Non-cavitated Dental Caries and the Relationship to Cavitated Lesions

In the U.S., dental caries assessments for epidemiological studies, such as the National Health and Nutrition Examination Survey (NHANES), typically employ a visual-tactile method that is weighted towards assessing cavitated dental lesions. Objectives: We examined the relationship between cavitated and non-cavitated dental lesions (NCL) in a primary dentition. Methods: STATA v8.0 was used to analyze data from 445 children enrolled in Head Start programs operated by Pine Ridge and Rosebud tribal governments who participated in an Indian Health Service fluoridation and dental caries study. Standard NHANES methodology was utilized to assess dentition and caries status, and a modified NHANES examination method was used to assess for NCL. Results: Among the 445 children evaluated, only 20 had at least 1 NCL and dfs = 0 (decayed-filled primary tooth surface). Participants had a mean of 1.8 surfaces with NCL and 59% had at least 1 NCL. The overall dfs was 11.4 and 76.9% had access to residential water fluoridation. In multivariate models adjusting for sex, residence, and fluoridation exposure, children with Severe Early Childhood Caries (S-ECC) or maxillary anterior caries experience were more than 2 times as likely to have at least 1 NCL (Odds Ratio (OR) 2.30, 95% CI 1.53-3.47; OR 2.37. 95% CI 1.61-3.50 respectively), and children with at least 6 surfaces of decay were more than 3 times as likely to have at least 1 NCL (OR 3.43, 95% CI 2.18-5.41). When the outcome variable was more narrowly defined as having at least 1 NCL on smooth surfaces only, the magnitude of the association increased fourfold for children with S-ECC (OR 4.36, 95% CI 2.68-7.10). Conclusions: The data suggests that in a high-risk population for dental caries, extent of disease remains relatively unchanged with the addition of NCL information and that S-ECC is a significant indicator for NCL.