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, 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%
Se: 48%; Sp: 74%
Se: 52%; Sp: 82%
Se: 62%; Sp: 78% Low
Drop-out >30%.
Samp- ling bias. Possible bias from fluoride treatment Table 5.6 continued 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 290
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 Scheinin et al 1994 [56] Finland
Patients trea- ted at Dept of Cariology, Oral Diagno- sis, University of Turku
n: 96 Age: Mean 62 Range: 47–79 All coronal and root surfaces
3 8 Coronal WHO 1987
Root caries
“denoted similarly” Available radio-
graphs No of
exam- iners
unclear Relia-
bility not stated
MS, LB, Candida, saliva secretion, buffer capacity, sucrase activity, visible plaque ≥1 new root DFS Proportion high risk: 51%
Mean root DS
incre- ment:
1st yr: 1.5 2nd and
3rd yr: 0.56/yr
51% develo-
ped ≥1 new root DFS Log regres- sion, OR, Se and Sp Model (root DFS, LB and candida) Se: 78%; Sp: 77%
Root DFS: 12.8 LB: 8.6
Single variables Root DFS Se: 45%; Sp: 94%
Se: 88%; Sp: 47%
Se: 67%; Sp: 68%
Se: 90%; Sp: 57%
Se: 76%; Sp: 55%
Se: 59%; Sp: 62% Low
Sampling bias. Bias from treat- ment likely. Reliability not tested Table 5.6 continued Accuracy = Proportion correctly identified; BW = Bitewing; DFRS = Decayed root surfaces; DFS = Decayed, filled surfaces (permanent teeth); DMFS = Decayed, missing, filled surfaces (permanent teeth); DMFT = Decayed, missing, filled teeth (permanent teeth); DS = Decayed surfaces; LB = Lactobacilli; MS = Mutans streptococci; OR = Odds ratio; PPD = Periodontal pocket depth; RR = Relative risk; Se = Sensitivity; Sp = Specificity; WHO = World Health Organization
291 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, 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 Scheinin et al 1994 [56] Finland
Patients trea- ted at Dept of Cariology, Oral Diagno- sis, University of Turku
n: 96 Age: Mean 62 Range: 47–79 All coronal and root surfaces
3 8 Coronal WHO 1987
Root caries
“denoted similarly” Available radio-
graphs No of
exam- iners
unclear Relia-
bility not stated
MS, LB, Candida, saliva secretion, buffer capacity, sucrase activity, visible plaque ≥1 new root DFS Proportion high risk: 51%
Mean root DS
incre- ment:
1st yr: 1.5 2nd and
3rd yr: 0.56/yr
51% develo-
ped ≥1 new root DFS Log regres- sion, OR, Se and Sp Model (root DFS, LB and candida) Se: 78%; Sp: 77%
Root DFS: 12.8 LB: 8.6
Single variables Root DFS Se: 45%; Sp: 94%
Se: 88%; Sp: 47%
Se: 67%; Sp: 68%
Se: 90%; Sp: 57%
Se: 76%; Sp: 55%
Se: 59%; Sp: 62% Low
Sampling bias. Bias from treat- ment likely. Reliability not tested Table 5.6 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 292
Table 5.7 Tillförlitligheten hos tidigare förekomst av karies (DFS/DS) som enskild prediktor eller kombinationer/modeller för prediktion av koronal karies/rotkaries hos vuxna/äldre. DFS/DS eller modell vid start Författare, år, referens Prediktor eller variabel Sensiti- vitet (%) Specifi- citet (%) DFS/DS Leske et al, 1989 [88] DFS (alla) DFS (55+) 68 82
37 MacEntee et al, 1993 [90] DS DFS 63
79 77 Scheinin et al, 1994 [56] DFS 45 94 Drake et al, 1997 (koronal karies) [83] DFS (svarta) DFS (kaukasier) 63 54
68 Modell Beck et al, 1988 [52] Män Kvinnor
73 79 77 83 Hänsel Petersson et al, 2003 [86]
