Thesis
Progression of non-cavitated carious lesions in permanent teeth and risk factors associated with their progression
University of Iowa
Master of Science (MS), University of Iowa
Summer 2021
DOI: 10.17077/etd.006009
Abstract
Non-cavitated caries is the initial non-painful stage of caries which can gradually progress to cavitation if measures are not taken to halt its progression. This study assessed the prevalence of non-cavitated lesions (D1), longitudinal transition of non-cavitated lesions (D1) from non-cavitated to either reversal, unchanged, or progression from age 17 to 23 years, and factors associated with progression vs. no progression.The Iowa Fluoride Study (IFS) recruited a birth cohort during 1992-95 in Iowa and followed it until 23 years of age, estimating fluoride intakes and occurrence of dental fluorosis and dental caries. In secondary analyses, this thesis assessed: 1) Prevalence of non-cavitated (D1) lesions at both the participant-level and surface-level, 2) Changes in the caries status of D1 lesions through different age intervals (ages 9-13, 13-17, 17-23, 9-23 for early-erupting teeth only, and 13-23 for late-erupting teeth only), and 3) Factors associated with progression of non-cavitated (D1) lesions from age 17 to 23 years.
Teeth were examined for dental caries by trained and calibrated dentist examiners, using the Iowa Fluoride Study criteria. Non-cavitated lesions at baseline age of each interval (i.e., at ages 9, 13, and 17 years) were re-assessed and scored to assess changes in their caries status at the follow-up age of each interval (i.e., at ages 13, 17, and 23 years). Data related to possible risk factors were collected from questionnaires and fluoride assays of different beverages and selected food products conducted as part of the IFS.
The caries transitions from D1 to 6 categories (sound S; questionable D0; remained D1; frank cavitation D2+; filled F; or missing due to decay M) were determined. These transitions were also collapsed into three categories of “Regression/Reversal” (i.e., S or D0), “No Change” (i.e., remained D1), or “Progression” (i.e., D2+ or F or M). Generalized Estimating Equations (GEE) with logit link were used for bivariate and multivariable regression analyses with a dichotomous site-specific outcome of progression vs. no progression (combining Regression and No Change). Backward elimination was used to develop multivariable models and the Quasi-Information Criterion (QIC) was used to determine the best final model. The highest person-level prevalence of non-cavitated lesions (D1) was at age 17 (60%). The zone/surface-level data also showed the highest numbers and rates of non-cavitated lesions (D1) for the same age, i.e., 1,125 D1 lesions (3%) at baseline (age 17). Regarding transitions, of the 1,125 surfaces with a D1 lesion at age 17, 11% (n = 125) showed progression to cavitation or filled, 18% (n = 203) remained non-cavitated, and 71% (n=801) had regression to sound or questionable at age 23. Transitions for other age intervals were also reported.
Among risk factors, occlusal tooth surfaces had substantially higher odds of caries progression (OR=6.64) compared to bucco-lingual surfaces (p<0.001). Pit and fissure surfaces had higher estimated odds of experiencing caries progression compared to smooth surfaces (p<0.001) (OR=3.33 from final Model 7). Sex was not statistically significant, but was forced to remain in the models. This thesis found no other risk factors, such as SES level, fluoride exposures, tooth-brushing frequency, or consumption of water, milk, sugar-sweetened beverages, and juice, to be significantly associated with caries progression of D1 lesions from 17 to 23 years in the multivariable regressions, that included tooth surface.
Non-cavitated lesions were more prevalent at age 17 than at ages 9, 13, and 23. There were higher rates of regression than progression or no change. Nonetheless, a substantial percentage progressed, suggesting that early detection and intervention are important in preventing frank cavitation. The occlusal tooth surface and pit and fissure surfaces have higher odds of caries progression.
Details
- Title: Subtitle
- Progression of non-cavitated carious lesions in permanent teeth and risk factors associated with their progression
- Creators
- Mahrukh Zafar
- Contributors
- Steven M Levy (Advisor)John Warren (Committee Member)Justine Kolker (Committee Member)Xian Jin Xie (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Dental Public Health
- Date degree season
- Summer 2021
- DOI
- 10.17077/etd.006009
- Publisher
- University of Iowa
- Number of pages
- xx, 334 pages
- Copyright
- Copyright 2021 Mahrukh Zafar
- Language
- English
- Description illustrations
- illustrations (some color), forms
- Description bibliographic
- Includes bibliographical references (pages 326-334)
- Public Abstract (ETD)
The early stage of tooth decay before the formation of a cavity is called non-cavitated caries or a white spot lesion. It is the initial, non-painful stage which can be reversed by the use of fluoridated water and toothpastes, a healthy diet, and good oral hygiene practices. This study explored this stage of tooth decay, with particular focus on adolescence and early adulthood (age 17 to 23 years). The study assessed the occurrence of these non-cavitated lesions at different ages, patterns of their progression and regression/reversal over time and the different demographic, diet- and hygiene-related factors that were associated with their progression.
The study found these non-cavitated lesions to be most prevalent in adolescence (at age 17) as compared to at ages 9, 13, and 23. At all ages, the rates of reversal to sound status were very high (~60-70%), while rates of progression were much lower. Most of the caries progression was in the form of teeth being filled. The study also found some tooth types (molars) and tooth surfaces (occlusal, pit and fissure) to have higher caries progression from age 17 to 23.
The high rates of regression/reversal, even after 6 to 14 years of follow-up, highlight the importance of non-cavitated stage. It is important to study this stage, including its prevalence, rates of progression and risk factors associated with progression, in order to prevent individuals from having more severe cavity problems, as well as high cost associated with treatment of deeper tooth decay.
- Academic Unit
- Preventive and Community Dentistry
- Record Identifier
- 9984124269502771
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