ROSHANAK KHATERI 5year, group 13
EVALUATION OF CARIES RISK INDICATORS DURING ADOLESCENCE A SYSTEMATIC REVIEW
Master’s Thesis
Supervisor Sandra Petrauskienė
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
MEDICAL ACADEMY FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY
EVALUATION OF CARIES RISK INDICATORS DURING ADOLESCENCE A SYSTEMATIC REVIEW
Master’s Thesis
Student.
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(signature)...
(name surname, year, group)
... 20....
(day/month)Supervisor
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(signature)...
(degree, name surname)
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(Kaunas, 2019
EVALUATION TABLE OF THE MASTER’S THESIS OF THE TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE
Evaluation:... Reviewer:...
(scientific degree. name and surname) Reviewing date: ...
No. MT parts MT evaluation aspects
Compliance with MT requirements and evaluation Yes Partiall y No 1 Summary (0.5 point)
Is summary informative and in compliance
with the thesis content and requirements? 0.3 0.1 0
2 Are keywords in compliance with the thesis
essence? 0.2 0.1 0
3
Introduction, aim and tasks (1 point)
Are the novelty, relevance and significance of the work justified in the introduction of
the thesis?
0.4 0.2 0
4 Are the problem, hypothesis, aim and tasks
formed clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6 Selection criteria of the studies, search methods and strategy (3.4 points)
Is the protocol of systemic review present? 0.6 0.3 0
7
Were the eligibility criteria of articles for the selected protocol determined (e.g., year,
language, publication condition, etc.)
0.4 0.2 0
8
Are all the information sources (databases with dates of coverage, contact with study
authors to identify additional studies) described and is the last search day
indicated?
9
Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations; number of found and
selected articles according to the combinations of keywords)?
0.4 0.1 0
10
Is the selection process of studies (screening, eligibility, included in systemic review or, if
applicable, included in the meta-analysis) described?
0.4 0.2 0
11
Is the data extraction method from the articles (types of investigations, participants,
interventions, analysed factors, indexes) described?
0.4 0.2 0
12
Are all the variables (for which data were sought and any assumptions and simplifications made) listed and defined?
0.4 0.2 0
13
Are the methods, which were used to evaluate the risk of bias of individual studies and how this information is to be used in data
synthesis, described?
0.2 0.1 0
14 Were the principal summary measures (risk
ratio, difference in means) stated? 0.4 0.2 0
15
Is the number of studies screened: included upon assessment for eligibility and excluded
22
Conclusions (0.5 points)
Do the conclusions reflect the topic, aim and
tasks of the Master’s thesis? 0.2 0.1 0
23 Are the conclusions based on the analysed
material? 0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
25
References (1 point)
Is the references list formed according to the
requirements? 0.4 0.2 0
26
Are the links of the references to the text correct? Are the literature sources cited
correctly and precisely?
0.2 0.1 0
27 Is the scientific level of references suitable for
Master’s thesis? 0.2 0.1 0
28
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older
than 5 years – at least 40%?
0.2 0.1 0
17
Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention
group; b) effect estimates and confidence intervals)
0.4 0.2 0
18
Are the extracted and systemized data from studies presented in the tables according to
individual tasks?
0.6 0.3 0
19
Discussion (1.4 points)
Are the main findings summarized and is
their relevance indicated? 0.4 0.2 0
20 Are the limitations of the performed systemic
review discussed? 0.4 0.2 0
21
Does author present the interpretation of the
Additional sections, which may increase the collected number of points
29 Annexes Do the presented annexes help to understand
the analysed topic? +0.2 +0.1 0
30
Practical recommen-
dations
Are the practical recommendations suggested
and are they related to the received results? +0.4 +0.2 0
31
Were additional methods of data analysis and their results used and described (sensitivity
analyses, meta-regression)?
+1 +0.5 0
32
Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of
each meta-analysis presented?
+2 +1 0
General requirements, non-compliance with which reduce the number of points
33
General requirements
Is the thesis volume sufficient (excluding annexes)? 15-20 pages (-2 points ) <15 pages (-5 points)
34 Is the thesis volume increased artificially?
-2 poin
ts
-1 point
38
Is text consistent, integral, and are the volumes of its structural parts
balanced?
