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The Use of the International Caries Detection and Assessment System

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Oral Health Assessment

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The Use of the International Caries Detection and
Assessment System (ICDAS) in a National Health Service
General Dental Practice as Part of an Oral Health Assessment
Charles Ormond, Gail Douglas and Nigel Pitts
Key Words: International Caries Detection and Assessment System, Oral Health Assessment, General Dental Practice, Time
Introduction: The Scottish Dental Clinical Effectiveness Programme
(SDCEP) is developing guidance for oral health assessment and review
that is intended for use in National Health Service (NHS) general
dental practice. One section of this guidance is assessment of the
teeth, including their caries status. The detailed caries assessment
method identified by the guidance group is the International Caries
Detection and Assessment System (ICDAS).
Aim: The aim of this study was to investigate the implications of
using the ICDAS in an NHS general practice and, in particular, the
time taken to use the system.
Method: After online and in-practice training and calibration, 50
adult and 50 child patients were randomly allocated for assessment
using the ICDAS detection codes. The ICDAS protocol states that
INTRODUCTION
In 2006, the Scottish Dental Clinical Effectiveness Programme
(SDCEP) formed a group to research and develop guidance
for a comprehensive oral health assessment. This guidance is
now about to be published in two formats: (a) brief guidance
in a paper format and (b) as a more comprehensive resource
(including background material and a range of optional
downloadable forms and web links) on the SDCEP website
(www.sdcep.org.uk).1 The recommendations for best practice
are common between the two formats, but it is acknowledged
that in some practices it may take time for international best
practice to be adopted across all areas.
Part of the guidance on oral health assessment and review
concerns the assessment of the teeth in order to provide a
recorded baseline to enable monitoring of the dentition and
C Ormond BDS, FDS, MGDS. General Dental Practitioner, Falkirk, Scotland, UK.
G Douglas PhD, BMSc(Hons),BDS(Hons), FDS, FDS (DPH), MPH. Department of Public Health, Leeds Dental Institute, Leeds, UK.
N Pitts BDS, PhD, FFGDP(UK), FDS, FFPH, FRSC. Director, Dental Health Services Research Unit, Dundee, Scotland, UK.
Oral Health Assessment in Primary Dental Care
© Primary Dental Care 2010;17(4):153-159
the teeth should be clean and dry. For this study, all patients had
their teeth brushed by the dentist before the assessment and the
results were recorded on draft ICDAS clinical pro forma sheets.
The time taken for the assessment was assessed with a stopwatch
and recorded in a spreadsheet program.
Results: The results showed that the mean time for the assessment
of an adult was 3.80 minutes, or 4.99 minutes if the time for pre-
examination cleaning and drying was included. For a child, the mean
time was 2.53 minutes, or 3.99 minutes if pre-examination brushing
time was included.
Conclusions: These results indicate that with training and experi-
ence, it is possible to carry out an ICDAS assessment in a time that
is practical in general dental practice.
to help produce a risk-based personal care plan or pathway.1
The ideal for tooth-related information to be recorded in
appropriate ways includes assessment of:
• Dental caries and restorations.
• Tooth-surface loss.
• Tooth abnormalities.
• Fluorosis.
• Dental trauma.
• Occlusion.
• Orthodontic treatment need.
The first author’s area of interest centres on the first of these
topics, namely dental caries and restorations. Apart from the
traditional methods2 of probing and other clinical visual systems
and radiography, a number of newer assessment tools for the
detection of caries already exist. They include:
• Fibreoptic transillumination (FOTI).3
Primary Dental Care • October 2010
153
 ICDAS in Oral Health Assessment

