PEDIATRIC DENTISTRY
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Conference Paper
O
Prevalence and Measurement of Dental Caries in Young Children Bruce A. Dye, DDS, MPH1 • Kuei-Ling C. Hsu, DDS, MS2 • Joseph Afful, MS3
Abstract: Purpose: Dental caries in preschool children was historically considered to have a unique and more intense pattern of decay and was known by a variety of terms. In 1999, the term early childhood caries (ECC), along with a classification system, was proposed to facilitate epidemiologic research of dental caries in young children. The purpose of this study was to assess the impact of those early childhood caries recommendations on the prevalence and measurement of caries in preschool children. Methods: A systematic search of the MEDLINE database was performed. Key search words included: ECC, dental decay, dental caries, carious dentin, baby bottle tooth decay, nursing caries, maxillary anterior caries, and labial caries. English language studies and studies on more than 100 children younger than six years old were eligible for selection. National Health and Nutrition Examination Survey data collected from 1988 to 1994, 1999 to 2004, and 2011 to 2012 were used to assess ECC prevalence using different operational definitions. Results: There were 87 articles selected for this review. The term ECC was used in 55 percent of the selected articles as the primary outcome measure. The majority of studies used a cross-section study design, but diagnostic criteria varied greatly. Caries experience in young children may be shifting away from majority of untreated surfaces to a majority of restored surfaces. Little difference was observed by dental surface type in the distribution of decayed and filled surfaces in primary teeth. Conclusions: Although the term early childhood caries is widely used, varied use of diagnostic criteria and operational definitions continue to limit comparability across studies. Emerging changes in the proportion of decayed and filled surfaces in the United States also raises questions regarding the ECC case definition limiting our ability to understand the epidemiology of dental caries in preschool children. (Pediatr Dent 2015;37(3):200-16) Received April 29, 2015 | Accepted April 29, 2015 KEYWORDS: EARLY CHILDHOOD CARIES, NURSING BOTTLE CARIES, TOOTH DECAY, NHANES, EPIDEMIOLOGY
Epidemiology is the study of the distribution and determinants of disease or adverse health conditions in people. Therefore, understanding the factors that promote disease or adverse health should lead to better interventions with subsequent improvement in the health of people. An important premise in the application of epidemiology is the consistent use of standardized case definitions and diagnostic criteria to measure disease, not only temporally but comparatively across different studies. Unfortunately, advancement in our understanding of the epidemiology of dental caries in young children continues to be restrained, even after the promise of five notable recommendations focusing on core epidemiological concepts was published in 1999 by a work group convened by three U.S. federal agencies.1 An important objective of these recommendations was to facilitate the assessment and reporting of dental caries in the primary dentition of children five years old and younger. Central to this effort was a proposed standardized case definition for studying dental caries in children based on a relatively new term known as early childhood caries (ECC). The term ECC emerged from a Centers for Disease Control and Prevention dental caries workshop in 1994 that characterized dental caries in young children as having a progressive pattern of tooth decay.2 This was based on the current understanding of the etiology of caries and its unique relationship with inappropriate infant feeding practices. In 1996, Alan Milnes published a comprehensive review on carious lesions 1 Dr. Dye is a dental epidemiology officer, National Institute of Health, National Insti-
tute of Dental and Craniofacial Research, Bethesda, Md., USA; 2Dr. Hsu is an assistant professor, Division of Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA; and 3Mr. Afful is a health statistician, Harris Corporation, under a contract with the Center for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md., USA. Correspond with Dr. Dye at
[email protected]
