A Longitudinal Study of Occlusal Caries in Newark New Jersey School Children: Relationship Between Initial Dental Finding and the Development of New Lesions

Objective: Dental caries is a significant public health problem especially amongst children from low-income backgrounds. This longitudinal study examined the development of new occlusal caries in 227 Newark, NJ children ages 10-18. The role of previous caries experience and the presence of occlusal white and dark lesions in predicting the development of new lesions were examined.

Design: At each visit, the patient's teeth were given a visual-tactile examination and the subject's decayed, missing and filled (DMFS) score was determined. Next, molars lacking probeable caries or restorations were examined using transillumination for occlusal white and dark spots. This examination was repeated periodically. A Cox proportional hazard was used to analyse data concerning the development of new occusal caries in molars.

Results: The longitudinal data indicates that patients who were caries free at visit-1 developed significantly fewer occlusal caries during the longitudinal study. The hazard ratio for subjects who had first-visit caries was 2.27 compared to caries free subjects. Intact molars with occlusal white or dark lesions had caries hazard ratios of 0.78 and 1.49 respectively, compared to molars lacking initial colour changes.

Conclusion: Having a prior caries history places the subject at increased risk of developing future caries. Teeth with dark lesions but not white lesions are at significantly increased risk for developing decay. White lesions may represent remineralizing or slowly progressing lesions. The results of this study can help identify patients and tooth surfaces at risk for future occlusal decay.