-0.2
point -0.5 points
39 Amount of plagiarism in the thesis. >20% (not evaluated)
40
Is the content (names of sections and sub-sections and enumeration of pages) in compliance with the thesis
structure and aims?
-0.2
point -0.5 points
41
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2
point -0.5 points
42 Are there explanations of the key
terms and abbreviations (if needed)?
-0.2
point -0.5 points
43
Is the quality of the thesis typography (quality of printing, visual aids,
binding) good?
-0.2
point -0.5 points
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points. Reviewer’s comments: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________
Reviewer’s name and surname Reviewer’s signature
TABLE OF CONTENTS
SUMMARY: ... 10
INTRODUCTION: ... 11
1. SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY ... 13
1.1 LITERATURE SEARCH STRATEGY ... 13
1.2 INCLUSION AND EXCLUSION CRITERIA ... 13
2. SYSTEMISATION AND ANALYSIS OF DATA ... 18
3. DISCUSSION ... 22
4. CONCLUSIONS ... 23
REFERENCES ... 24
ABBREVIATIONS
DMFT Index -Decayed, Filled, Missing permanent Teeth Index DMFS Index -Decay-Missing-Filled permanent Surfaces Index SiC Index -Significant Caries Index
DCI- dental care index
OHI-S -Simplified Oral Hygiene Index PI –Plaque index
SES- socioeconomic status OR- odd ratio
EVALUATION OF CARIES RISK INDICATORS DURING ADOLESCENCE
SUMMARY:
Objective: To find out and evaluate the role of the biological, behavioral and socio-economic indicators from the childhood life which is associated with dental caries among adolescents and to find out which indicators has the most influence.
Material and methods: According to the PRISMA guidelines, publications of this systematic review was selected through PUBMED and Google scholar. The comprehensive search was restricted to English language articles, published from 2008 to 2018. In the results it was
shown 80 abstracts of publications. Later, 30 articles related to the topic were revised and 12 articles were selected regarding to PICOS criteria to this systematic review.
Results: Female gender was defined as a caries risk indicator. Area of residency is important caries risk indicator and adolescents from rural area had significantly higher scores of DMFT. Oral health behavior of the adolescents plays a role in caries development, DMFT index was higher in the adolescents who brushed their teeth less frequently than those who brushed their teeth on a more regular basis. Medical issues such as pregnancy course, mothers’ perceived stress, reasons of previous dental appointment were defined as caries risk indicators.
Conclusion: This systematic review revealed that many caries risk indicators play a role in caries development during adolescence period. The main groups like socioeconomic, behavioral, related to medical issues indicators should not be underestimated in caries development process.
INTRODUCTION:
Dental caries is a multifactorial disease with genetic, biological and behavioral causes [1]. Dental caries may affect both primary and permanent dentitions, and it can also damage the not only crown of the tooth, but also exposed root surfaces [2]. It can lead to infection, pain and reduced quality of life [3]. More than half of adolescents throughout the world suffer from some form of oral disease such as dental caries [4].
Despite the improvement in oral health and a general reduction in dental caries in all ages in developed countries, studies in developed countries indicate that about 60 to 90 per cent of school-age children suffers from dental caries [5]. For instance, the survey data from national population-based oral health in Brazil have revealed an increase in the prevalence of caries-free 12 years-old children from 31% to 44% from 2003 to 2010 [6]. Dental caries between adolescents is mainly explored in age groups younger than 15 years. Adolescents need a unique method to induce them about their oral health problems [7].
According to the World Health Organization (WHO), adolescents are individuals aged from 10 to 19 years [8] and WHO also stated that dental caries is one of the most common oral health conditions in the world [9].It affects most of adolescents worldwide. Around 20% of all people in the world are young adults [9]. They have also indicated that oral disease, such as dental caries, remains the main challenge in public health [10]. The adolescent age group is potentially at higher risk of dental caries because of their higher risk time for oral piercings, increased sugar intake and their diet, nicotine initiation, and finally orthodontic considerations [7].
Factors that have been related to dental caries in cross-sectional studies are considered to be caries risk indicators, while factors identified in longitudinal studies are recognized to be risk factors [11]. Risk indicators are associated with patients current oral health state, but not how the disease has developed [12].