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affecting the primary maxillary incisors in young children, which described the condition as nursing caries and was often referred to as baby bottle tooth decay (BBTD). 3 In this review, he described nursing caries as presenting with a specific pattern of rampant dental caries in preschool children, yet there was no consensus definition for nursing caries, which he concluded was a significant limitation for comparing studies investigating the etiology and prevalence of the disease. In 1996, the term nursing caries was not a relatively new definition. Nursing caries, or related nomenclature, had been used in dentistry for at least three decades. The term appeared in the literature in 19624 and was later described by Preston Shelton in 1977 as a “mounting concern among pediatric dentists” because of increasing virulence and incidence in children younger than four years old.5 He characterized the disease as initially affecting primary maxillary incisors often followed by the primary first molars. He referred to the disease as “nursing bottle caries” (NBC) and concluded that the rampant carious process observed was associated with excessive bottle-feeding. Over the years, other synonyms for NBC appeared and disappeared in the lexicon, such as nursing bottle syndrome, milk bottle syndrome, labial caries, prolonged nursing habit caries, bottle-popping caries, and baby bottle tooth decay. Dental caries in preschool children had become such an important issue that, by the time the first national health objectives were launched in the 1990s, reducing the prevalence of BBTD was identified as one of the first Healthy People oral health objectives for the United States.6 With a growing attention on rampant dental caries in preschool children, partially as a result of the rising cost to treat the disease and subsequent morbidity,1 the National Institute of Dental and Craniofacial Research (NIDCR), among other organizations, sponsored a conference on ECC in 1997. Proceedings from this conference indicated that research involving
PEDIATRIC DENTISTRY
dental caries in young children was hindered by the lack of a universally accepted definition and diagnostic criteria for describing dental caries occurring in early childhood. As a result, a review was later prepared to catalogue case definitions and diagnostic criteria used in ECC studies between 1966 and 1998.7 In their review of 94 selected studies, Ismail and Sohn found “wide variation in the case definitions and diagnostic criteria used to diagnose ECC or to define severe ECC.” For their review, the authors defined severe ECC primarily as smooth surface carious lesions in primary maxillary incisors; hence, the classical definition was used for terms such as NBC or BBTD. The authors concluded that a universally accepted classification system was needed for ECC to aid research investigating the etiology, epidemiology, and prevention of dental caries in young children; previous studies of severe ECC have focused on decayed or restored primary maxillary incisors in young children. Dental caries in young low-income children remained a public health problem. In 1999, as a result of the review prepared by Ismail and Sohn, the work group supported by NIDCR published their proposed case definitions for ECC and severe ECC in children. For children 71 months old or younger, ECC was defined as having one or more decayed, missing, or filled tooth surfaces (dmfs greater than zero), and severe ECC was based on various dmfs scores dependent upon a combination of age and affected teeth.1 Factoring age into the case definition of severe ECC was a reflection of earlier discussions advocating the need to characterize and differentiate rampant caries in early childhood from general caries experience in early childhood. 8,9 In 2003, the American Academy of Pediatric Dentistry adopted the 1999 workgroup classification of ECC as the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth (dmfs greater than zero) younger than six years old; and severe ECC as the presence of any smooth surface dental caries in children younger than three years old, or in children three to five years old the presence of any dental caries in the maxillary anterior teeth, or a dmfs score greater than three in threeto four-year-olds, a dmfs score greater than four in four- to five-year-olds, or a dmfs score greater than five in five- to six-year-olds.10 The purpose of this study was to assess the impact that the introduction of the terminology and classification of early childhood caries has had on improving our understanding of the epidemiology of dental caries in young children. To address this aim, we have pursued two strategies. First, we have conducted a comprehensive, systematic literature review covering a 15-year period, beginning with the introduction of ECC case definitions into the literature in 1999 spanning to the present (2014). Second, we have analyzed national data from the United States to evaluate how dental caries patterns in young children may have changed since the recommendations for caries assessment in young children were published in 1999 and to interpret these findings in the broader context of ECC.