• Laser fluorescence.4,5
• Quantitative light-induced fluorescence
(QLF).6
• Electrical caries measurement.7
Clinical visual caries assessments are, however,
still seen as the foundation for the detection
and assessment of caries. The detailed clinical
visual caries assessment method identified on
the basis of reviews of published evidence
by this guidance group and the SDCEP
guidance for the prevention and management
of dental caries in children8 is the Interna-
tional Caries Detection and Assessment
System (ICDAS).9 This is a clinical visual
caries-scoring system designed for use in
clinical practice, dental education, research
and epidemiology.
The use of the ICDAS in general dental
practice aims to provide high-quality infor-
mation about caries status which, when cou-
pled with a caries risk assessment, enables a Figure 1 ICDAS caries severity scores (provided by Dr Andréa G Ferreira Zandoná, Oral Health Research Unit, University of Indiana, USA).
personalised care pathway to be developed
for individual patients.10 The newer caries detection aids can 8 – Temporary restoration.
be useful diagnostic adjuncts to complement clinical visual 9 – Used for the following:
detection and in the future, it may prove to be especially useful 96 – Tooth surface cannot be examined.
if the recordings can be linked to the ICDAS codes. At present, 97 – Tooth missing because of caries.
further research into this aspect is required, along with practi- 99 – Unerupted tooth.
cal steps to integrate the storage and recall of caries scores to Thus a sound, unrestored tooth would score 00 and code 43
monitor the behaviour of lesions over time. would indicate an amalgam restoration with localised enamel
ICDAS is a new concept for most general dental practitioners breakdown due to caries but with no visible dentine. The chart
(GDPs) and concern was raised that this method would be used for recording the ICDAS findings is at Figure 2.
far too time-consuming to be carried out in National Health There are also ICDAS scoring systems for root caries and
Service (NHS) general dental practice. There was, therefore, a caries activity. However, these were not used in this study. A
need to carry out research to ascertain whether this was the recent publication9 gives a fuller explanation of the ICDAS
case and whether the time required would be a fundamental system.
barrier to the implementation of the ICDAS in general dental
practice. AIM
The ICDAS detection codes range from 0 to 6 depending The aim of this study was to investigate the implications of
on the severity of the lesion and the basis of the codes is shown using the ICDAS in NHS general dental practice and, in
in Figure 1. particular, the time taken to use the system.
A two-digit coding system is suggested by the ICDAS to
identify restorations/sealants with the first digit, followed by METHOD
the caries code shown in Figure 1. The suggested code for Before commencing the study, the investigator (CO) under-
restorations/sealants is as follows: took a training programme. This consisted of a half-day of slide
0 – Sound. presentations and discussions of the ICDAS codes and protocol
1 – Sealant, partial. for the examination. The training conducted included both
2 – Sealant, full. theoretical aspects and discussions about real patients within
3 – Tooth-coloured restoration. the study setting; this is close to ideal, although training in
4 – Amalgam restoration. other clinical research studies has been conducted over longer
5 – Stainless steel crown. periods. An e-learning programme, available on the world
6 – Porcelain, gold or PFM crown or veneer. wide web or as a CD-ROM, was used for training, self-testing,
7 – Lost or broken restoration. and calibration.11 It is essential to view this several times in

Primary Dental Care • October 2010

154

Figure 2 The ICDAS chart.
Figure 3 A completed ICDAS chart.
order to increase the consistency and hence the reliability of
the scores. This e-learning program was also completed by the
dental care professional (DCP) who recorded the information
on the ICDAS charts employed in this study (see Figure 2).
A submission was made to the joint ethics committee of
Fife NHS Board/Forth Valley Health Board and no ethical
approval for the study was deemed to be necessary. Over a
period of one month, 50 adults and 50 children (under 18
years of age) were selected at random from patients attending
one GDP. The procedure was explained and the patients/par-
ents signed a consent form prior to the examination. After
obtaining patient or parental consent, each one was provided
with an ICDAS charting when they attended for a routine
examination.
C Ormond et al
At the time of examination, the only
exclusions to taking part in this study were
uncooperative patients (none) and patients
who at that time required antibiotic cover
(none) for invasive treatment.
The ICDAS protocol dictates that the
teeth to be examined are clean and dry. In
order to ensure that patients’ teeth were
clean, the investigator brushed their teeth
before drying them with air.
Each examination was timed from start
(from the point of the patient sitting on
the dental chair) to finish (at the end of
the examination) by a previously trained
DCP with a stopwatch. The results were
entered into a Microsoft Excel spreadsheet
(Microsoft Corporation, Redmond, USA)
in minutes and seconds.The range of times
taken to perform the exam inations in
different age groups and the mean times
were analysed.
The ICDAS examination should be
used in conjunction with bitewing radio-
graphs, taken at risk-determined inter-
vals, because some approximal lesions
may show on radiographs but not be
obvious using the ICDAS, or any other
visual method. A completed ICDAS chart
is at Figure 3.
RESULTS
Tables 1 and 2 show the results for adults
and children, respectively.
The overall mean examination time for
adults was 4.99 minutes (range: 2.716-11.1
minutes) including brushing time and
3.8 minutes (range: 2.016-10 minutes)
without brushing. The outlying 10-minute
duration examination was the first adult patient to be examined
and substantial improvement on this time was achieved as more
exams were completed. Generally, patients with more teeth and
more restorations took longer to examine.
For children, the overall mean examination time was 3.54
minutes (range: 1.36-7.05 minutes) with brushing and 2.53
minutes (range: 0.916-5.7 minutes) without brushing.
Figure 4 shows the distribution of time taken to complete
an ICDAS for adults and children.
DISCUSSION
When piloting the protocol, before starting to collect data, a
problem was encountered. It was that patients do not routinely
present for examination with teeth that are clean and dry, as
Primary Dental Care • October 2010
155
 ICDAS in Oral Health Assessment