Behavioral factors such as repetitive tooth brushing, using and toothpaste, fluoridated mouth rinses and professional fluoride application were caring elements for caries development in adolescents [13]. Dental plaque is a complicated biofilm that develops on the dental hard tissue and ultimately can lead to dental caries when a proper level of oral hygiene is not maintained [14]. Also, regular dentist visits, check-ups or prevention was a powerful element for low levels of caries activity. The level of oral health self-perception is a significant indicator of dental caries in adolescents [13].
The scientific researches prove the concept that behavioral, social and physical environments all were found to be the factors induced dental caries [13]. Factors associated with dental caries are researched in studies to produce more data about individuals who have high caries risk, and the classification of these factors makes it easier to select the most significant groups to target in preventive dentistry programs [10, 15].
The latest investigation on social and physical environment dental caries risk factors has showed the expansion from individual-level to family-level [16, 17]. Parental education identified as a social determinant for dental caries. There is also a report demonstrates that the prenatal factors, maternal overweight, as well as smoking, are risk factors for dental caries expansion in offspring during the adolescents [18]. Their behaviors in where they spend longer times outdoors [19]. Studies also showed the differences experience of dental caries between the city and the countryside areas, in addition to socioeconomic differences in the country may induced between the counties [20].
Aim:
The aim of this systematic review is to select the published articles which have evaluated the role of the biological, behavioral and socio-economic indicators associated with dental caries among adolescents.
Objectives:
1. To analyse the publications according to inclusion and exclusion criteria of this systematic review and to sort out the main caries risk indicators in adolescence.
2. To compare the results of selected studies regarding the main outcomes.
3. To assess the most significant biological, behavioral and socio-economic indicators which are associated with dental caries among adolescents.
1. SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY 1.1 LITERATURE SEARCH STRATEGY
According to the PRISMA guidelines, publications of this systematic review were selected through PubMed and Google scholar. The following key words and their combinations early Dental caries/Dental caries risk indicators/Adolescents/Prevalence/Caries Index/DMFT score/Oral Hygiene Indices were used to search.
The comprehensive search was restricted to English language articles, published from 2008 to 2018. One investigator carried out the selection and evaluation of articles. In the results it was shown 80 publications (abstracts). If full-content publications were not accessible without purchasing and duplicated articles were excluded. Later, 30 articles related to the topic were revised, of which 12 consistent with the subject of this review were qualified regarding to PICOS criteria. After all information’s having collected and exclusions that have been made, the gathering information was sufficient and efficient for the research project (Figure 1).
1.2 INCLUSION AND EXCLUSION CRITERIA 1.2.1 Inclusion criteria for the selection were: Subjects of 11– 18 year old with permanent dentition;
Assessed caries risk indicators and factors during adolescence period; Articles published later than 2008;
Publications written in English language; Full texts are available;
1.2.2 Exclusion criteria were: Case reports;
Systemic review and review articles;
Studies with participants <11 year old and > 18 years old; Non-full texts are available;
Conference articles;
Published papers before 2008; Studies performed on animals;
1.2.3 PICOS (eligibility criteria)
In this systematic review 11-18 years old adolescents were subjects. Studies were conducted to assess caries experience (DMF-T or DMF-S index) and associations with potential caries risk indicators. The following indexes were used to evaluate dental and oral hygiene status: DMF-T index, DMF-S index, Dental care index (DCI= FT/DMF-T × 100%), Significant caries index (the mean of the extreme values of DMF index, in one-third of the population), OHI-S index, Plaque Index (PI). Caries risk indicators analyzed in this systematic review are presented in Table 1. The three main groups of caries risk indicators were analyzed in the included studies:
Behavioral indicators: fluoride history, sugar consumption, diet habits, use of soft drinks, oral hygiene, bad habits (smoking, alcohol use).
Socio-economic indicators: educational level of mothers, socioeconomic status, Insurance status, household income, area of residence (rural and urban).
Indicators related to medical issues: prenatal history (smoking, maternal diseases during pregnancy, premature birth, psychological factor), past caries experience in the primary dentition, early eruption of first primary tooth.