Methods
Our review followed a systematic process of identifying articles via database searching, following guidelines for the preferred reporting of items for systematic reviews and meta-analysis.11 A search of the MEDLINE database was conducted by a Centers for Disease Control and Prevention research librarian. The search was limited to only the title field, covering the period between January 1999 to December 2014, and was designed to answer two basic questions: (1) What is the prevalence of
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ECC? (2) What are the changes in prevalence and measurement of ECC? The primary search term was early childhood caries. Other keywords included tooth decay (restricted to children younger than or equal to five years old), dental caries (restricted to children younger than or equal to five years old), baby bottle tooth decay (restricted to children younger than or equal to five years old), nursing caries (restricted to children younger than or equal to five years old), maxillary anterior caries (restricted to children younger than or equal to five years old), and carious dentin (restricted to children younger than or equal to five years old). Other associated terms used in the search included: diagnosis; classification; epidemiology; prevalence; assessment; early detection; etiology; biomarker; and risk factor. To be eligible for inclusion, studies had to be a randomized controlled trial, a cohort or case control study, or a cross-sectional study published in the English language. Studies had to include more than 100 children younger than six years old. Systematic reviews or reviews with meta-analysis were also identified but not included in our review. The article had to clearly: describe the diagnostic criteria used for assessing dental caries in the primary dentition; report prevalence or measurement of dental caries in young children; and describe the objective, methods, and results with no major flaws. The search yielded 243 records, of which 54 were identified as potential reviews or review-like articles. Abstracts from the identified studies were hand searched to ascertain eligibility by two reviewers. The first reviewer screened all abstracts and identified each as potentially eligible, not eligible, or eligibility status unable to determine. Articles were also sorted into papers reporting single studies or papers reporting on multiple studies, such as reviews. A second reviewer screened abstracts focusing on single studies and identified each as eligible, not eligible, or unable to determine. If both reviewers were in consensus, the abstract was identified as eligible for review. All studies identified by the first reviewer as undetermined but marked as potentially eligible by the second reviewer were also identified as eligible for the review. Of the 179 abstracts reviewed, 103 papers were selected based on the abstract screening; after fulltext review by the second reviewer, 87 papers were considered eligible and information from these papers was abstracted for this review. Because there was substantial inconsistency in reporting quality assurance statistics pertaining to the examination methods used to measure dental caries, information on data quality and reliability was not abstracted for this review. We also used data from the National Health and Nutrition Examination Survey (NHANES) collected from 1988 to 1994, 1999 to 2004, and 2011 to 2012.12 NHANES is a cross-sectional survey that uses a stratified, multistage sampling design to obtain a representative probability sample of the civilian, noninstitutionalized population of the United States. Data were collected via in-home interviews with health examinations and laboratory tests conducted in mobile examination centers (MEC). The home interviews included an extensive questionnaire that assessed a variety of sociodemographic characteristics and numerous health issues, including oral health. Survey participants were examined by a trained dentist in the MEC. The dental exam was conducted under artificial light with a nonmagnifying mirror and a dental explorer. If needed, dental surfaces were dried with compressed air. Assessments for dental caries and restorations were made at the tooth surface level and conformed to Radike’s criteria, with minor modifications.13 The dental caries assessment protocols for NHANES during 1988 to ECC PREVALENCE AND MEASUREMENT
