D. Birkhed

Recommendations at the Plenary Session

Recommendations at the Plenary Session Dr. Moller: Ladies and Gentlemen, I would like to thank the members of group C for having participated so excellently in the discussion and in the formulation of our report. In addition I would particularly like to thank our co-chairman and rapporteur Mrs. Williams and the author of the original paper, Prof. Holm. We started out by considering the title of the background paper. The original title was ‘Diet and Caries High-Risk Groups in Developed and Developing Countries’. We looked at this title as formulated last year in Angers and we were in some degree of jeopardy, in that we do not know very much about diet and caries in the two types of countries, developed and developing. So we reformulated the title to be, as you can see in the consensus report, ‘Diet and Associated Risk Factors in High-Caries Groups in Industrialized and Non-Industrialized Countries’. With this as the starting point, we tried to look at what is high risk or a high-risk group, as Dr. Newbrun said, we tried to make a definition of what we should understand by this expression. Because in the past, when talking about high-risk groups, it is normally related to already experienced disease or past experience of dental caries. Recognizing then that dental caries is a multifactorial disease, of course the set of predictors that would forecast the event of caries experience in a population would also be multifactorial. It would relate to all the expected predictors as a group and you can see from our document that we are trying to put up a hypothetical equation for that. We comment that there might be some predictors related to diet in terms of its content of fermentable carbohydrate or sugars, with special recognition as to the type of carbohydrate, the frequency, pattern and mode of consumption. We went on to look at the nutritional aspects. We also considered saliva, oral hygiene, genetic factors, and finally social indicators, but we also recognized the fact that we need to look first of all at the possibility of finding such predictors, this means more research for reliable predictors. We could then see which of these predictors would be feasible to employ in a practicable clinical setting. It is obvious if it is too cumbersome or too complicated to determine a predictor from a cost benefit point of view, it would not be feasible to look into the situation of developing countries. A country like Tanzania could not spend 50% of its total health budget to make predictions of dental caries in its population. In the industrial countries, caries is now so low that it might be a waste of money to try to chase this small group by employing expensive predictors. In developing countries or in non-industrialized countries, we have a completely different situation. We do not really know how dental caries starts in some of these countries where there has been practically no caries at all. Suddenly caries starts to develop, but does it start in a small group getting a little bit of caries and gradually a little more or does it start with a large percentage of the population getting a little caries? Is the total population at risk and is it then worthwhile to try and chase and identify the small group in that population who are, one could say, the focal point of development of caries in that population group? These are areas which I think are important, especially in non-industrialized countries. Where there has been no caries in the past, there has been no caries challenge, then suddently,

Diet and Associated Risk Factors in High-Risk Groups in Industrialized and Non-Industrialized Countries

Diet and Associated Risk Factors in High-Risk Groups in Industrialized and Non-Industrialized Countries Introduction The group acknowledged that the term ‘high-risk’ is often defined in terms of past caries experience. However, a prospective analysis, in which risk prediction for future caries incidence should be determined, was more appropriate. Definition ‘High-risk’ groups included people most likely to develop caries over a given period of time, at a level considered to be high for that society. There was a consensus among the group concerning the importance of identifying these high-risk groups. Predictors Dental caries is a multifactorial disease. One or more predictors cannot usually explain more than half of the variation in observed caries increment. False positives and negatives typically amount to 60-70%. The group decided to propose possible predictors and to consider what further research might be necessary to obtain further information. Predictor assessment has been complicated by problems of measurement (how, how often, when?) and variations in the methods of analysis of data. Criteria describing specific predictors vary between countries. Variations in methods of analysis may also vary between some countries or between industrialized and non-industrialized countries, since the balance of influencing variables can vary between countries. It is unlikely that a substantial proportion of the total can be predicted using a simple research design. The probability of high risk is a function of oral microflora, dietary factors, nutritional factors, fluorides, oral hygiene, genetics, salivary and other factors, i.e. P {high risk) = X ‚ + X2 + X3 + ? Predictors of high caries risk may constitute causative risk factors or associated risk indicators. The former would include diet and microflora, the latter so-ciodemographic variables. The importance of using multi-variate analysis cannot be overstated. Computer software is now available to facilitate this. As components of a study design, a number of the following risk assessment should be considered together: Diet Important components of diet assessment should include the type(s) of carbohydrate consumed, their frequency and pattern or mode of consumption. Notes should be taken of particular habits characteristic of the population (such as bottle feeding or pa-nela sucking in Colombia), which may affect patterns of caries attack. With regard to reported dietary data, there is always a problem of validity. However, the group felt that recent past studies (usually involving older children 10-14 years) were adequate; but that despite sophisticated methodology adopted, correlation levels with foods/drinks consumed were relatively low.

Changes in Diet and Caries Prevalence

Changes in Diet and Caries Prevalence Members of Workshop A Prof. E. Newbrun Chairman, University of California, San Francisco, Calif., USA Prof. B. Angmar-Manson Raporteur, Karolinska Institute, Stockholm, Sweden Prof. T. Marthaler Presenter, Institut de Médecine Dentaire, Zurich, Switzerland Mr. M. Midda Dental School, University of Bristol, England Dr. M. Miller Dental Resource Center, Princeton, N.J., USA Dr. S.J. Moss New York University, New York, USA Prof. A. Thylstrup Royal Dental College, Copenhagen, Denmark Miss L. Stevens London, England Opening Plenary Session