Caries risk assessment as a predictor of metabolic control in young Type 1 diabetics.

AIMS: To investigate the relationship between caries risk and glucosylated haemoglobin and to evaluate the use of a computerized caries risk assessment program as a predictor of metabolic control in schoolchildren with Type 1 diabetes mellitus. METHODS: The material consisted of 64 young Type 1 diabetes mellitus patients (8-16 years) attending an outpatient paediatric clinic. Within 2 weeks after the onset of diabetes, a caries risk assessment was carried out with the aid of a computer-based program (Cariogram) and data on the level of metabolic control were collected from the medical records at the 3-year check-up. Caries increment was registered at recall clinical examinations. RESULTS: A statistically significant positive relationship between caries risk and metabolic control was found (r = 0.51; P < 0.01), with a sevenfold increased risk of impaired metabolic control after 3 years in those assessed with high caries risk at onset (OR 7.3; P < 0.01). When the Cariogram was used as a predictor for the metabolic state of the disease, the sensitivity and specificity was 75% and 71%, respectively. The negative predictive value was 91%. CONCLUSIONS: Our data suggested that a caries risk assessment at the diagnosis of diabetes mellitus in children may be a good indicator of overall health care that can provide useful prognostic information on the level of metabolic control after 3 years.

Evaluation of a computer program for caries risk assessment in schoolchildren.

The 'Cariogram' is an interactive PC program for caries risk evaluation. It takes into account the interactions between caries-related factors and expresses a graphic assessment of the risk. The aim of this study was to assess the caries risk in schoolchildren using the Cariogram and to evaluate the program by comparing the caries risk assessments with the actual change in DMF. A 2-year prospective study on 446 schoolchildren, 10-11 years old, was conducted. At baseline, data on general health, diet, oral hygiene and use of fluoride were obtained. Saliva analyses included mutans streptococci and lactobacilli counts, buffer capacity and secretion rate. DMFT and DMFS were calculated from records and bitewing radiographs. Scores were entered and caries risk was assessed. Re-examination for caries was done after 2 years. The children were divided into 5 groups according to the assessed caries risk at baseline. Where the Cariogram predicted a 0-20% (high risk), 21-40%, 41-60%, 61-80% and 81-100% (low risk) chance of avoiding new lesions, 8, 35, 42, 73 and 83%, respectively, had no new lesions 2 years later. Logistic regression analyses were carried out. When the Cariogram was included, only two factors, the Cariogram (p < 0.001) and the DMFS at baseline, i.e. past caries experience (p = 0.001), turned out to be significantly associated with caries increment. The Cariogram was the most powerful explanatory variable. When the Cariogram was excluded, lactobacillus count, mutans streptococci, diet intake frequency and DMFS at baseline were significantly associated with caries increment. The Cariogram predicted caries increment more accurately than any included single-factor model. How this finding can be translated into daily practice in the best and most practical way is a matter for future research.

Caries risk assessment: a comparison between the computer program 'Cariogram', dental hygienists and dentists.

UNLABELLED: The 'Cariogram', which is an interactive PC-program for caries risk evaluation, illustrates the interaction between caries related factors and expresses the caries risk graphically. It also demonstrates a weighted impact of the different etiological factors on the risk. The aim of this paper was to use the Cariogram program on a set of patients, and to compare the outcome of its risk evaluation with those made by dental hygienists and dentists. A questionnaire, containing the descriptions of five patients with detailed information on nine factors generally associated with caries, was given to the participants. They were asked to rank the patients according to their 'chance to avoid dental caries' during the coming year. The results were compared with the assessments obtained from the Cariogram. RESULTS: 73.5% of the dental hygienists and 78.5% of the dentists ranked the patients for caries risk either identically or with only one deviation when compared to the Cariogram. It was concluded that the 'opinion' of the Cariogram on caries risk was in agreement with that of the majority of the participants. In addition, the Cariogram program induced discussions about the relative impact of etiological factors of caries. It is envisaged that the Cariogram can serve as one further tool in the teaching of caries risk.