Examination of three different methods of dental caries scoring during eruption of the premolar and second molar teeth in 10- to 13-year-old children using cross-sectional data.J Clin Dent. 2007; 18(4):95-100.JC
Premolars and second permanent molars mainly erupt in children between 10 and 13 years of age. This age range provides a relatively large number of caries-free or near caries-free tooth surfaces at a baseline measurement that can become carious during such trials. Since traditional DMFS scoring does not take the addition of new surfaces into account, the aim of this study was to compare that scoring system to two methods where sound surfaces are included in the scoring.
The comparison was done in a cross-sectional caries prevalence study so that caries progression and tooth eruptions (as occurs in a longitudinal investigation) would not confound the methods assessments. A total of 729 children between 10 and 13 years of age were recruited from four public schools in Venezuela and assigned to age groups 10, 11, 12, and 13. Decayed, missing, and filled surfaces (DMFS) of their respective premolar and second molar teeth were scored by one calibrated examiner (CM) using a mirror and probe and the criteria reported by Radike, but with one major modification; that was, avoidance of any forceful probing of suspected non-cavitated pits and fissures for caries lesions. In each subject, traditional DMFS were determined in which sound surfaces were not considered. These scores were compared to the scoring of DMFS plus sound surfaces (DMFSS) as described by Katz, et al. and Huntington.
Mean traditional DMFS scores (+/- SEM) obtained for the permanent premolars and second molars of 10-, 11-, 12-, and 13-year-old children were 3.06 +/- 0.27, 3.32 +/- 0.27, 3.44 +/- 0.27, and 5.69 +/- 0.37, respectively. A large difference in these scores was observed between the 12- and 13-year-old children, in contrast to smaller differences between the 10- and 11-, and the 11- and 12-year-olds. Eruption of premolar and second molar teeth examined at the same time showed per cent eruptions as follows: 27.2% at age 10; 60.8% at age 11; 84.9% at age 12; and 95.5% by age 13. Most eruption was observed in the 10- to 12-year-olds, in contrast to the largest DMFS differences appearing between children 12 and 13 years of age. Looked at longitudinally, the incongruence of prior eruption and resulting caries reaching detection levels was about one to two years. All three methods of scoring showed the sharp increment in their respective caries scores between ages 12 and 13, whereas smaller and directionally opposite score changes occurred between years 11 and 12. With the Katz, et al. and Huntington DMFSS methods, the scores between 11 and 12 years decreased, whereas traditional DMFS scoring showed an increase. Although these differences were not large, the pattern of traditional DMFS scoring differed significantly from the other two methods (p < 0.001).
Traditional DMFS scoring in children between 10 and 13 years of age will not detect the new surfaces, and the resulting extra caries increments that would arise in a clinical trial. With the Katz, et al. or Huntington scoring methods, where these new surfaces are counted, adjustment is made for any such caries rate error. In caries remineralization studies, this could be of significance.