Gräns 20% Gräns 40% Gräns 60% Gräns 80% 35 54 88 100
88 74 35 4 Ravald et al, 1992 [55] Scheinin et al, 1994 [56] Hawkins et al, 1997 (koronal karies) [85] Kombination Kombination Kombination 62 78
78 77 46 DFS = Antal kariesskadade, fyllda permanenta ytor; DS = Antal kariesskadade permanenta ytor 293 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.7 Tillförlitligheten hos tidigare förekomst av karies (DFS/DS) som enskild prediktor eller kombinationer/modeller för prediktion av koronal karies/rotkaries hos vuxna/äldre. DFS/DS eller modell vid start Författare, år, referens Prediktor eller variabel Sensiti- vitet (%) Specifi- citet (%) DFS/DS Leske et al, 1989 [88] DFS (alla) DFS (55+) 68 82
37 MacEntee et al, 1993 [90] DS DFS 63
79 77 Scheinin et al, 1994 [56] DFS 45 94 Drake et al, 1997 (koronal karies) [83] DFS (svarta) DFS (kaukasier) 63 54
68 Modell Beck et al, 1988 [52] Män Kvinnor
73 79 77 83 Hänsel Petersson et al, 2003 [86]
Gräns 20% Gräns 40% Gräns 60% Gräns 80% 35 54 88 100
88 74 35 4 Ravald et al, 1992 [55] Scheinin et al, 1994 [56] Hawkins et al, 1997 (koronal karies) [85] Kombination Kombination Kombination 62 78
78 77 46 Få syratoleranta och syra- producerande bakterier. Kortvariga pH-fall i biofilmen:
• Begränsat intag av
fermentabla kolhydrater • God munhygien • Tillräcklig fluortillförsel • Frekvent intag av
fermentabla kolhydrater • Dålig munhygien • Otillräcklig fluortillförsel Utbildning, kunskaper, livsstil, attityder, beteende Ålder, tandmorfologi, tandyta, salivfunktion, genetiska faktorer Sociodemografi och välfärd Samhällsnivå Individnivå Biologisk nivå Tillväxt av syratoleranta och syraproducerande bakterier. Utdragna pH-fall i biofilmen: Demineralisering > remineralisering Figur 5.1 Faktorer som är involverade i kariesprocessen. 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 294
Table 5.8 Post-eruptive age as risk factor. Studies with high or medium 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 (%) Ex- plained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Caries rates Survival time Relative risk (RR) Study quality and relevance Comments Abernathy et al 1986 [47] USA 4 365
7–8 and 12 years
Sample from the control group of a prevention programme (sealing) study Occlusal surfaces of 1st and 2nd molars
Mean DMFS start Grades
1+2 F (non F): 0.9 (1.4) Grade 5: 3.2 (4.7) 4 42
plained No
differ- ence in
baseline DMFS
between those
lost and those
followed Radike
(1968) No BW
16 exam- iners
Yes Post-eruptive age: 1–4 yrs after tooth eruption
D or F (decayed or filled surface)
Life table method
Annual DMF rates. Untreated (not sealed) group (1–5 = post-eruption period)
1. 0.16
2. 0.13 3. 0.11
4. 0.09 5. 0.06
2nd molars 1. 0.12
2. 0.18 3. 0.18
3. 0.18 4. 0.12
5. 0.08 Medium
High attri- tion rate. No control over crite- ria used for filling – pos- sible bias Baelum et al 2003 [48] Denmark
845 12–14 years Sample from a clinical trial on the effect of supervised tooth brushing and chewing gum All tooth surfaces except
permanent 1st molars Mean DMFS at
start: 6.4 3 5 WHO (1997)
and Nyvad
(1996) BW 1 exam- iner Yes
Post-eruptive age: ≤1 yr, 2–3 yrs and >3 yrs Sound to carious and sound to cavitated Caries rates, hazard ratio (RR)