Table 1. The main groups of caries risk indicators.
Indicators Children Mothers
Behavioral Related to oral hygiene
management [22,23,25,29,31]
Frequency of tooth-brushing Duration of tooth brushing Usage of auxiliary measures
Type of tooth paste (with fluoride or fluoride free) Related to diet [25,31] Frequency of eating
Frequency of sugar sweetened food and beverages
consumption
“Bad habits” [28] Smoking
Alcohol use Socio-economic (social determinants)
Related to economy [21,24,28] Insurance status Household income
Related to socio-demographical aspects [13,22,23,28,29]
Neighborhood social capital, social support Racial background Religion Maternal age Marital status Educational level
Maternal social welfare allowance Country of birth
Religion Residential area [22,24,30] Rural vs. urban
Medical issues Related to prenatal period
[26,21]
Preterm birth
Newborn’s birth weight Child’s birth order Method of delivery
Pregnancy course Premature delivery Maternal overweight
Related to general health status [13,24]
Psychological factor Perceived stress
Related to oral heath [22,26,27,29]
Age at first visit to dentist Past caries experience in the primary dentition
Early eruption of first primary tooth
Location of teeth in dental arches
The bias evaluation (Table 2) is presented and according to the assessment results, it shows low risk of bias.
Table 2. Bias evaluation of studies included to this systematic review. Authors, year Sufficient
sample size, its calculation
Proper explanation of statistical analysis
Clearly presented caries risk indicators
Statistically significant results (p<0.05) Zemaitiene et al. (2017) + + + + Zemaitiene et al. (2016) + + + + Alshahrani et al. (2018) + + + + Montero et al. (2018) + + + + Engelmann et al. (2016) + + + - Shin et al. (2016) + + + + Hietasalo et al. (2008) + + + + Mathur et al. (2014) + + + + Ditmyer et al. (2010) + + + - Pakpour et al. (2011) + + + + Vadiakas, et al. (2012) + - + +
Figure 1: Illustrates by a flow chart the process of filtering (PRISMA flow diagram) Records screened
(n=50)
Records identified through database searching in PubMed
and Google scholar (n=80)
Records after duplicates removed (n=50)
Records excluded as clearly
irrelevant (title‚ criteria) (n=20)
Studies included in qualitative synthesis (n=12)
Full-text articles excluded, with
reasons (n=14)
Full-text articles assessed for eligibility (n=30)
Studies included in quantitative
synthesis (meta-analysis) (n=12)
Identification
Screening
Eligibility
Included
2. SYSTEMISATION AND ANALYSIS OF DATA
The main findings of this systematic review are presented in Table 3. Overall, 12 articles were analyzed, while 4 stratified cluster sampling, 1 randomized controlled trial, 6 cross-sectional studies and 1 retrospective study. The size of samples varied from 380 to 6040 subjects. Association were assessed between status of permanent dentition in adolescents and caries risk indicators.
This systematic review covered studies conducted in various continents and countries, like USA, Portugal, Lithuanian, Greece, Korea, Iran, Pennsylvania, Finland and Brazil.
Majority of articles assessed associations between more than one group of caries risk indicators and the current dental status. Socio-economic indicators were analyzed in 9 publications [13, 21, 22, 23, 24, 25, 27, 28, 29, 30] while behavioral indicators were analyzed in 7 articles [22, 23, 24, 28, 29, 31].Subsequently, 5 publications covered indicators related medical issues [13, 24, 26, 27, 29] DMF-T scores varied from 1.14±0.78 (female) and 1.16±0.11 (male) [21] to 6.66±0.09 [28] 4 studies [21, 23, 24, 31] found moderate scores of DMF-T index, 3 studies [26, 27, 29, 30] - high scores of DMF-t index and 1 survey- very high of DMF-T index [28] respectively.
One study assessed dental status among adolescents with DMF-S index and found that DMF-T= 2.3 [25].
SiC index was analysed in 3 publications. Results showed that SiC index varied from 2.95 [21] to 6.14 [30]. Dental care index was analysed in one study [30].
