Caries Progression Rates Revisited: A Systematic Review

R Hummel, N A E Akveld, J J M Bruers, W J M van der Sanden, N Su, G J M G van der Heijden, R Hummel, N A E Akveld, J J M Bruers, W J M van der Sanden, N Su, G J M G van der Heijden

Abstract

Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d3/D3), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09-0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

Keywords: DMF index; adolescent; child; epidemiology; incidence; longitudinal studies.

Conflict of interest statement

The authors received no financial support and declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the study selection for inclusion in the systematic review, meta-analysis, and meta-regression analyses. DMFS, decayed, missing, and filled surfaces; DMFT, decayed, missing, and filled teeth.
Figure 2.
Figure 2.
Forest plot of the caries incidence rate per person-year at risk (D3) in the permanent dentition and the 95% confidence interval (CI). The caries incidence rate (first caries events [D3] per person-year at risk) could be recalculated for 15 studies. These reported on 1,995 caries events for a total of 10,768 participants with a total follow-up time of 22,292 person-years. The data were pooled using a random-effects model, because the reported caries incidence rates showed marked heterogeneity (I2 of 100%). The studies were weighted by the number of total person-years. The weight of the studies ranged from 6.5% to 6.7%, and the median was 6.7%.

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