Low

Sampling 

bias. Incom-

plete data 

reporting. 

No discrimi-

nation bet-

ween D and

F at baseline

Locker

1996 [89]

Canada

2 metropolitan 

and 2 non-

metropolitan, 

independently 

living Onta-

rio, Canada. 

Selected by 

interviews

n: 493

Age: 50+

All root 

surfaces

3

29

NIH publi-

cation no 

87-2868

No BW

No of 

examiners 

unclear

Yes

Sociodemograp-

hic, general health, 

physicosocial, 

health behaviour, 

oral care (self

and dentist, oral 

health indicators, 

baseline DFS, age

All together  

32 variables

≥1 new root

DFS

Proportion 

high risk:  

Not stated

(After  

3 years)

Mean DFS

increment: 

0.6

27% deve-

loped ≥1 

new DFS

and 16%

≥1 new DS

Log regres-

sion, RR,

OR

Model: signi-

ficant RR

Smoking: 1.5

Irregular

dental visiting: 

1.8 

Wearing  

partial den-

ture: 2.4

No of teeth 

more than 

median: 2.4

≥1 root DS at

baseline: 2.3

Significant OR

Age 65+: 2.5

Dental visiting

pattern: 1.9

Baseline root 

DS: 2.2

Low

Sampling bias 

and bias from 

treatment. 

Se and Sp not 

reported

Table 5.6 continued

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286

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

MacEntee

et al

1993 [90]

Canada

Institutional-

ised (n=98)

and indepen-

dently living 

(n=58) in

Vancouver

n: 156

Age: 65+

5 coronal 

and 4 root 

surfaces

1

24%

Analysed

Coronal: 

Radike

1968, 

root: Katz 

1984

No BW

3 exam-

iners 

calibrated

Relia-

bility not 

stated

Baseline DFS,

MS, LB, oral

hygiene (plaque

index), saliva

secretion, medi-

cation, dental 

visits, sugar 

consumption

≥1 new DS

or ≥1 new

DFS

Proportion 

high risk: 

Not stated

(After  

1 yr)

Mean

root DFS

incre-

ment.

Institu-

tionali-

sed: 3.3

Indepen-

dently 

living: 1.0

71% of

institutio-

nalised

59% of

indepen-

dently 

living 

develo-

ped ≥1 

new DFS

(root

+coronal)

OR, log

regression

Significant OR

in models

New DS

Baseline 

caries: 5.0

Residence:

0.3 (Se: 63%;

Sp: 79%;

accuracy 

0.71)

New DFS

Baseline 

caries: 7.7

Model: Se:

70; Sp: 77

Model with

baseline caries  

excluded

LB: OR 2.0

Poor oral 

hygiene:  

OR 1.9

Sugar con-

sumption: 

OR 2.0

Residence:

OR 0.3

Se: 72%;  

Sp: 58%;

accuracy: 

0.72

Low

Reliability

not stated. 

Se and Sp 

not repor-

ted. Root

caries not 

reported 

separately

Table 5.6 continued

287

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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

MacEntee

et al

1993 [90]

Canada

Institutional-

ised (n=98)

and indepen-

dently living 

(n=58) in

Vancouver

n: 156

Age: 65+

5 coronal 

and 4 root 

surfaces

1

24%

Analysed

Coronal: 

Radike

1968, 

root: Katz 

1984

No BW

3 exam-

iners 

calibrated

Relia-

bility not 

stated

Baseline DFS,

MS, LB, oral

hygiene (plaque

index), saliva

secretion, medi-

cation, dental 

visits, sugar 

consumption

≥1 new DS

or ≥1 new

DFS

Proportion 

high risk: 

Not stated

(After  

1 yr)

Mean

root DFS

incre-

ment.

Institu-

tionali-

sed: 3.3

Indepen-

dently 

living: 1.0

71% of

institutio-

nalised

59% of

indepen-

dently 

living 

develo-

ped ≥1 

new DFS

(root

+coronal)

OR, log

regression

Significant OR

in models

New DS

Baseline 

caries: 5.0

Residence:

0.3 (Se: 63%;

Sp: 79%;

accuracy 

0.71)

New DFS

Baseline 

caries: 7.7

Model: Se:

70; Sp: 77

Model with

baseline caries  

excluded

LB: OR 2.0

Poor oral 

hygiene:  

OR 1.9

Sugar con-

sumption: 

OR 2.0

Residence:

OR 0.3

Se: 72%;  

Sp: 58%;

accuracy: 

0.72

Low

Reliability

not stated. 

Se and Sp 

not repor-

ted. Root

caries not 

reported 

separately

Table 5.6 continued

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288

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

Ravald et al

1992 [55]

Sweden

Referrals to a

specialist clinic 

for periodontal 

treatment

n: 98

Age: Mean 51

Range: 33–76

All root 

surfaces

2

33

Active 

root DS:

Hix 1976 

and Nyvad 

1982, 

inactive 

DS: own

criteria

BW, 

photos

1 exam-

iner

Yes

Smoking, general 

health, medica-

tion, fluorides, 

dietary habits, 

saliva secretion 

rate and buffer 

capacity, MS, LB,

visible plaque, 

sugar clearance 

time

≥1 new root

DFS

Proportion 

high risk: 

Not stated

51%

develo-

ped ≥1 

new root

DFS

Log regres-

sion, Se 

and Sp

For MS,

saliva secre-

tion and 

buffer, sugar 

clearance 

and dietary 

habits:

Se+Sp <120;

Smoking

Se: 54%;  

Sp: 67%

LB

Se: 48%;  

Sp: 74%

Visible plaque

Se: 52%;  

Sp: 82%

Combining 

variables

Se: 62%;  

Sp: 78%

Low

Drop-out

>30%.

Samp-

ling bias. 

Possible 

bias from 

fluoride 

treatment

Table 5.6 continued

289

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