Caries Risk Assessment by Different Approaches before Fixed Orthodontic Treatment

Previous data have suggested a high caries prevalence in patients undergoing orthodontic treatment but little is known concerning the carious risk of these patients before the beginning of treatment. Objective: The objective of the study was to assess the caries risk of young patients before fixed appliances were placed. Methods: 31 healthy young patients scheduled for treatment were enrolled in this pilot study and received a clinical and X-Ray examination (exclusion criteria: low salivary flow rate, active caries lesions). In order to assess the caries risk, 3 prediction tests were performed immediately before the beginning of treatment: the ClinproCarioLPop (CCLP, 3M ESPE, Germany) assessing the metabolic activity of cariogenic bacteria by their production of lactic acid, the Cario-Analyse (CA, Pierre Fabre, France) assessing by RT-PCR the numbers of Streptococcus Mutans and Lactobacillus in a sample of saliva and thirdly by plate culturing cariogenic bacteria from a sample of plaque. Results: The patients (mean age 15 ± 4.6 years) had a DMFT of 2.9 ± 3.4 and DMFS of 4.5 ± 5.9 (mean ± SD). Judging from each of the tests, no patient had a low caries risk and a high risk was predicted for 68% with the CCLP and for 42% with the CA. Furthermore, Streptococcus Mutans scores were higher than 104 CFU /ml saliva for 55% of the patients and higher than 10 CFU per sample of plaque for 32% of them. Statistical analysis only showed weak correlations between the three indicators of caries risk (P>0.05). Conclusions: According to the present data, most of the patients selected for orthodontic treatment already presented a high caries risk, underlining the need for a better instruction of the patients before the beginning of orthodontic treatment.