The Prospective Study of Caries Increment in Pre-school Children

Aim of Study: The study was designed as a prospective model of caries increment, plaque presence and levels of cariogenic microorganisms with repeated examinations over three years to determine the caries increment dynamics and its relationship to risk factors of carious attack.

Material and Methods: At the baseline, 273 children (150 boys and 123 girls) with the mean age of 3.86 years were included in the study. Dentition of the children was clinically examined in the field, in nurseries, using a mirror, rounded probe and headlight with a caries detection limit of a D3 lesion according to the WHO recommendations. The presence of plaque on the upper frontal teeth was recorded and Dentocult SM test was performed. At an interval of approximately one year from the baseline the test was repeated in the second and third year of the study. To determine differences in age, caries indicators (dt, dmft), presence of plaque and Dentocult SM results Mann-Whitney and Wilcoxon tests were used. Correlations of caries increment, plaque and Dentocult SM scores were evaluated by Wilcoxon's test and Pearson's correlation coefficient. Pearson's test was also used to assess the predictivity of plaque and Dentocult SM over time (the significance level at p < 0.05).

Results: At baseline, the mean number of teeth with untreated caries per child was 1.28 and the mean dmft was 1.75. At baseline, 30.8% of the children were free of dental caries, 56.8% had restored teeth and 12.4% of the children had some untreated decay. Plaque on the anterior teeth at baseline was present in 30.98% of the children. The difference between the boys and girls was not significant. The mean value of Dentocult SM test at baseline was 1.40. At the second examination, the boys had a significantly higher mean Dentocult SM score than girls (p = 0.042), in the first and third test, the differences between the boys and girls were non-significant.
The mean caries increment between the first and second examination was dmft = 0.68 per child. In the first and second year of the study the boys had a significantly higher caries increment than the girls (0.80 vs. 0.55 and 0.33. vs. 0.18). The caries increment after the first year of the study was significantly higher for boys and girls than in the second year (0.68 vs. 0.26). A highly significant association of the presence of plaque and the number of teeth with untreated caries (the teeth) and the dmft score (0.0001) was found during all three consecutive examinations. Significant correlations were found between Dentocult=0 and caries increment in the subsequent investigation, both between the first and second (p = 0.002), the second and third (p = 0.032) and the first and third examinations (p = 0.003).

Conclusion: The three-year longitudinal study of caries increment in the deciduous dentition and its relationship to the microbial agents (plaque and cariogenic microorganisms) showed the dynamics of the dental caries development and the importance of assessing these factors in preschool children by caries risk analysis. The study documented the need for enhanced preventive measures at the older preschool age in compliance with primary preventive strategies against dental caries.

Keywords: children 3-5 yers-old; caries increment; longitudinal study