Table 1: Results for adults Table 2: Results for children

Age Consent Toothbrushing Time* for Total Number Age Consent Toothbrushing Time* for Total Number
ICDAS time* of teeth ICDAS time* of teeth
35 yes 1.1 10 11.1 24 12 y 1.35 5.7 7.05 28
80 y 1.033 4.166 5.199 23 5 y 0.5 2.95 3.45 20
83 y 1.1 4.5 5.6 15 3 y 2.6 2.6 20
80 y 1.133 7.15 8.283 24 9 y 1 3.7 4.7 22
50 y 1.1 5.25 6.35 25 8 y 1.016 3.783 4.799 22
79 y 1.133 9 10.133 20 4 y 1.033 2 3.033 20
75 y 1.166 3.5 4.666 15 16 y 1.2 3.083 4.283 28
19 y 1 3.75 4.75 29 11 y 1.333 4.166 5.499 25

19 y 1.166 3.15 4.316 28 14 y 1.2 3 3.2 28

34 y 1.033 4.25 5.283 26 17 y 1.166 3 4.166 28

35 y 1.25 6.616 7.866 32 6 y 1 3 4 27

19 y 1.016 5 6.016 28 9 y 1 2.816 3.816 21

60 y 1.2 5.166 6.366 24 2 y 1.783 1.783 20

19 y 1.083 3.25 4.333 26 15 y 1.05 2.633 3.683 24

10 y 1.033 3.133 4.166 21
42 y 1.033 4 4.033 31
4 y 1 1 2 20
58 y 1.183 2.183 3.366 16
11 y 1.5 2.266 3.766 28
51 y Hygienist 1st 3.116 3.116 26
10 y 1.016 1.733 2.749 24
54 y 1.633 2.533 4.166 25
17 y 1.166 1.416 2.582 24
46 y 1.416 3 4.416 28
17 y 1.316 3.95 5.266 28
21 y 1.816 3.483 5.299 31
17 y 1.283 3.916 5.199 28
35 y 1.683 3.316 4.999 27
15 y 1.05 2.1 3.15 28
44 y 1.083 2.016 3.099 23
10 y 1.033 2 3.033 18
55 y 1.416 2.75 4.166 24
13 y 1 1.783 2.783 24
45 y 1.033 2.316 3.349 28
7 y 1 2.25 3.25 22
23 y 1.133 3.533 4.666 29
9 y 1.066 2.45 3.516 24
56 y 1.216 3.383 4.599 23
5 y 1 2.083 3.083 20
33 y 1.25 3.033 4.283 26
5 y 1 0.916 1.916 20
56 y 1.5 4 5.5 30
6 y 1 1.083 2.083 22
47 y 1.55 5.2 6.75 26
8 y 1.083 1.466 2.549 22
57 y 1.4 3.216 4.616 21
12 y 1.066 1.766 2.899 28
49 y 1.216 4.35 5.566 24
8 y 1.133 2.45 3.583 21
74 y 1.033 3.283 4.316 12
15 y 1.15 2.583 3.733 23
53 y 1.483 3.2 4.683 25
13 y 1.283 4.133 5.416 27
21 y 1.35 6.55 7.9 30
5 y 1 1.45 2.45 20
23 y 1.016 3.25 4.266 27
3 y 1 1.25 2.25 20
18 y 1.1 3.033 4.133 30
15 y 1.15 3.233 4.383 28
22 y 1.333 2.516 3.849 24 17 y 1.133 3.783 4.916 28
20 y 1.283 4.783 6.066 28 15 y 1.166 2.6 3.766 24
37 y 1 3.616 4.616 27 12 y 1.15 2.083 3.233 28
49 y 1.166 4.083 5.249 24 14 y 1.05 1.633 2.683 27
18 y 1.466 3.033 4.499 26 17 y 1 2.233 3.233 28
60 y 0.666 2.05 2.716 10 11 y 1.066 3.25 4.316 22
67 y 1.216 3.233 4.449 17 9 y 1 2.583 3.583 25
50 y 1.166 3.5 4.666 28 16 y 1.066 2.766 3.832 28
42 y 1.183 3.083 4.266 24 8 y 1.116 3.633 4.749 23
25 y 1.45 2.183 3.633 32 17 y 1 2.6 3.6 28
21 y 1.083 2.016 3.099 28 1 y 1.366 1.366 12
25 y 1.35 2.316 3.666 32 7 y 1.016 1.333 2.349 16
21 y 1.066 2.9 3.966 28 10 y 1.183 1.783 2.966 18
66 y 1.25 2.2 3.45 22 13 y 1.2 2.916 4.116 29
Total 59.734 191.004 249.738 1223 Total 52.322 129.186 180.575 1209
Mean 1.22 3.8 4.99 24.46 Mean 1.1 2.53 3.54 23.7
* All times are in minutes * All times are in minutes