One study [22] did not singled out the index of dental caries evaluation. Socio-economic indicators
Numerous studies showed that gender can be defined as a caries risk indicators. The main outcomes of studies revealed that females tend to be at a higher risk of dental caries [27], girls presented with 1.25 times greater likelihood than boys of presenting with a higher mean DMFT Score [28].
Maternal education is defined as a caries risk indicators. Some studies confirmed that the risk of permanent tooth caries of children was higher in those whose mothers had a low educational level [13, 29]. Furthermore, children with parents of higher education and visited a dentist regularly for check-ups prevention showed lower caries experience [22]. Meanwhile, one study found that neither the mother’s education nor the subject’s birth order were associated with caries polarization [27]. Behavioural indicators:
Regarding oral health behavior in the adolescents, DMF-T index was higher in the adolescents who brushed their teeth less frequently than those who brushed their teeth on a more regular basis [25,29]. Although it was confirmed that DMFT was lower among children who brushed their teeth at least once a day compared to those with sporadic or no tooth brushing, but differences were not statistically significant [22].
A high consumption of sugar sweetened products was considered as caries risk indicators. Chocolate consumption was common in the adolescent diet and DMF-T score was significantly associated with all of them [31.Montero et al. (2018)]. Children eating candy at least once a day were more likely to have at least three new caries lesions than those ate candy less often than once a day [25].
Caries risk indicators related to medical issues:
Medical issues as caries risk indicators did not play an essential role in caries development. Location of tooth, especially posterior segments and mandibular arch may be defined as a caries risk indicator [26]. Several studies confirmed that previous dental visits’ history has an impact on the current dental status [22,29].
Table 3. Characteristics of studies included in the systematic review for caries risk indicators in adolescents. Outcome Indices Caries indicators Age Size Study design Authors
Female gender (OR=1.36
[95% CI: 0.98–1.88]), early eruption of the first primary tooth (OR=1.38 [95% CI:0.99–1.94]), and past caries experience in primary dentition primary (OR=1.87 [95%CL:1.37–2.55]) may be defined as dental caries risk indicators.
DMFT= 2.93±2.81
SiC index
(males vs, females) SiC positive group (36% vs 64%) SiC negative group (43 % vs 57 %). (p=0.04) Gender
Earlier eruption of the first primary tooth
Residential area Mother’s education level
Age at first visit to dentist Pregnancy and delivery course 18 1063 A cross-sectional study Zemaitiene et al. (2017)
Caries experience was lower in the urban than in the rural areas (p=0.001), and different counties as well.
SiC Index=6.14 DMFT= 2.93± 2.81 DCI=62.3% Gender Place of residence Urbanization 18 1063 A cross-sectional study Zemaitiene et al. (2016)
Caries prevalence was
highest in posterior segments than the anterior segments and in mandibular more than maxillary teeth (p<0.001).
DMFT= 4.3 ± 5.59
Age
Dental caries position (maxilla and mandible) 15-17 3411 A cross- sectional study Alshahrani et al. (2018) Frequency of consumption
of sweetened/fast food was a significant factor associated with caries experience (p<0.05).
DMFT= 2.32±2.51
Diet
Oral hygiene habits 11-17 782 A cross-sectional study Montero et al. (2018) Lower-income neighborhood presented a higher chance for having untreated dental caries compared with their counterpart. (OR 1.70: CI95% 1.19 -2.43). DMFT= Male 1.16±0.11 Female 1.14±0.78 SiC index = 2.95 Plaque Index = 51.53% SES
Oral hygiene status Neighbourhood mean income 12 1134 A cross-sectional study Engelmann et al. (2016)
Eating candy at least once a day were more likely to have ≥3 new caries lesions that consuming candy less often than once a day during four year period
[OR = 2.3, 95% CI = 1.25– 4.30, P = 0.008].
Tooth brushing twice a day decreases chance to have new caries lesions than tooth brushing once a day [OR =0.31, 95% CI =0.11-0.87, P = 0.026]
DMFS= 2.3
(95%CI: 1.9- 2.6) Oral hygiene habits
Diet 11-12 497 -cross A sectional study Hietasalo et al. (2008)
Area of residence is very strong and significant caries determinant for an adolescent (p<0.0001). DMFT= 1.36 (95% CI:1.27 -1.46). SES Behavioural factor Psychosocial factor Area of residence 12-15 1386 A cross-sectional study Mathur et al. (2014)
Hispanics had higher DMFT scores than non-Hispanics (OR = 2.135, 95%CI : 0.29-0.59).
