Subtypes of early childhood caries predict future caries experience

Abstract

Objectives: To test whether postulated subtypes of early childhood caries (ECC) are predictive of subsequent caries experience in a population-based cohort of Swedish children. Methods:The study included children aged between 3 and 5 years at study entry with dental records available for at least 5 years of follow-up. Dental record data were retrieved from the Swedish Quality Registry for Caries and Periodontal disease (SKaPa) for the initial and follow-up visits. Participants who had ECC at study entry were assigned to one of five ECC subtypes (termed classes 1-5) using latent class modelling of tooth surface-level caries experience. Subsequent experience of caries was assessed using the decayed, missing and filled surfaces indices (dmfs/DMFS) at follow-up visits, and compared between ECC subtypes using logistic and negative binomial regression modelling. Results:The study included 128 355 children who had 3 or more dental visits spanning at least 5 years post-baseline. Of these children, 31 919 had caries at the initial visit. Baseline ECC subtype was associated with differences in subsequent disease experience. As an example, 83% of children who had a severe form of ECC at age 5 went on to have caries in the permanent dentition by the end of the study, compared to 51% of children who were caries-free at age 5 (adjusted odds ratio of 4.9 for new disease at their third follow-up).Conclusions: ECC subtypes assigned at a baseline visit are associated with differences in subsequent caries experience in both primary and permanent teeth. This suggests that the development and future validation of an ECC classification can be used in addition to current prediction tools to help identify children at high risk of developing new caries lesions throughout childhood and adolescence.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

“…This timely dental care was concordant with our observation of a 0.27 lower mean number of untreated dt in the intervention group. Therefore, our findings of reduced decay in nearly one-third of the tooth can be clinically significant because existing early childhood caries is the single greatest predictor of future caries due to the cariogenic bacterial load; studies also report that when more surfaces are affected (ie, increased severity), it increases caries in other primary and permanent teeth . We speculate that the counseling regarding baby teeth and resources to seek dental care delivered by clinicians in the intervention group resulted in qualitatively different care-seeking behaviors by parents (eg, actively pursuing dental care).…”

Evidence for clinical subtypes of early childhood caries

“…We found that this ECC subtype classi cation at age 5 was predictive of caries experience in permanent teeth at ages 12-13. Moreover, we recently showed that classi cation of ECC cases in the 5 subtypes perform well compared to a dentist-assigned caries risk score in a subset of Swedish children over a 7year mean follow-up period 33 . Importantly, these patterns appear to be robust to different caries lesion clinical detection thresholds, are relevant to the entire population of 3-5-year-olds and generalize across populations with different caries risk and access to care.…”

Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial

“…Internationally, rates are higher, ranging from 43% to 82% by continent (Uribe et al 2021). Affected children remain at high risk for caries progression in both primary and permanent dentitions (Jordan et al 2016;Li and Wang 2002;Gormley et al 2022) ). Yet, there remains a need for behavioral approaches that complement surgical and pharmacologic therapies by addressing dietary and hygienic caries determinants.…”

“…Internationally, rates are higher, ranging from 43% to 82% by continent (Uribe et al 2021). Affected children remain at high risk for caries progression in both primary and permanent dentitions (Jordan et al 2016; Li and Wang 2002; Gormley et al 2022) unless disease determinants are mitigated. Typical procedure-based preventive interventions, including semiannual dental prophylaxes and fluoride applications, have variable preventive value (Newbrun 2001) as their effectiveness may remain only until the next dietary challenge.…”