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This observational, cross-sectional study aims to evaluate the current caries risk profiles of children who underwent dental treatment under general anesthesia (GA) for early childhood caries (ECC) between 2015 and 2020 at Aydın Adnan Menderes University, Faculty of Dentistry. A minimum of 44 systemically healthy children will be included.
Caries risk will be assessed using the Cariogram model, incorporating clinical parameters (DMFT/dmft, Plaque Index, Gingival Index, probing depth), salivary factors (stimulated flow rate, buffer capacity), and standardized questionnaires covering diet, fluoride exposure, socioeconomic status, and dental visit history. Data will be collected in a single visit, analyzed using SPSS.
The study aims to provide scientific evidence for long-term preventive strategies and oral health policies targeting high-risk pediatric populations treated under GA for ECC.
Early childhood caries (ECC) is defined as the presence of one or more decayed, missing, or filled primary teeth in children, particularly those aged 71 months or younger. ECC is one of the most common chronic diseases of childhood, with a prevalence reaching up to 70% in communities with low socioeconomic status. According to the data from the Turkish Oral and Dental Health Profile studies, while a decrease in the average number of decayed teeth and dmft index was observed in 2018 compared to 2004, an increase in the average number of filled and missing teeth was detected. Although this demonstrates improved access to caries treatment services, the persistently high prevalence of ECC indicates a continuing need for effective preventive strategies.
In the treatment of ECC, particularly in younger children with extensive caries and challenging behavior management, dental interventions are frequently performed under general anesthesia (GA). However, long-term follow-up studies have shown insufficient attention to oral hygiene and limited access to preventive applications among children treated under GA. Research on this patient group reveals a high incidence of recurrent caries after treatment. These findings indicate that approaches focusing solely on treatment are insufficient, as the risk of caries persists, and these individuals require long-term, structured follow-up.
The aim of this thesis study is to objectively evaluate the current caries risk levels of individuals who underwent dental treatment under GA for ECC. For this purpose, children treated for ECC under GA at Aydın Adnan Menderes University Faculty of Dentistry between 2015 and 2020 will be recalled, and their current caries risk profiles will be analyzed using the Cariogram model, the most up-to-date official web-based version available at "cariogram.uni.mau.se".
Caries risk assessment will be performed using a comprehensive set of parameters integrated into the Cariogram model, including:
Each parameter will be scored according to standardized criteria. Participants will be invited only once, and the study will have a cross-sectional design, with data collection completed in a single visit.
This research will provide scientific data for monitoring and protecting high-risk pediatric populations at both individual and community levels in the fight against caries. Furthermore, the findings are expected to contribute to the planning of preventive oral health services and the development of oral health policies. By examining the course of caries risk in individuals treated under GA for ECC in later years, this study will help better understand the need for preventive care in this population. These evaluations will not only reveal the current situation but also contribute to the development of effective and sustainable preventive service models for these individuals.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single Group- Children with Early Childhood Caries Treated under GA | This study includes a single group of systemically healthy children aged 6-16 years who underwent dental treatment under general anesthesia for early childhood caries (ECC) between 2015 and 2020 at Aydın Adnan Menderes University Faculty of Dentistry. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Caries Risk Assesment | Diagnostic Test | Participants will undergo a single-visit evaluation in which caries risk will be comprehensively assessed using the Cariogram model. The assessment will integrate findings from clinical examination (including DMFT/dmft scores, Plaque Index, Gingival Index, and probing depth), salivary analysis (stimulated flow rate and buffer capacity), and standardized questionnaires evaluating diet, fluoride exposure, socioeconomic status, and dental visit history. No treatment or experimental intervention will be performed; all data will be collected exclusively for observational analysis. |