Primary Dental Care • October 2010

156
 C Ormond et al

the first author no longer tells patients that

ICDAS results they are caries free if no restorative treatment
25
is required because code 1 and 2 lesion/s
ICDAS Adults
ICDAS Children may be present. Figure 5 shows the histolog-
20 ical progression of caries extent through the
teeth as it relates to the increasing ICDAS
Number of patients

15
score.12
With regard to clinical decision-making,
the ICDAS can be said to provide a third
10
option, other than not treating or restoring
caries. It is the preventive care and monitor-
5 ing option, which is to arrest or remineralise
enamel through the use of fluor ide or
other remineralising agent combined with
0
1 2 3 4 5 6 7 8 9 10 improved oral hygiene and diet modifica-
Time in minutes tion. This intensity of care needed with this
Figure 4 Results for adults and children. option depends on the caries risk of the
patient. Also, clinicians must be sure of
required by the ICDAS protocol. It was therefore decided to which lesions have the potential to remineralise because for
carry out toothbrushing before the charting took place in an many it may be difficult to assess which lesions are active and
effort to ensure that the patients’ teeth were in a condition that which are not. The ICDAS also includes a developing activity
conformed to the protocol. An ideal situation would be for the assessment system (see www.icdasfoundation.dk).
patients to have been seen by a hygienist before the examina- If the ICDAS chart can be used in conjunction with a
tion was carried out. However, this is not normal practice. formal caries risk assessment then it will have great potential.
Because patients require to be seen first by a dentist, some However, it has not been easy to find a suitable caries risk
modification to the regimen used in this study would have assessment form. Many documents discuss caries risk8,13-15 and
been necessary and this would have added to the time taken suggest that the risk is recorded. Unfortunately, prior to the
for the examination. In other countries, patients have been SDCEP guidance, none recommended any forms to collate
required to clean their own teeth prior to the examination by the information. The best that the investigator in the current
a dentist. study could find was the Caries Management Based on Risk
The mean times taken for the ICDAS examination showed Assessment (CAMBRA)16 and for patient motivation the
that with experience, time should not be a barrier to carrying Cariogram may also prove useful.17
out the assessment in general practice. There are limitations to As can be seen from the completed chart (Figure 3), it is
the generalisability of these timings in that only one dentist difficult to interpret at first sight. To compare one chart to a
conducted the examinations and it will be interesting to subsequent chart is even more difficult using paper records. If
compare these timings with those in forthcoming pilots of it were possible to enter the data into a computer and have the
oral health assessment and review. It must be
remembered that the caries examination is only a
part of an overall oral health assessment and con-
siderable time is necessary for completing all the
component parts.
If the ICDAS charting is to have any clinical
value, then time must be taken to explain the
findings to the patient. In the current study, it was
found that patients were engaged in the discussion
and the chart had good motivational aspects.
The thought-processes of the examining
dentists also need to change in that they need to
think about the progress of caries into enamel and
dentine as this can be helpful when considering
which treatment approach to adopt: preventive Figure 5 ICDAS scores related to the progression of caries (provided by Dr Andréa G Ferreira Zandoná, Oral Health Research Unit,
or restorative. As a result of using the ICDAS, University of Indiana, USA).

