Evaluation of caries risk reduction following preventive programs in orthodontic patients, using Cariogram computer model: A quasi-experimental trial

DOOST-HOSEINI, Maryam; SEIFI, Massoud; PAKKHESAL, Mina; SABOURY, Abolfazl; AMDJADI, Parisa; NAGHAVIALHOSSEINI, Aliakbar

doi:10.1590/2177-6709.26.5.e2120218.oar

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Dental Press Journal of Orthodontics

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ORIGINAL ARTICLE • Dental Press J. Orthod. 26 (05) • 2021 • https://doi.org/10.1590/2177-6709.26.5.e2120218.oar copy

Evaluation of caries risk reduction following preventive programs in orthodontic patients, using Cariogram computer model: A quasi-experimental trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

This study evaluated the effectiveness of preventive strategies on caries risk reduction in patients undergoing orthodontic treatment, using the Cariogram program.

Methods:

In this quasi-experimental study, samples were selected using a convenience quota sampling technique, in a public dental school. At first, caries risk profile was determined for each subject using the Cariogram before brackets bonding. The sample size consisted of 36 patients. The intervention group (n = 18) received preventive programs, and the control group (n = 18) was trained based on the routine oral health education by means of pamphlets. Then, Cariogram parameters were calculated for patients in both groups after six months.

Results:

The age range of participants was from 12 to 29 years. The mean percentage of the “Actual chance of avoiding new cavities” section in the intervention group increased from 45.72 ± 21.64 to 62.50 ± 17.64. However, the mean percentage of other parameters - such as “Diet”, “Bacteria” and “Susceptibility” - decreased after six months (p< 0.001). Besides, the differences in the mean percentage between intervention and control group at the end of the study period (T₁) related to the Cariogram parameters were statistically significant (p< 0.001). Accordingly, the mean percentage of ‘Actual chance of avoiding new cavities’’ parameter in the intervention group (62.50) was statistically higher than in the control group (42.44) (p< 0.001).

Conclusion:

Implementing different preventive approaches is able to reduce the caries risk in patients undergoing fixed orthodontic treatment, which can be clearly demonstrated using Cariogram program.

Keywords:
Caries risk assessment; Preventive; Orthodontic; Cariogram

Factors	Information and data collected	Cariogram scores
1 - Caries experience	Previous caries experience at baseline, including cavities, filling and missing teeth due to caries	0: Caries-free and no filling 1: Lower than the age group range 2: Within the age group range 3: Higher than the age group range
2 - Related diseases	General disease or conditions associated with dental caries, data from interviews and questionnaire	0: No disease, healthy 1: Disease/conditions, mild degree 2: Severe degree, long-lasting
3 - Diet, content	Estimation of the cariogenicity of the food, in particular fermentable carbohydrate content	0: Very low fermentable carbohydrate 1: Low fermentable carbohydrate 2: Moderate fermentable carbohydrate 3: High fermentable carbohydrate
4 - Diet, frequency	Estimation of number of meals and snacks per day (mean for a normal day)	0: Maximum 3 meals per day 1: Maximum 5 meals per day 2: Maximum 7 meals per day 3: More than 7 meals per day
5 - Plaque amount	Estimation of hygiene based on Silness-Loe plaque Index	0: PI < 0.4 (very good oral hygiene) 1: PI = 0.4 - 1.0 (good oral hygiene) 2: PI = 1.1 - 2.0 (poor oral hygiene) 3: PI > 2.0 (very poor oral hygiene)
6 - Streptococcus mutans	Estimation of levels of Streptococcus mutans in saliva using Strip mutans test (Orion Diagnostica Oy, Espoo, Finland)	0: 0 - 10³3 Featherstone JD. The caries balance: the basis for caries management by risk assessment. Oral health Prev Dent. 2004;2:259-64. CFU/ml saliva 1: 10 ³3 Featherstone JD. The caries balance: the basis for caries management by risk assessment. Oral health Prev Dent. 2004;2:259-64.- 10⁴4 Teich ST, Demko C, Al-Rawi W, Gutberg T. Assessment of implementation of a CAMBRA-based program in a dental school environment. J Dent Educ. 2013 Apr;77(4):438-47. CFU/ml saliva 2: 10 ⁴4 Teich ST, Demko C, Al-Rawi W, Gutberg T. Assessment of implementation of a CAMBRA-based program in a dental school environment. J Dent Educ. 2013 Apr;77(4):438-47.- 10⁵5 Tagliaferro EP, Ambrosano GM, Meneghim MD, Pereira AC. Risk indicators and risk predictors of dental caries in schoolchildren. J Appl Oral Sci. 2008 Dec;16(6):408-13. CFU/ml saliva 3: > 10⁵5 Tagliaferro EP, Ambrosano GM, Meneghim MD, Pereira AC. Risk indicators and risk predictors of dental caries in schoolchildren. J Appl Oral Sci. 2008 Dec;16(6):408-13. CFU/ml saliva
7 - Fluoride program	Estimation of the extent of fluoride available in the oral cavity, data from questionnaire	0: Receives ‘maximum’ fluoride program 1: Irregular but complete fluoride program 2: Fluoride toothpaste only 3: Avoiding fluorides, no fluoride
8 - Saliva secretion	Estimation of amount of saliva, using paraffin-stimulated saliva	0: more than 1.1 ml saliva/min 1: Low (0.9 - 1.1 ml stimulated saliva/min) 2: Low (0.5 - 0.9 ml saliva/min) 3: Very low (< 0.5 ml saliva/min)
9 - Saliva buffering capacity	Estimation of capacity of saliva to buffer acids	0: pH ≥ 6.0 1: pH 4.5 - 5.5 2: pH ≤ 4.0

Cariogram parameters	Time	Control group		Intervention group		p-value
Cariogram parameters	Time	Mean ± SD	Range	Mean ± SD	Range
Actual chance of avoiding new cavities	T0	46.00 ? 21.11	15 - 87	45.72 ? 21.64	14 - 87	< 0.001
Actual chance of avoiding new cavities	T1	42.44 ? 19.45	14 - 80	62.50 ? 17.64	32 - 93	< 0.001
Diet	T0	16.72 ? 7.19	5 - 30	17.50 ? 7.13	3 - 29	< 0.001
Diet	T1	17.89 ? 5.98	6 - 30	14.28 ? 7.45	1 - 31	< 0.001
Bacteria	T0	13.33 ? 8.36	2 - 30	13.50 ? 8.13	1 - 29	< 0.001
Bacteria	T1	17.22 ? 8.46	5 - 37	9.22 ? 5.89	1 - 19	< 0.001
Susceptibility	T0	17.33 ? 5.80	3 - 27	16.89 ? 6.79	4 - 29	< 0.001
Susceptibility	T1	15.56 ? 5.49	5 - 25	8.78 ? 4.68	1 - 17	< 0.001
Circumstance	T0	6.61 ? 3.53	1 - 12	6.39 ? 3.88	1 - 13	< 0.001
Circumstance	T1	6.89 ? 3.51	1 - 12	5.22 ? 3.62	1 - 12	< 0.001

Cariogram parameters	Mean ± SD	Max	Min	p *
Actual chance of avoiding new cavities	20.33 ? 2.90	26.23	14.42	< 0.001
Diet	-8.16 ? 1.32	-5.48	-10.84	< 0.001
Bacteria	-4.38 ? 0.80	-2.75	-6.02	< 0.001
Susceptibility	-6.33 ? 1.24	-3.79	-8.87	< 0.001
Circumstance	-1.44 ? 0.38	-0.65	-2.23	< 0.001

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