Areas with no community water fluoridation increase chances to higher DMFT (OR = 1.98, 95% CI: 0.40-0.59). DMFT= 6.66±0.09 Smoking status Racial background Age Gender Fluoridated community Insurance status 12-15 3000 A retrospect ive study Ditmyer et al. (2010)
Age (p<0.05), gender (boys) (p<0.05), higher family income (p<0.001), tooth brushing less that twice a day (p<0.001) flossing less that twice a day (p<0.05), previous visit to a dentist due to pain (p<0.01), lower parental education (p<0.01), poor self-reported oral health status (p<0.01) were caries indicators.
DMFT=2.61±1.89 SES
Age Gender
Oral hygiene habits Parental education Visits to the dentist 14-18 380 A cross- sectional study Pakpour et al. (2011)
Gender (12 year group, p=0.006), father’s
educational level p<0.002), reason for previous dental visit (p=0.001) were indicators for dental caries. -
Sociodemographic status
Parents’ educational level
Oral hygiene habits Dental attendance 12;15 2481 A cross- sectional study Vadiakas, et al. (2012) Socioeconomic status is important in determining the caries experience of adolescents (p<0.03). DMFT= 1.46±0.16 (14-year-olds) 2.12±0.18 (16-year-olds) SES Ethnicity
Oral hygiene habits Fluoride exposure Recency of receipt of dental services Parental education 14;16 6040 A cross-sectional study Polk et al. (2010)
3. DISCUSSION
This systematic review revealed that associations between socio-economic caries risk indicators and caries experience (DMF-T or DMF-S indexes) among adolescents were analysed in the majority of included studies. Although some authors highlighted more than 100 potential caries risk indicators, the most commonly mentioned indicators were subjects' gender, parental education level, area of residence, ethnicity and family’s income. Meanwhile, behavioural indicators such as oral hygiene habits and dietary habits should not be underestimated, although the lower number of studies were included. Finally, last, but not least medical issues, for example, pregnancy course, mothers’ perceived stress, reasons of previous dental appointment were defined as caries risk indicators. Some studies used not only DMFT index for evaluation of dental status in adolescents' population’, but also SiC index and dental care index due to various reasons. It is essential to know the target group with the highest scores of dental caries experience to implement adequate preventive programs. Meanwhile, dental care index presents utilisation of dental service and allowed to assess the pattern of attendance to dental offices. The gaps in dental health services and dental health practices lead to poor dental health among different countries [32]. Therefore, to decrease the risk factors, the people and community should be informed or aware of and some unique program in school.
One of the most effective techniques of oral hygiene for plaque removal is toothbrushing. The toothbrush bristles should be able to clean most areas of the mouth thoroughly, and the latest design can clean interproximal tooth surfaces. Tooth brushing behaviour, including force, duration, motivation and motion, are also critical to tooth brushing efficacy [33]. Dental caries in the primary dentition is related to dental plaque, brushing teeth once a day or more, and have received preventative dental care [34].
According to the number of papers and different studies, two leading indicators causing dental caries, toothbrushing and parental education. In gender indicator the following studies [27, 28]both show a
Both DMFT and Significant Caries Index (SiC) are dental caries indices to focus on oral health inequalities more precisely. DMFT measure has become a less significant population descriptor. Therefore, to refocus on classifying the high caries prevalence group the Significant Caries Index (SiC) was created [35].
The frequency sugar-sweetened or fast food consumption was a significant factor associated with caries experience [31]. Diet has an impact not only on dental caries but on overall health status and obesity [36]. Regular fermentable carbohydrates' intake that has low oral clearance rates rises the risk for enamel caries and possibly is even more dangerous for root surfaces [37]. Studies also suggest that a high sugar diet would lead to a higher risk of dental caries [38]. Child’s caries indicators with mothers with low educational level and experienced stress would be higher. The socioeconomic status would be important in determining the caries experience of adolescents. While the prevalence of dental caries has decreased worldwide, [39], however, still in some countries' prevalence results show no improvement. This could be due to behavioural factors [40] also some medical issues have an impact as well. However, people who receive ideal fluoride exposure and have regular oral hygiene processes can safely use dietary carbohydrates [41]. Dental caries is also lifestyle related, lifestyle factors (such as nutritional habits) and good oral hygiene decrease dental caries[42].