| Measure | Description | Time Frame |
|---|---|---|
| Caries Risk Assessment | Caries risk will be evaluated using the Cariogram model, which combines clinical, salivary, behavioral, and socioeconomic factors to estimate each participant's "chance to avoid caries." Key inputs include caries experience (DMFT/dmft), plaque and gingival status, salivary flow and buffering, diet and oral hygiene habits, fluoride exposure, dental attendance, and socioeconomic or health-related influences. The Cariogram software will integrate these variables to generate a visual risk profile and a final percentage score for objective comparison between participants. The following parameters are evaluated in the Cariogram: Caries History Systemic disease: 0: No disease, 1: a mild systemic disease, 2: Severely affecting systemic diseaseDietary content: the cariogenic potential of foods 0: ≤ 10³ CFU/ml, 1: 10⁴ CFU/ ml, 2: 10⁵ CFU/ml, 3: ≥10⁶ CFU/ml Diet frequency: Average daily number of meals and snacks 0≤ 3 meals/day, 1: 4-5 meals/day, 2: 6-7 meals/day, 3: >7 meals/day | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| DMFT/dmft Scores | DMFT/dfs index in individuals consists of the following components: D (Decayed): Number of decayed and untreated permanent teeth M (Missing): Number of permanent teeth extracted due to caries F (Filled): Number of permanent teeth restored with fillings T(Teeth) For each participant, these three components will be recorded separately, and the total DMFT score will be calculated. 0: DMFT=0, 1: DMFT=1, 2: DMFT=2, 3: DMFT ≥ 3 |
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Inclusion Criteria:
Exclusion Criteria:
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Children aged 6-16 years who underwent dental treatment under general anesthesia for early childhood caries (ECC) at Aydın Adnan Menderes University, Faculty of Dentistry between 2015-2020
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Melis Akyıldız | Contact | 05387970703 | baharmeliss@hotmail.com | |
| Ebru Ersan | Contact | 05547350346 | ebruersan96@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Melis Akyıldız | Aydın Adnan Menderes University, Faculty of Dentistry | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aydın Adnan Menderes University, Faculty of Dentistry | Recruiting | Aydin | Aydın | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | American Academy of Pediatric Dentistry. (2023). Definition of Early Childhood Caries (ECC). AAPD Reference Manual. | ||
| 30992106 | Background | Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies. Pediatr Dent. 2019 Mar 15;41(2):95-112. | |
| Background | T.C. Sağlık Bakanlığı. (2004). Türkiye Ağız ve Diş Sağlığı Profili (TADSAP-2004). Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Yayınları. | ||
| Background | T.C. Sağlık Bakanlığı. (2018). Türkiye Ağız ve Diş Sağlığı Profili (TADSAP-2018). Türkiye Halk Sağlığı Kurumu Yayınları. | ||
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|
| Baseline |
| Plaque Index (Silness-Löe) | Oral hygiene status will be assessed using the standardized Plaque Index criteria on specified tooth surfaces. Plaque Index (PI) - Silness and Löe 0: No plaque
0: 0 (Excellent), 1: 0.1-0.9 (Good), 2: 1.0-1.9 (Moderate), 3: 2.0-3.0 (Poor) | Baseline |
| Gingival Index (Löe-Silness) | Gingival health will be measured using the Gingival Index to evaluate the degree of gingival inflammation. 0: Normal gingiva - no edema, 1: Mild edema, no bleeding after gentle probing, 2: Moderate to severe gingival edema, bleeding after air drying, 3: Severe inflammation; redness and edema. Ulceration. Tendency for spontaneous bleeding | Baseline |
| Stimulated Salivary Flow Rate (mL/min) | Stimulated salivary flow rate will be measured using wax-stimulated saliva collection and expressed in mL/min. 0: ≥0.7 mL/min
| Baseline |
