The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

The purpose of this analysis is to compare three different statistical models for predicting children likely to be at risk of developing dental caries over a 3-yr period. Data are based on 4117 children who participated in the University of North Carolina Caries Risk Assessment Study, a longitudinal study conducted in the Aiken, South Carolina, and Portland, Maine areas. The three models differed with respect to either the types of variables included or the definition of disease outcome. The two "Prediction" models included both risk factor variables thought to cause dental caries and indicator variables that are associated with dental caries, but are not thought to be causal for the disease. The "Etiologic" model included only etiologic factors as variables. A dichotomous outcome measure--none or any 3-yr increment, was used in the "Any Risk Etiologic model" and the "Any Risk Prediction Model". Another outcome, based on a gradient measure of disease, was used in the "High Risk Prediction Model". The variables that are significant in these models vary across grades and sites, but are more consistent among the Etiologic model than the Predictor models. However, among the three sets of models, the Any Risk Prediction Models have the highest sensitivity and positive predictive values, whereas the High Risk Prediction Models have the highest specificity and negative predictive values. Considerations in determining model preference are discussed.

The University of North Carolina caries risk assessment was conducted between 1986 and 1989 with 5000 children initially in grades 1 and 5 from low fluoride sites in South Carolina and Maine. Clinical, microbiologic, behavioral, and demographic factors served as independent variables used in logistic multiple regression models to determine the predicted caries risk classification of each child. The 3-yr DMFS increment of each child was the dependent variable, and the 20-25% of those in each cohort with the highest increment were considered the high risk group. Sensitivity and specificity values averaged 0.60 and 0.83 respectively, indicating the misclassification of substantial numbers of children. This paper reports analysis of the DMFS increments of the misclassified children. The majority of children had DMFS increments within one or two surfaces of the classification cut points. Many false negative children had increments composed entirely of filled surfaces, often of minimal extent and without evidence of previous decay. Many false positive children had increments composed of decayed surfaces and would have benefitted from being identified as high risk and assigned to a preventive program. Other false positive children had sealants placed after the baseline examination that undoubtedly reduced their true increment. It is concluded that the consequences of misclassification are not serious for most children in this study.

Over 4000 first and fifth grade children from the areas surrounding Aiken, South Carolina, and Portland, Maine, participated in a 4-yr study to develop caries risk assessment models. The predictors used at baseline included detailed clinical examinations. salivary microbiological tests, and sociodemographic and dental behavior data. Mean 3-yr caries increments in South Carolina were twice those in Maine. For the four risk assessment models (two grade cohorts at two sites) specificity values averaged 0.83 and sensitivity values averaged 0.60. Clinical predictors such as prior DMFS. pit and fissure morphology, and predicted caries risk status were the major contributors to the models.

Central to the development of a model for identifying children at high risk to caries is a clinical evaluation to assess dental status and other conditions potentially useful in caries prediction. Traditionally, this evaluation has been based on a relatively lengthy visual/tactile examination conducted by a dentist. Replacing the dentist examination with a dental auxiliary conducted screening evaluation could lead to reduced time and costs. The 4-yr University of North Carolina Caries Risk Assessment Study involved approximately 5000 schoolchildren initially in Grades 1 and 5 living near Aiken, South Carolina, and Portland, Maine. The effectiveness of caries prediction models using visual/tactile examination data were compared with the same models using simplified screening evaluation data. Results showed sensitivity ranged from 0.57 to 0.61 for the visual/tactile and screening models by site and grade cohort. Specificity for the models ranged from 0.80 to 0.83. None of these differences in sensitivity and specificity between visual/tactile (dentist) and screening (hygienist) models was statistically significant. Findings show that for the prediction of children at high risk to dental caries the clinical evaluation may be conducted with no reduction of precision by using dental hygienist performed screening evaluations rather than dentist conducted visual/tactile examinations. While no cost data were collected, these results imply that costs to future prediction programs could be reduced by using screening evaluations.

A random sample of 1,019 adults 65 years of age and older, living in their own homes, consented to a clinical dental examination and an interview. Eight hundred nine subjects were dentate and 210 were edentulous. Each dentate person was examined for caries and periodontal conditions, as well as a separate determination of restorative and extraction treatment needs. Most people in this study lacked restorative treatment needs of any kind. Blacks required restorative treatment and extractions more often than whites. Carious coronal and root surfaces, pocket depths, number of teeth, as well as educational level and time since last visit to the dentist were related to treatment needs. While clinical findings were related to treatment needs, precise determinations of treatment needs of this elderly population generally could not be based solely on clinical findings. Additional behavioral, social, and health factors appear to play a role in dentists' decisions when determining treatment needs of older persons.