Due to multifactorial caries etiology, specific behavioural and sociodemographic risk indicators increase the risk of caries [43, 44, 45]. The detection of dental caries in the early stage is complicated using conventional diagnostic methods and examination [3] therefore new dental caries techniques detection has been developed [46]. Most of these new technologies use light, some measure reflectance which can find primary lesions they may offer advantages that include minimum light signal dilution and insensitivity to the presence of bacteria [47]. Consequently, the leading caries risk indicators need to be sorted out to implement more effective prevention of caries development in adolescence and adulthood periods.
4. CONCLUSIONS
This systematic review revealed that many caries risk indicators play a role in caries development during adolescence period. The main groups like socioeconomic, behavioural, related to medical issues indicators should not be underestimated in caries development process. Gender, parental education level, tooth brushing habits, area of residence, ethnicity, family’s income, dietary habits and history of previous dental visit are the most common risk indicators of dental caries. They play a
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Protocol of systematic review according to PRISMA-P Evaluation of Caries Risk Indicators During Adolescence
Background/ Rationale
Objectives/aims
The aim of this protocol is to review and collect the published articles which have evaluated the role of the biological, behavioral and socio-economic indicators from the childhood life associated with dental caries among adolescents.
Methods Criteria PICOS: Populations or Participants: 11 to 18-year-old adolescents Interventions:
No interventions were used and applied. The study just assesses the dental caries risk Comparators:
Biological indicators: saliva, prenatal history (smoking, maternal diseases during pregnancy, premature birth), dental biofilm, presence of enamel defects, diseases and antibiotics during early childhood
Behavioral indicators: fluoride history, access to oral health services, sugar consumption, diet habits, area of residence, use of soft drinks, oral hygiene, performance in school Socio-economic indicators: gender, educational level of mothers, socioeconomic status Outcomes:
Prevalence of dental caries, Dental care index, DMFT score (D (decayed) M (missing) and F (filled) T (teeth) index), Significant Caries Index, Oral Hygiene indices (the Simplified Oral Hygiene Index (OHI-S), the Oral Hygiene Index (OHI), Patient Hygiene Performance (PHP), Plaque Index (PI), Gingival Index (GI))
Study design:
Clinical examination, Questionnaire design, Cross-sectional and analytical study on dental caries
Specific Inclusion Criteria: 1. Age range 11– 18 years
2. Studies that performed caries risk indicators and factors during adolescence 3. Only permanent dentition
4. Report characteristics: newer than 2008 5. English language
6. Full texts
Exclusion criteria: 1. Case study
2. Systemic review and review articles
3. Pediatric and adult participants (older than 18 years old and younger than 11 years old) 4. Non-full texts
5. Conference articles
6. Published papers before 2008
Publication type
Sources
PubMed and Google scholar were searched from 2000 to 2018.
Keywords: Dental caries, Dental caries risk indicators, Adolescents, Prevalence, Caries Index, DMFT score, Oral Hygiene Indices
ANNEXES
EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE Graduate student
of the year ______, and the group _____ of the integrated study programme of Odontology Master’s Thesis title:
………...……….………...…………
………...….………...……...
No. MT evaluation aspects Evaluation
Yes Partially No 1 Has the student’s presentation lasted for more than 10 minutes?
2 Has the student presented the main problem of the Master’s thesis, its aim and tasks?
3 Has the student provided information on research methodology and main research instruments?
4 Has the student presented the received results comprehensively? 5 Have the visual aids been informative and easy to understand? 6 Has the logical sequence of report been observed?
7 Have the conclusions been presented? Are they resulting from the results?
8 Have the practical recommendations been presented?
9 Have the questions of the reviewer and commission’s members been answered correctly and thoroughly?
10 Is the Master’s thesis in compliance with the essence of the selected study programme?
Remarks of the member of evaluation committee of Master’s Thesis