Primary Dental Care • October 2010

157
 ICDAS in Oral Health Assessment
Table 3: Prescriptions for fluoride supplements with
the NHS GDS
Supplement Prescriptions (n) Cost (£)
Duraphat* toothpaste 2800ppm 194,054 1,159,472
Duraphat* toothpaste 5000ppm 129,712 1,116,117
Fluoriguard* Daily Rinse 0.05% AF 19,300 100,370
Fluoriguard* Daily Rinse 0.05% 49,476 238,123
En-De-Kay† Daily Mouthwash 16,698 47,192
Total 409,240 3,070,514
* Colgate UK, Guildford, UK.
† Manx Healthcare, Warwick, UK.
computer compare the readings to see whether any changes in
the caries status of lesions had occurred and to couple this
with the caries risk assessment chart, a very powerful tool for
preventive dentistry would exist. This development work is
currently under way. This system could be used in conjunction
with systems such as the English Department of Health’s
Prevention Toolkit to give treatment options.18 It would
then be possible to monitor lesions to see whether preventive
treatments were effective.
In Scotland, there is an overall surveillance of caries in
children via the National Dental Inspection Programme
(NDIP),19 which looks at the dental health of children in
school years P1 (aged 5-6 years ) and P7 (aged 12-13 years).
Although this is effective in population studies, it does not
help an individual dentist with an individual patient because
the GDP would ideally like to know about the progress of
lesions much more quickly than NDIP could tell him/her. If
a lesion went from code 1 to code 3 between two examina-
tions then it would be an indication that the GDP’s preventive
care plan required modification.
The UK Adult Dental Health Survey has typically been
carried out every 10 years; the most recent Survey is of
England, Northern Ireland, and Wales. If as an alternative or
a complement to such surveys, regular ICDAS chartings were
carried out and recorded electronically at every examination
(with the frequency based on risk assessment) collectively
this could over time build up to give more up-to-date and
detailed information on the dental health of much of the
nation.
In 2009, in England over 400,000 prescriptions for fluoride
supplements were written within the General Dental Services
of the NHS (Table 3).20 At present, it is difficult to tell whether
this preventive treatment is cost-effective because it is difficult
to measure. For example, many prescriptions for Duraphat
toothpaste are written each week and there is no way of
knowing whether this is effective in preventing caries, other
than an impression that patients are not producing so many
new cavities.21 ICDAS charting would provide a method for
Primary Dental Care • October 2010
158
quantifying caries progression and so measuring the effect of
preventive treatment.
Also in 2009, within the NHS in England, £2.3 billion was
spent by the taxpayer and a further £0.5 billion by patients on
dental treatment. These figures could be reduced by effective
prevention. GDPs currently use assessments such as the Basic
Periodontal Examination to monitor periodontal disease and
treatment. For orthodontic treatment need, the Index of
Orthodontic Treatment Need (IOTN) is used to assess whether
orthodontic treatment should be carried out. Similarly, if a
systematic means exists to assess and monitor caries, it should
be used.
In order for a change to treatment based on prevention to
be effective, an effective and fair overhaul of the present
remuneration system is essential.22 If the ICDAS is to be used
routinely in general dental practice, training will be necessary
for dental practitioners and DCPs using the system.
Further research into using the ICDAS in general dental
practice is indicated and under way in a number of settings.
This could include the use of root caries charting and longer-
term follow-up of patients to see whether preventive interven-
tions have been successful. This could also include patient
interviews to find out whether greater involvement in their
care pathway or personal care plan had changed their attitude
towards their dental health.
In summary, the ICDAS tooth assessment is only part of an
ideal oral health assessment; before considering the feasibility
of carrying out a comprehensive assessment, under present
and evolving remunerative systems, it will be necessary to
carry out a similar exercise using all elements of the oral health
assessment.1 Such pilots are currently being planned. The
traditional regimen where the dentist first sees the patient and
records a treatment plan may no longer be appropriate. If
the desire is to move to a preventive approach and produce
care pathways and personal care plans for our patients, then
compatible remuneration systems will be required.
CONCLUSION
The current study has suggested that the ICDAS can be used
in general dental practice to record and monitor caries and
that, once trained, a clinician does not, on average, take more
than five minutes (including brushing time) for adults and four
minutes (including brushing time) for children to record caries
and existing restorations using the ICDAS.
ACKNOWLEDGEMENTS
This study was funded in part by an award from the British
Society of General Dental Surgery. The authors wish to thank
the ICDAS foundation for the invitation for the first author to
attend international workshops in Dundee and Philadelphia.

