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PEDIATRIC DENTISTRY V 37 / NO 3 MAY / JUN 15. Epidemiology ... in the primary dentition of children five years old and younger. Central to ... timore, Md., USA; and 3Mr. Afful is a health statistician, Harris Corporation, under a contract with ...
PEDIATRIC DENTISTRY

V 37 / NO 3

MAY / JUN 15

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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ECC PREVALENCE AND MEASUREMENT

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

V 37 / NO 3

MAY / JUN 15

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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V 37 / NO 3

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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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V 37 / NO 3

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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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PEDIATRIC DENTISTRY

V 37 / NO 3

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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