The baseline caries experienced of approximately 5,000 children in South Carolina and Maine was used as the dependent variable in caries risk assessment analyses. Clinical, microbiologic, and demographic factors served as independent variables in a multivariate relationship to caries through regression and discriminant function analyses. Four factors--number of dental visits by the child in the past year, presence of white spot lesions, and both the urgency of need for restorative care and the future caries increment predicted by the examiner--associated significantly and consistently with caries prevalence in primary and permanent teeth of first and fifth graders at both study sites. Several factors associated significantly with caries prevalence at only one site or grade within a site, suggesting that wide applicability of a specific caries risk assessment model may be limited. In these analyses, sensitivity ranged from .60 to .72 and specificity varied from .86 to .91 in the four grade-site groups. The ultimate goal of this longitudinal study is to identify highly caries-prone children in time to prevent the occurrence of a future caries increment. Although the lack of consistent association of many variables, including microbiologic factors, with baseline caries prevalence was unexpected, it is expected that some of these variables will contribute predictive power in the prospective study.

This paper seeks to achieve four goals, each of which forms the basis for a section in the presentation. First, the rationale of risk assessment is fully described. In this section, some of the necessary conditions are identified that make disease prediction worth pursuing. The second section discusses some essential background to the understanding of risk assessment in dentistry. In this segment, attention is focused on population-based and individual-based perspectives, alternative approaches to expressing health risk, and methods for comparing the predictive accuracy of alternative risk assessment models. The third section of the paper develops a conceptual framework for risk assessment in dentistry. Particular emphasis is devoted to the identification of risk factors and their incorporation into alternative statistical models. In the fourth section, empirical data are offered by which certain comparisons of the alternative risk models can be drawn. The paper concludes with a discussion that emphasizes data and technical limitations, speculates on future applications, and suggests new avenues for research.

Baseline clinical dental examinations were conducted on 5,233 children in grades 1 or 5 from the areas surrounding Aiken, SC, and Portland, ME, as part of a longitudinal study being conducted to predict children at high risk to dental caries. Mean caries levels in the Aiken area were nearly twice those of the Portland area. Black children experienced slightly more disease than whites. In addition to lower levels of caries experience, Portland children also had more treatment needs met, as indicated by higher filled ratio scores.

Providers' periodontal diagnostic and treatment behaviors were assessed in 34 practices in two North Carolina counties. Regularly attending patients had a low prevalence of gingival pocketing on index teeth, moderate attachment loss, and fairly prevalent bleeding and calculus. Treatment frequency and patient knowledge were generally adequate, but the notation of periodontal status in the patient record was insufficient. A continuing education intervention resulted in substantial and significant improvement in notation rates. Changes in rates with which services were provided, and changes in patient periodontal status were smaller and mixed. The study shows that continuing education can be effective in helping some but not all providers adopt needed, appropriate behaviors.

Dentists have been used as examiners in caries prevalence examinations almost exclusively. Only rarely have dental hygienists been reported as examiners in these types of studies. This article describes the degree of agreement for prevalence data (DMFT, dmft) and specific caries prediction information collected by hygienist-screeners and dentist-examiners. A total of 5,233 first- and fifth-grade children were screened by hygienist-screeners using a tongue blade only and then examined by dentist-examiners using an explorer and mirror. Agreement was analyzed in terms of percent agreement and the kappa statistic. The values for screener-hygienist dentist-examiner agreement were compared to interexaminer and interscreener reliability values. Means were also calculated for the caries indices. The results indicated good agreement for the caries indices between the screener-hygienist and dentist-examiner. Agreement for the prediction indices tended to be lower. The results suggest that hygienists can be used as examiners in caries prevalence studies.

A 4 week, double blind clinical trial was conducted to assess the antiplaque/anticalculus activity of test dentifrices containing varying levels of zinc citrate. Subjects were divided into 6 groups, 4 experimental, 1 positive control and a placebo group. All subjects only brushed at home using the placebo control during study weeks 1 and 3. Plaque and calculus were collected at the end of study weeks 2 and 4 on mylar strips worn on lower incisor teeth. Dentifrice efficacy was assessed by comparing group dry and ash weight decrements. While there were no significant differences between the test and control groups, there was a demonstrable trend toward greater inhibition with higher zinc citrate levels, especially among subjects with high levels of plaque and calculus at baseline.

T his study assesses the comparative effectiveness of three types of dental floss and toothbrushing in reducing interproximal bleeding sites, measured by stimulation with wooden interdental cleaners using the interdental bleeding index assessment method. The 119 adult subjects with gingival inflammation were randomly assigned to one of four groups at the beginning of a supervised 2 week clinical trial. The toothbrushing only group achieved a 35% reduction in bleeding sites and the three flossing groups all demonstrated dramatic reductions of about 67%. The three varieties of dental flosses were about equally effective in reducing interproximal bleeding and doubly effective as toothbrushing alone. Compared to probing, the interdental bleeding index method is considered a simplified method of assessing interproximal gingival inflammation.