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Case Reports in Pediatric Dentistry
Evert van Amerongen, Maddelon de Jong-Lenters, Luc Marks,
Jaap Veerkamp, editors
New Malden: Quintessence, 2009
£72; hardcover; 144 pp; 270 col illus
ISBN: 978 1 85097 196 2
Many of us will have been required, at some point in our training,
to write up an interesting or complex case for presentation to
colleagues or examiners. Huge effort is put into considering all
possible treatment options before selecting the best approach for
our patient, conscientiously completing the treatment over many
visits, then meticulously preparing the images, text and references in
order to communicate what we have achieved. In the process, we
will have learned much about a particular condition or treatment
modality but, after a brief airing, our case report is soon forgotten
and left on a shelf to gather dust. This book aims to harness these
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treated by experienced paediatric dentists.
The content covers a broad spread of paediatric dental
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one in three of the case reports, each addressed from a different
perspective with an emphasis on clinical application of current
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hypomineralisation and dental trauma are examples of further cases.
Inclusion of a couple of less common conditions serves as a
reminder always to be on the lookout for the unusual, yet a strength
of the book is that obscure conditions of merely academic interest
do not receive undue emphasis. Manufacturers’ details are helpfully
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programme. Dent Update. 2008;35:320-3.
22. Page J, Weld JA, Kidd EAM. Caries control in health service practice. Br Dent J. 2010;208:58.
Correspondence: C Ormond, Clark & Watson Dental Surgeons,
27 Newmarket Street, Falkirk FK1 1J J.
E-mail: chasormond@aol.com
given for dental materials. Each chapter is supported by a concise
and relevant reference list, which allows the reader to explore
subjects at greater length or to follow up the evidence for any
contentious statements.
The book is lavishly illustrated with images taken, in many cases,
over impressively long follow-up periods. These are of uniformly high
quality, adding to its interest and visual appeal. However, I was
occasionally distracted by inconsistency in the formatting and display
of the images: for example, mirror views are sometimes reversed and
sometimes not, and the book lacks a standard layout for sequences
of clinical views.
The contributors are drawn from dental schools and practices
across Europe. At times, to the UK reader, this gives rise to
unfamiliar clinical terminology but the meaning is usually readily
understood in its context.
This book deserves a place in any dental library. It would be of
interest to general practitioners but also useful reading for specialists
in paediatric dentistry. I could see it being popular with both
undergraduate and postgraduate students who have tired of the
standard textbooks and are looking for a fresh perspective.
Availability of a paperback edition at a more competitive price would
be likely to increase its appeal to individual purchasers.
As I turned the final pages, I felt as I do on the return journey
from an international conference: refreshed by exposure to a wide
range of ideas, stimulated by different approaches and equipped with
some new tools to solve clinical problems for the children who will
come into my surgery tomorrow.
JENNY HARRIS MSC , BDS, FDS.
SPECIALIST IN PAEDIATRIC DENTISTRY, SHEFFIELD PCT AND
re ook
CHARLES CLIFFORD DENTAL HOSPITAL, SHEFFIELD.
w
B
vie
Primary Dental Care • October 2010
159