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DIAGNOSTIC AND CASE CRITERIA USED IN CARIES STUDIES OF YOUNG CHILDREN*
Table 1a. Reference author
Year of publication
Country
Nomenclature
Diagnostic criteria
Case definition
Hattab24
1999
Jordan
Nursing caries (NBC)
WHO (1997) criteria requiring cavitation (visual assessment only)
NBC=dft>0 in 2 maxillary incisors
Ramos-Gomez22
1999
USA (California)
ECC
Visual assessment
5 definitions: (1) dmft>0 in 1 maxillary incisor; (2) dmft>0 in 2 maxillary incisors; (3) dfs>0 on labial or lingual in 1 maxillary incisor; (4) dfs>0 on labial or lingual in 2 maxillary incisors; (5) dmft=>5
Kaste25
1999
USA
ECC
Visual assessment
ECC=dfs>0 in maxillary incisors
1999
USA (Texas)
Nursing caries (NBC)
Dental record data review
NBC=≥2 maxillary incisors with dft>0
2001
ECC
NR
ECC=dfs>0 in 2 maxillary incisors
ECC
NIDCR method (1989)
ECC=dfs>0
Nursing caries (NBC)
WHO (1997) criteria
NBC=dft>0 in 2 maxillary incisors
Quartery
26
Lulic-Dukic Quinonez
2001
Wyne
2001
Croatia USA (North Carolina) Saudi Arabia
27
28
29
Marino
2001
Chile
Dental caries
WHO (1997) criteria
Caries=dmfs>0
31
2002
Brazil
ECC
Visual assessment
Caries=dmft>0
32
Dimitrova
2002
Bulgaria
ECC
WHO (1997) criteria
Any dental caries present
Rajab33
2002
Jordan
Dental caries
WHO (1997) criteria (visual assessment only )
Caries=dmft>0
Ramos-Gomez34
2002
USA (California)
ECC
NIDCR/NHANES (Radke)
Caries=dfs>0
Chan
2002
Hong Kong
Dental caries
WHO (1997) criteria
Caries=dmft>0
2002
USA (Connecticut)
Dental caries
NIDCR/NHANES (Radke)
Multiple definitions based on affected surface patterns, including maxillary anterior only and all surfaces (dmfs)
Hallett37
2002
Australia
ECC
BASCD and WHO (1997) criteria
ECC=dmft>0
Albert
2002
USA (New York)
Dental caries
Dental record data review
Caries=dft>0
Sayegh
2002a
Jordan
Dental caries
Visual assessment only and assessing caries in enamel(d2)/dentin(d3)
Caries=dmft>0
Jin40
2003
South Korea
ECC
NIDCR method (1991; also known as NHANES method)
ECC based on NIDCR workshop statement
Ramezani41
2003
Iran
Nursing caries (NBC)
WHO (1997) criteria
NBC=dft>0 in 2 maxillary incisors
Nurko42
2003
USA (Texas)
Dental caries
WHO (1997) criteria
Caries=dft>0
Hallett 43
2003
Australia
ECC
BASCD and WHO (1997) criteria
AAPD criteria
Askarizadeh44
2004
Iran
Nursing caries (NBC)
WHO (1997) criteria
NBC=dft>0 in 2 maxillary incisors
Peressini
2004
Canada
ECC
Lesions in pits and fissures or on smooth surfaces with detectable softened floor; explorer entered dentin on approximal surface or tooth had temporary filling
ECC=dmft>0 in ≥2 maxillary anteriors OR dmft=>4
2004
USA
Dental caries
NHANES (Radke)
Caries=dfs>0
Chadwick
2005
UK (Wales)
Dental caries
BASCD (1997)
Caries=dmft>0
Namal
2005
Turkey
Dental caries
WHO (1997) criteria
Caries=dft>0
Schroth49
2005
Canada
ECC
WHO (1997) criteria
AAPD criteria
Seki50
2005
Japan
Dental caries
WHO (1997) criteria (visual assessment only and assessing caries in enamel(d2)/ dentin(d3) )
Caries=dft>0
30
Rosenblatt
35
Douglass
36
38 39
45
Dye46 47
48
Table continued on next page 202
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PEDIATRIC DENTISTRY
Table 1a.
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Continued
Reference author
Year of publication
Country
Nomenclature
Diagnostic criteria
Case definition
Tsai51
2006
Taiwan
ECC
WHO (1997) criteria
ECC based on NIDCR workshop statement
Mahejabeen52
2006
India
Dental caries
WHO (1997) criteria
Caries=dmft>0
Martens53
2006
Belgium
ECC/SECC
BASCD and WHO (1997) criteria; dmfs calculated based on d1 level
ECC based on NIDCR workshop statement
Psoter54
2006
USA (Arizona)
ECC
Visual exam identifying caries as a visual break in the enamel surface, pit and fissure discoloration with adjacent opacity, evidence of marginal ridge undermining, or anterior shadowing on transillumination.