This paper presents the comparative effectiveness of fluoride mouthrinse (FMR) on high and low caries forming children after a 4-yr exposure to weekly rinse beginning in the first grade. Over 1200 grade 1 children drawn from both fluoride deficient and fluoridated sites were divided into treatment and concurrent, longitudinal control groups. After 4 yr these children were stratified according to caries increment; those above the 75th percentile were considered high caries formers, all others were designated low caries formers. After adjustment of the mean increments for differences in SES, age, race, and sex in rinse and control groups, high caries formers (approximately 25% of the children) in the rinse and control groups in fluoride deficient areas showed increments of 7.00 and 7.79 surfaces, respectively, indicating a savings of 0.79 surfaces. Low caries formers (approximately 75% of the children) demonstrated increments of 1.11 DMFS in the rinse group and 1.40 in the control group (savings 0.29 DMFS). The pattern was quite similar for children in fluoridated areas except that the increments, as well as the savings realized, were lower. The results raise questions as to the practical effectiveness of school based FMR programs even for high caries forming children.

This article presents the rationale and content of a current study that seeks to improve methods to identify children at high risk to dental caries. It summarizes the results of the development of a 12-factor, preliminary caries prediction model based on data derived from the National Preventive Demonstration Program. Despite data limitations, the model produced a sensitivity of .5 and specificity of .8 for four-year caries increment prediction in first- and fifth-grade children. Data on a number of additional potential predictors are being collected in two sites to expand and improve the existing model. These factors are identified.

This article presents the caries prevalence and treatment patterns of children relative to a classification of family economic status, based on the child's eligibility for the free or reduced-cost school lunch program. Dental caries prevalence is reported for children aged 8-11 years at the beginning of a longitudinal clinical trial in the nonfluoridated city of Tampa, Florida. These children were placed into one of three school lunch subsidy categories--poverty, near-poverty, and nonpoverty--using federal government income eligibility guidelines for the school lunch program. The results support an inverse relation of caries prevalence to economic status, as well as the expected direct relation of family income to treatment needs met. The nonpoverty group exhibited the lowest number of decayed surfaces and had nearly 70 percent of their treatment needs met. The poverty group had significantly higher scores both for total caries experience (DMFS) and decayed surfaces (DS) than either of the other groups. Filled surfaces (FS) scores were not significantly different for any of the groups. This method of classifying children by school lunch program eligibility is considered valid because of the rigorous requirements used in determining family income, as well as the thorough verification procedure that is applied. The method is easy to use once officials have been convinced that confidentiality will be maintained.

The development and validation of a caries prediction model comprising 13 sociodemographic and dental examination variables on Grade 1 and Grade 5 children in the National Preventive Dentistry Demonstration Program are described. The objective was to derive a method of predicting children at high risk to caries early in order that preventive measures might be undertaken. True high risk children were defined in two ways: highest 25% of children based on their 4-yr DMFS increment, and their total DMFS score at the end of the study. In both cases, children predicted to be at high risk were defined as the 25% with the highest discriminant score. Discriminant function and logistic regression analyses were used to determine the extent to which the 13 variables collectively discriminated between true high risk and non-high risk children so defined. Sensitivity was approximately 0.50 and specificity around 0.82, using the 4-yr increment as the criterion for defining true high risk, and approximately 0.64 and 0.88, respectively, using the final DMFS score for defining true high risk.

Conjecture versus empirical data: a response to concerns raised about the National Preventive Dentistry Demonstration Program. S P Klein, H M Bohannan, R M Bell, J A Disney, and R C GravesCopyRight https://doi.org/10.2105/AJPH.76.4.448 Published Online: October 07, 2011

An 18-month longitudinal study of 197 5 to 18-yr-old children was conducted to assess the performance of multiple baseline variables in predicting which children would experience high increments of caries. Nine predictors were assessed; DMFS and defs scores, number of permanent teeth, indices of fissure retentiveness and occlusal morphology, S. mutans and lactobacilli levels, and sex and race. Discriminant analyses were applied to data for children in five age groups to identify the 30% who would have the largest 18-month DMFS increments. Prediction performance was assessed by comparisons with the actual high increment group, defined as those children with increments in the upper quartiles of the DMFS distributions within age groups. The analyses predicted between 56% and 91% of actual high increment children depending on age group. The children identified in the analyses experienced between 59% and 91% of the disease experienced by the actual high increment groups.