| Salivary Buffering Capacity (pH) | Salivary buffering capacity will be assessed using Dentobuff test strips to measure salivary pH. 0: pH ≥6.0
| Baseline |
| Probing Depth (mm) | Probing depth refers to the distance (in millimeters) between the gingival margin and the deepest point of the periodontal tissues surrounding the tooth that can be probed. This measurement is performed using a special instrument called a periodontal probe, which has a rounded tip and is calibrated in millimeters. 1-3 mm: Healthy gingiva/sulcus, 4 mm: Initial periodontal disease, 5-6 mm: Moderate periodontitis, ≥7 mm: Advanced periodontitis | Baseline |
| Fluoride Program | The amount of fluoride present in the mouth. Obtained through interview. 0: Maximum Program, 1: Supplement, 2: Toothpaste Only, 3: No Fluoride | Baseline |
| 19491160 |
| Background |
| Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009 Jun;140(6):650-7. doi: 10.14219/jada.archive.2009.0250. |
| 21972925 | Background | Kim Seow W. Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model. Int J Paediatr Dent. 2012 May;22(3):157-68. doi: 10.1111/j.1365-263X.2011.01186.x. Epub 2011 Oct 4. |
| 31942447 | Background | Oubenyahya H, Bouhabba N. General anesthesia in the management of early childhood caries: an overview. J Dent Anesth Pain Med. 2019 Dec;19(6):313-322. doi: 10.17245/jdapm.2019.19.6.313. Epub 2019 Dec 27. |
| 36480646 | Background | Patel S, Fantauzzi AJ, Patel R, Buscemi J, Lee HH. Childhood caries and dental surgery under general anesthesia: an overview of a global disease and its impact on anesthesiology. Int Anesthesiol Clin. 2023 Jan 1;61(1):21-25. doi: 10.1097/AIA.0000000000000385. Epub 2022 Nov 17. |
| 37576136 | Background | Li JY, He SY, Wang PX, Dai SS, Zhang SQ, Li ZY, Guo QY, Liu F. Incidence and risk factors of unplanned retreatment following dental general anesthesia in children with severe early childhood caries. Front Pediatr. 2023 Jul 27;11:1163368. doi: 10.3389/fped.2023.1163368. eCollection 2023. |
| 15286120 | Background | Featherstone JD. The continuum of dental caries--evidence for a dynamic disease process. J Dent Res. 2004;83 Spec No C:C39-42. doi: 10.1177/154405910408301s08. |
| 16008632 | Background | Bratthall D, Hansel Petersson G. Cariogram--a multifactorial risk assessment model for a multifactorial disease. Community Dent Oral Epidemiol. 2005 Aug;33(4):256-64. doi: 10.1111/j.1600-0528.2005.00233.x. |
| 24916679 | Background | Twetman S, Fontana M, Featherstone JD. Risk assessment - can we achieve consensus? Community Dent Oral Epidemiol. 2013 Feb;41(1):e64-70. doi: 10.1111/cdoe.12026. |
| 37875839 | Background | Taqi M, Zaidi SJA. Predictive validity of the reduced Cariogram model for caries increment in non-cavitated and cavitated lesions: cohort study. BMC Oral Health. 2023 Oct 24;23(1):790. doi: 10.1186/s12903-023-03479-w. |
| 20400721 | Background | Gao XL, Hsu CY, Xu Y, Hwarng HB, Loh T, Koh D. Building caries risk assessment models for children. J Dent Res. 2010 Jun;89(6):637-43. doi: 10.1177/0022034510364489. Epub 2010 Apr 16. |
| 22222621 | Background | Campus G, Cagetti MG, Sale S, Carta G, Lingstrom P. Cariogram validity in schoolchildren: a two-year follow-up study. Caries Res. 2012;46(1):16-22. doi: 10.1159/000334932. Epub 2012 Jan 4. |
| Background | Utreja, D., Singh, A., Purohit, B. M., & Purohit, R. N. (2019). Application of Cariogram in Caries Risk Assessment Among Schoolchildren in India. Oral Health & Preventive Dentistry, 17(2), 133-138 |
| 14158464 | Background | SILNESS J, LOE H. PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. Acta Odontol Scand. 1964 Feb;22:121-35. doi: 10.3109/00016356408993968. No abstract available. |
| 25198634 | Background | Al Shayeb KN, Turner W, Gillam DG. Periodontal probing: a review. Prim Dent J. 2014 Aug;3(3):25-9. doi: 10.1308/205016814812736619. |
| 27672245 | Background | Gugnani N, Pandit IK, Srivastava N, Gupta M, Sharma M. International Caries Detection and Assessment System (ICDAS): A New Concept. Int J Clin Pediatr Dent. 2011 May-Aug;4(2):93-100. doi: 10.5005/jp-journals-10005-1089. Epub 2010 Apr 15. |
| Background | Cavalcante, G. M. S., Teles, R. P., Scarparo, R. K., Silva, M. E. R., & Mialhe, F. L. (2014). Dental caries experience among children with cerebral palsy in Brazil: A case-control study. Journal of Applied Oral Science, 22(3), 215-220. https://doi.org/10.1590/1678-775720130689 |