ECC=dmfs>0
Du55
2007
China
Dental caries
WHO (1997) criteria
Caries=dmft>0 and Rampant caries=dmfs>0 in 2 maxillary incisors
Ferro56
2007
Italy
Dental caries
BASCD (1997) criteria; dmft calculated based on d3 level only
Caries=d3mft>0
Sowole57
2007
Nigeria
Dental caries
WHO (1997) criteria
Caries=dmft>0 and rampant caries=dmft>0 in maxillary incisors
Tiberia58
2007
Canada
SECC
NR
ECC=dmfs>0; SECC=dmfs=>20
Finlayson59
2007
USA (Michigan)
ECC /SECC
ICDAS
ECC=dmft>0; SECC=smooth surface dfs>0 in 0
Oliveira62
2008
Brazil
ECC /SECC
WHO (1997) criteria (visual assessment only)
ECC=dmfs>0; SECC=dmfs=>6
Robke63
2008
Germany
Nursing bottle caries (NBC)
WHO (1997) criteria
NBC=dmft>0 in maxillary anterior teeth
Postma64
2008
South Africa
ECC
NR
Adapted Wyne’s ECC criteria based on dmft
Tyagi65
2008
India
Nursing caries (NBC)
Caries in enamel/dentin using Gruebbel’s criteria to create dfs
NBC=dfs>0 in 2 maxillary incisors
Wyne66
2008
Saudi Arabia
Dental caries
WHO (1997) criteria
Caries=dmft>0
Lawrence67
2008
Canada
ECC/dental caries
NIDCR method (1999)
Caries=dmft>0
Vazquez-Nava68
2008
Mexico
Dental caries
WHO (1997) criteria with additional assessment for white spot lesions
Caries=deft>0
Ardenghi69
2008
Brazil
ECC
WHO (1997) criteria (visual assessment only)
ECC based on NIDCR workshop statement; and separate maxillary incisors caries=dfs>0
Jigjid 70
2009
Mongolia
ECC
WHO (1997) criteria
ECC=dmft>0
Nunn71
2009
US (Massachusetts)
ECC
Visual for cavitated lesions
ECC=dmft>0 in maxillary anterior teeth (nursing bottle caries)
Nunn72
2009
USA
ECC
NHANES (Radke)
ECC=dmft>0 in maxillary anterior teeth (NBC)
Table continued on next page ECC PREVALENCE AND MEASUREMENT
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PEDIATRIC DENTISTRY
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Continued
Table 1a. Reference author
Year of publication
Country
Nomenclature
Diagnostic criteria
Case definition
2009
USA (Michigan)
ECC
Medicaid record data review
ECC=amalgam or resin restoration, SSC, sedative filling, core buildup, pulp treatment, or extraction of any primary tooth; SECC=any dental treatment on a smooth surface primary tooth
Senesombath74
2010
Laos
ECC
WHO (1997) criteria
ECC=dmft>0
Slabsinskiene
2010
Lithuania
ECC
WHO (1997) criteria
EC C = d mf t > 0 ; S EC C = anter ior dmfs=>4 or BBTD was present
Anderson76
2010
USA (New Hampshire)
Dental caries
Untreated caries: cavitated and non-cavitated lesions
Caries=dmft>0
Priyadarshini77
2011
India
ECC
Caries recorded based on deft
AAPD criteria
Zhou
WHO (1997) criteria
ECC=dmft>0
Alaki73
75
2011
China
ECC
79
Fontana
2011
USA (Indiana)
Dental caries
ICDAS
ICDAS =>3
Vazquez80
2011
Mexico
Dental caries
WHO (1997) criteria
Caries=dmft>0
Rajshekar81
2011
India
Dental caries
WHO (1997) criteria
Caries=dmft>0
Hashim82
2011
UAE
SECC
WHO (1997) criteria
SECC=dmfs>0 in maxillary anterior teeth
Ozer 83
2011
Turkey
ECC
Caries in enamel(d2)/dentin(d3)
AAPD criteria
Li84
2011
China
ECC
National Epidemiological Survey Group of Oral Health Technology criteria/similar to: cavitated lesions in enamel including discolored pits and fissures with catch on probing (d2); early lesions presence of white opacity along gingival margin/opacity or discoloration without cavitation (d1)
ECC=dmft>0
Kumarihamy 85
2011
Sri Lanka
ECC
WHO (1997) criteria
Any caries in primary teeth based on the d1-d3 scale for dmft
Prakash86
2012
India
ECC
WHO (1997) criteria
ECC deft>0
87
Singh