Divine proportions in attractive
and nonattractive faces
Pancherz H, Knapp V, Erbe C, Heiss AM
World J Orthod. 2010;11:27-36.
Aim
To test Ricketts’ 1982 hypothesis that facial beauty is measurable by
comparing attractive and nonattractive faces of females and males with
respect to the presence of the divine proportions.
Methods
The analysis of frontal view facial photos of 90 cover models (50 females,
40 males) from famous fashion magazines and of 34 attractive (29 females,
five males) and 34 nonattractive (13 females, 21 males) persons selected
from a group of former orthodontic patients was carried out in this study.
Based on Ricketts’ method, five transverse and seven vertical facial reference
Dental caries and body mass index
by socio-economic status in
Swedish children
Gerdin EW, Angbratt M, Aronsson K, Eriksson E, Johansson I
Community Dent Oral Epidemiol. 2008;6:459-65.
Objectives
The aim of the present study was to evaluate the association between
dental caries, childhood body mass index (BMI), and socioeconomic status in
Swedish children.
Methods
The study cohort consisted of 2303 10-year-old children with data on
socioeconomic status, BMI at 4, 5, 7 and 10 years of age, and caries at 6, 10
and 12 years of age. Anthropometric measures were carried out by trained
A systematic review of the preventive
effect of oral hygiene on pneumonia
and respiratory tract infection in
elderly people in hospitals and nursing
homes
Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J
J Am Geriatr Soc. 2008;56:2124-30.
The objective of this study was to investigate the preventive effect of oral
hygiene on pneumonia and respiratory tract infection, focusing on elderly
people in hospitals and nursing homes, by systematically reviewing effect
estimates and methodological quality of randomized controlled trials
(RCTs) and to provide an overview of additional clinical studies in this area.
Literature searches were conducted in the Medline database, the Cochrane
library databases, and by hand-searching reference lists. Included publications
Primary Dental Care • October 2010
160
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distances were measured and compared with the corresponding calculated
divine distances expressed in phi-relationships (f = 1.618). Furthermore,
transverse and vertical facial disproportion indices were created.
Results
For both the models and patients, all the reference distances varied largely
from respective divine values. The average deviations ranged from 0.3% to
7.8% in the female groups of models and attractive patients with no
difference between them. In the male groups of models and attractive
patients, the average deviations ranged from 0.2% to 11.2%. When
comparing attractive and nonattractive female, as well as male, patients,
deviations from the divine values for all variables were larger in the
nonattractive sample.
Conclusion
Attractive individuals have facial proportions closer to the divine
values than nonattractive ones. In accordance with the
ct
hypothesis of Ricketts, facial beauty is measurable to some
tra
s
degree.
Ab
nurses according to standardized routines. The occurrence of caries was
registered from county records, and the children were classified into one of
five socioeconomic clusters based on their census registration address.
Results
Caries prevalence decreased with increasing socioeconomic status at all
ages, whereas childhood BMI and proportion of overweight/obese children
were unrelated to socioeconomic status. Obese, but not overweight,
children had more caries affected teeth than non-obese, and BMI had an
independent, though weak, effect on caries variation in multiple regression.
Interestingly, overweight/obese 4-year-olds, who had normal body weight at
5, 7 and 10 years of age, had significantly less caries than children who had
normal body weight from 4 to 10 years of age.
Conclusions
Overweight and caries prevalence are significantly associated in
Swedish children. However, the association is weak. Nevertheless,
ct
the concept that child dental services and child welfare
ra
services can benefit from joint programs is supported. st
Ab
were analyzed for intervention (or topic) studied, main conclusions, strength
of evidence, and study design. RCTs were further analyzed for effect
magnitudes and methodological details. Absolute risk reductions (ARRs) and
numbers needed to treat (NNTs) were calculated. Fifteen publications
fulfilled the inclusion criteria. There was a wide variation in the design and
quality of the studies included. The RCTs revealed positive preventive effects
of oral hygiene on pneumonia and respiratory tract infection in hospitalized
elderly people and elderly nursing home residents, with ARRs from 6.6% to
11.7% and NNTs from 8.6 to 15.3 individuals. The non-RCT studies
contributed to inconclusive evidence on the association and correlation
between oral hygiene and pneumonia or respiratory tract infection in
elderly people. Mechanical oral hygiene has a preventive effect on mortality
from pneumonia, and non-fatal pneumonia in hospitalized elderly people and
elderly nursing home residents. Approximately one in 10 cases of death
from pneumonia in elderly nursing home residents may be prevented
by improving oral hygiene. Future research in this area should be
ct
ra
focused on high-quality RCTs with appropriate sample size
st
calculations.
Ab