ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Children With Caries In Their Primary Dentition Pose a Higher Risk of Developing Caries In Their Permanent Dentition
Clinical Question Does the prevalence of caries lesions in the primary dentition predict the prevalence of caries in the permanent dentition?
Clinical Bottom Line In children with primary-dentition carious lesions, the risk of caries in the permanent dentition is increased. This is supported by both a prospective, longitudinal cohort including 186 children and a retrospective study of 374 children based originally from a cohort.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16643535Skeie/2006186 childrenProspective Cohort Study
Key resultsA statistically significant correlation between carious lesions in the primary and permanent dentitions was discovered (r=0.5, P<0.01). Similarly, an association was found between caries in primary second molars and caries in the permanent dentition (r= 0.5, P<0.01). The correlation between carious lesions between first molars in the primary dentition and caries in the permanent dentition was r= 0.4 and P <0.01. In children that did not have any carious lesions in the beginning of the study (at age 5 [n=57]), 61.4% (n= 35) had developed caries in their permanent dentition when examined at age 10. In children with carious lesions in the beginning of the experiment at age 5 (n=129), 81.4% (n = 105) acquired caries in their permanent dentition (x^2 = 8.49, P= 0.004). 92.2% (n=71) of the children with active carious lesions, filled carious lesions, or extractions at the beginning of the study (age 5) had permanent dentition carious lesions at the age of 10 as well. Skeie stated that, "'Primary second molars' and 'all primary molars' were the most powerful predictors for allocation into the risk group" (Skeie 152). It was discovered that being a child with more than two carious surfaces on a primary second molar at age 5 was a good indicator for being high caries risk at 10 years old. These results are based on a prospective, longitudinal study of 186 children examined at 5 and 10 years of age.
#2) 11385197Mejare/2001374 childrenCase Control Study
Key resultsThe likelihood of caries on the first permanent molar is 15 times greater if adjacent to a carious primary second molar than if adjacent to a healthy tooth. No increase in caries rate was discovered with deeper carious lesions vs. enamel or dentin caries. The caries rate for the mesial surface of the first permanent molar is 3.4 times greater if dentin carious lesions or restorations are present on the distal of the first primary molar or the mesial of the second primary molar as opposed to adjacent sound teeth. The caries rate for the distal surface of the secondary primary molar is 2.7 times greater if dentin carious lesions or restorations are present on the distal surface of the first primary molar or mesial of the second primary molar as opposed to adjacent sound teeth.
Evidence Search ("risk factors"[MeSH Terms] OR ("risk"[All Fields] AND "factors"[All Fields]) OR "risk factors"[All Fields]) AND ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "prevalence"[All Fields] OR "prevalence"[MeSH Terms]) AND ("radiography, bitewing"[MeSH Terms] OR ("radiography"[All Fields] AND "bitewing"[All Fields]) OR "bitewing radiography"[All Fields] OR ("radiography"[All Fields] AND "bitewing"[All Fields]) OR "radiography, bitewing"[All Fields]) AND ("humans"[MeSH Terms] OR "humans"[All Fields])
Comments on
The Evidence
Validity: Skeie: This cohort study included children who were assembled at a common point (age 5). The patients were all assembled and examined at 5 years of age (n=217) and were followed up at 10 years of age (n=186). The patients who were not examined at 10 years of age (n=31) did not participate either because of reluctance to participate or moving. There were no competing interests. The study was designed to incorporate children of different socio-economic upbringings; however, the parents of the patients were found to have an educational level superior to the general public. Five dentists completed the baseline examinations, and only one dentist performed the examinations when the patients were 10 years old. Clinical and radiographic guidance sessions were completed to gain reproducibility in the exams. Mejare: The children chosen for this study were part of a previous cohort study that followed the children from age 11 or 13 to age 21 or 22 years old. Yearly bitewing radiographs recorded progression of caries. The average age of the first bitewing radiograph was 6.7 years old (SD, 1.42). The last radiographs used for this study were taken at an average age of 11.5 years old (SD, 0.86). To ensure reproducibility, they tried setting the children up with the same dentist for each examination. Because this is a retrospective study, the clinic had not agreed upon when to restore lesions, so the data may be inconsistent. However, because there was no evidence that the dentists used an unofficial method in determining whether or not to restore, it is unlikely that bias for that procedure existed. There were no competing interests. Perspective: Skeie: Based on this cohort, it is reasonable to conclude that caries in the primary dentition is a good indication of caries in the permanent dentition. Mejare: Based on the retrospective study, it is reasonable to determine that in the presence of caries in the distal surface of the second primary molar there is an increased caries risk in the mesial surface of the first permanent molar.
Applicability Skeie: Although the study was performed on offspring of people in a higher socioeconomic status, the evidence is applicable to the majority of pediatric dental patients. Children with caries in their primary dentition are more likely to experience caries in their permanent dentition. The evidence also shows the need for caries prevention in children. The examinations were provided free of charge, and the results will help patients and their parents understand the importance of adequate dental hygiene. Mejare: The evidence presented in the retrospective study is applicable to all children today. It proves that children with caries on their primary second molars are more likely to develop caries on their permanent first molars. The results collected from this study also help to verify the significance of good oral hygiene.
Specialty/Discipline (Pediatric Dentistry)
Keywords Cariology, pediatric patients, aproximal caries, caries rate, mixed dentition, permanent molars
ID# 3035
Date of submission: 03/29/2016spacer
E-mail ardoinh@livemail.uthscsa.edu
Author Holly Ardoin
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kevin Donly, DDS, MS
Faculty mentor/Co-author e-mail DONLY@uthscsa.edu
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