2012
India
ECC
Visual cavitated and noncavitated based on Gruebell’s deft criteria
ECC based on NIDCR workshop statement
Perera88
2012
Sri Lanka
ECC
ECC=deft>0
Razmiene89
2012
Lithuania
Dental caries
Modified WHO criteria: dentinal (d3) only WHO (1997) criteria
Caries dmft or dmfs >0
Masumo90
2012
Uganda and Tanzania
ECC
BASCD and WHO (1997) criteria
ECC=dt>0
Phipps91
2012
USA (AI/AN)
ECC/dental caries
ASTDD-BSS
Caries dft>0
Leroy
2012
Belgium
Dental caries
BASCD and WHO (1997) criteria and noncavitated(d1) Fyffe criteria
Caries=d1mft>0
Parisotto93
2012
Brazil
ECC
WHO (1997) criteria and WHO+ECL (early caries lesions)
ECC=dmfs>0
Schroth94
2013
Canada
BBTD/SECC
Caregiver self-report of caries presence
SECC=caries in primary maxillary anteriors of 3-5-year-olds
Kopycka95
2013
USA (New York)
ECC
Visual cavitated and noncavitated lesions
ECC dfs>0; SECC was AAPD criteria
Gaidhane96
2013
India
ECC
WHO (1997) criteria
AAPD criteria
78
92
Table continued on next page 204
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Continued*
Table 1a. Reference author
Year of publication
Country
Nomenclature
Diagnostic criteria
Case definition
Dogan97
2013
Turkey
ECC
WHO (1997) criteria/cavitated lesions in enamel, including discolored pits and fissures with catch on probing (d2): early lesions presence of white o p ac i ty al o n g g i n g i val m ar g i n / opacity or discoloration without cavitation (d1)
ECC dft>0
Correa-Faria98
2013
Brazil
ECC
WHO (1997) criteria
Caries experience=yes/no
Boka99
2013
Greece
Dental caries
Visual assessment only and assessing caries in enamel(d2)/dentin(d3)
Dental caries=dmfs>0
Ribeiro100
2014
Brazil
ECC
Visual/tactile assessment for cavitated and noncavitated lesions
ECC=dmfs>0; SECC definition used AAPD criteria
Oliveira101
2014
Brazil
Dental caries
ICDAS
Collapsed ICDAS=codes 5-6 (caries=d3mfs)
Hong102
2014
Singapore
ECC
2014
Kuwait
ECC
Majorana104
2014
Italy
Wagner105
2014
Zhang106 Tanaka107
Nazar103
Choa108 Monaghan
109
Caries in enamel(d2)/dentin(d3)
ECC=d2-3s>0
Cavitated lesions in enamel including discolored pits and fissures with catch on probing (d2): early lesions presence of white opacity along gingival margin/ opacity or discoloration without cavitation (d1)
ECC=ds>0
ECC
ICDAS II
Collapsed ICDAS=1-3/4/5-6 (cavitation) maximum score
Austria
Dental caries
WHO (1997) criteria
Caries in primary teeth based on the d3-d4 scale for dmfs
2014
China
Dental caries
WHO (1997) criteria (visual assessment only )
Caries=dmft>0
2014
Japan
Dental caries
NR
Caries=dmft>0
2014
UK
Dental caries
BASCD (1997)
Caries=dmft>0
2014
UK
Dental caries
BASCD with visual assessment only and assessing caries in at the d3 level (dentin)
Caries=d3mft>0
* dmfs/dmft/deft=decayed (d), missing (m), and filled (f ) or extracted (e) and filled (f ) dental surfaces (s) or teeth (t); NR=not reported; ECC=early childhood caries; AI/AN= American Indian/Alaskan Native; SECC=severe early childhood caries; BBTD/NBC=baby bottle tooth decay/nursing bottle caries; ICDAS=International Caries Detection and Assessment System; WHO=World Health Organization; BASCD=British Association for the Study of Community Dentistry; AAPD=American Academy of Pediatric Dentistry; NIDCR=National Institute of Dental and Craniofacial Research; NHANES=National Health and Nutrition Examination Survey; ASTDD=Association of State and Territorial Dental Directors; BSS=Basic Screening Survey; SiC=Significant Caries Index.