Sound to carious (RR). Erupted for ≥3 yrs: 1 2–3 yrs: 0.90 1–2 yrs: 1.06 <1 yr: 1.90 Intact to cavity (RR) ≥3 yrs: 1 2–3 yrs: 0.82 1–2 yrs: 0.93 <1 yr: 1.90 High
295 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.8 Post-eruptive age as risk factor. Studies with high or medium 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 (%) Ex- plained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Caries rates Survival time Relative risk (RR) Study quality and relevance Comments Abernathy et al 1986 [47] USA 4 365
7–8 and 12 years
Sample from the control group of a prevention programme (sealing) study Occlusal surfaces of 1st and 2nd molars
Mean DMFS start Grades
1+2 F (non F): 0.9 (1.4) Grade 5: 3.2 (4.7) 4 42
plained No
differ- ence in
baseline DMFS
between those
lost and those
followed Radike
(1968) No BW
16 exam- iners
Yes Post-eruptive age: 1–4 yrs after tooth eruption
D or F (decayed or filled surface)
Life table method
Annual DMF rates. Untreated (not sealed) group (1–5 = post-eruption period)
1. 0.16
2. 0.13 3. 0.11
4. 0.09 5. 0.06
2nd molars 1. 0.12
2. 0.18 3. 0.18
3. 0.18 4. 0.12
5. 0.08 Medium
High attri- tion rate. No control over crite- ria used for filling – pos- sible bias Baelum et al 2003 [48] Denmark
845 12–14 years Sample from a clinical trial on the effect of supervised tooth brushing and chewing gum All tooth surfaces except
permanent 1st molars Mean DMFS at
start: 6.4 3 5 WHO (1997)
and Nyvad
(1996) BW 1 exam- iner Yes
Post-eruptive age: ≤1 yr, 2–3 yrs and >3 yrs Sound to carious and sound to cavitated Caries rates, hazard ratio (RR)
Sound to carious (RR). Erupted for ≥3 yrs: 1 2–3 yrs: 0.90 1–2 yrs: 1.06 <1 yr: 1.90 Intact to cavity (RR) ≥3 yrs: 1 2–3 yrs: 0.82 1–2 yrs: 0.93 <1 yr: 1.90 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 296
Table 5.8 continued Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries preval- ence at start Obs Time (yrs) Drop- out (%) Ex- plained Diag- nostic criteria Exam- iner (n) Relia- bility Predictor variables Validating criteria Statistical methods Results Caries rates Survival time Relative risk (RR) Study quality and relevance Comments Mejàre et al 2004 [2] Sweden
534 12–13 years All children from a com- munity south of Stockholm with mixed socioeconomy Occlu- sal and
approximal surfaces
Radio- graphic
study Mean
DMFT at start: 3.2 Mean DFS approximal: 0.6 15
Ex- plained
No dif- ference
in base- line DFS or DS between
those lost and those followed
Own criteria (radio- graphic)
2 exam- iners
Yes Post-eruptive age: Age groups 12–15, 16–19 and 20–27 Sound to enamel,
enamel to dentine, in dentine, sound to dentine Incidence (caries rate=number of new lesions/100 tooth-sur- face-years) Survival analysis
Caries rates, Sound to dentine for all teeth 12–15 yrs: 2.0 16–19 yrs : 0.9 20–27 yrs: 0.7 Occlusal surfaces, 1st molars 12–15 yrs: 4.4 16–19 yrs: 2.3 20–27 yrs: 1.5 Occlusal surfaces, 2nd molars 12–15 yrs: 6.7 16–19 yrs: 3.0 20–27 yrs: 2.7 High BW = Bitewing; DFS = Decayed, filled surfaces (permanent teeth); DMFS = Decayed, missing, filled surfaces (permanent teeth); DMFT = Decayed, missing, filled teeth (permanent teeth); DS = Decayed surfaces; WHO = World Health Organization 297 K A P I T E L 5 • r I s K b E d ö M n I n g Table 5.8 continued Yüklə 4,3 Mb. Dostları ilə paylaş:
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