1994, 1999 to 2004, and 2011 to 2012 are essentially the same. NHANES examiners undergo extensive training and followup that includes repeated examinations by a reference examiner to ensure data quality and reliability. Additional information on survey sample design, dental examination procedures, and data assurance are available elsewhere.14-17 For our study, we used information on two- to five-yearolds who participated in NHANES. We used data from 4,261 children participating in 1988 to 1994, 2,360 children participating in 1999 to 2004, and 898 children participating in 2011 to 2012. Participants were required to have completed an oral health exam to be included in the analytical sample. Poverty
status has been demonstrated to be strongly associated with oral health status in children in the United States.18-19 For our analyses, we used the percentage of federal poverty level (FPL), which is an index based on the ratio of family income to poverty. The Department of Health and Human Services’ poverty guidelines were used as the poverty measure to calculate this index. These guidelines determine financial eligibility for certain federal programs, such as Head Start, Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamp Program), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the National School Lunch Program. ECC PREVALENCE AND MEASUREMENT
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Table 1b. SELECTED STUDY CHARACTERISTICS AND REPORTED PREVALENCE OF DENTAL CARIES FROM STUDIES OF YOUNG CHILDREN* Reference
Year
Study type
Sample
Age group
Study size
Prevalence (% dmf)
Other
Ramos-Gomez22
1995
Cross-sectional
Convenience
0)
Lulic-Dukic27
NR
Cross-sectional
Convenience
2-5 ys
145
ECC=30
Mean dmfs affected with ECC=8.6
Quinonez28
NR
Cross-sectional
Convenience
18-36 mos
150
ECC=20
—
Wyne29
NR
Cross-sectional
Random
2-6 ys
1,016
NBC=27.3
Mean dmft affected with NBC=8.6; mean dt affected with NBC=7.6
Marino30
1994
Cross-sectional
Convenience
3-6 ys
177
Dental caries=78
Mean dmfs=11.78
Rosenblatt31
NR
Cross-sectional Quasi-randomized
12-36 mos
468
Caries=28.4
Mean dmft=1.29
Dimitrova32
1999
Cross-sectional
Random
12-47 mos
370
ECC/caries=20.8 (1 y), 40 (2 ys), 56.2 (3 ys)
—
2001
Cross-sectional
Random
1-5 ys
384
Caries=48
Mean dmft=1.9
Ramos-Gomez
NR
Cross-sectional
Convenience
3-55 mos
146
ECC=43
Mean ds=4.5; mean dfs=5.0
Chan
NR
Cross-sectional
Random
0 (26%)
Parisotto
NR
Cross-sectional
Convenience
36-59 mos
351
ECC=40
Mean dmfs=3.0 Mean dmft=1.9
Schroth94
NR
Cross-sectional
Random
