Jurnal 1

Background. The authors conducted a two-yearlongitudinal study to show the predictive abilities of acaries activity test (Cariostat, Dentsply-Sankin, Tokyo),and to include the predicted screening indexes thatwere based on previous caries activity test results and lifestyle factors that influence caries activity.Methods. The subjects were 1,206 children born in 2000. These childrenparticipated in health examinations at 18 months, 2 years and 31⁄2 years ofage at Kurashiki-City Public Health Center in Kurashiki-City, Japan. Twoof the authors performed caries activity tests at 18-month and 2-year exami-nations. Questionnaires regarding the patient’s lifestyle were mailed to eachparticipant’s parents or guardians. The authors analyzed these question-naires to evaluate lifestyle factors that made participants susceptible to caries.Results. A caries activity test score at 18 months of age not only reflectedcaries incidence but also predicted caries incidence and screening results in2- and 31⁄2-year-old children. A caries activity test score at 2 years of age bothreflected and predicted children’s caries incidence and screening results at31⁄2 years of age. Breast-feeding and use of the bottle to intake liquids otherthan water produced significant caries susceptibility in 18-month-old chil-dren. Additionally, increased frequency and total time of sucrose intake put2-year-old children at high risk of developing caries and failure of parentalbrushing produced a high risk in 31⁄2-year-old children.Conclusions. A caries activity test could predict 31⁄2-year-old children’scaries risk based on 18-month and 2-year-old test results. Early weaning,less sucrose intake and toothbrushing by parents were effective in reducinga child’s caries risk.Clinical Implications. The caries activity test is more useful than oral examination because it can indicate the need for caries-preventivetreatment before a carious lesion actually is manifest.Key Words. Dental caries; dental caries activity tests; dental caries susceptibility; incidence.JADA 2008;139(1):63-71.

Because caries is pre-ventable, the diagnosis ofcaries as a tooth lesion isnot sufficient for a treat-ment plan. The clinician

must devise a need-related treat-ment plan on the basis of certainscientific diagnosis. In doing so, heor she should assess a patient’scaries risk status, because it pro-vides an estimate of future cariesactivity.1 Therefore, an accuratecaries risk assessment in earlychildhood is a necessary prerequi-site to effectively formulating a“total health” strategy.2

It is difficult to identify caries-susceptible children on the basis ofa visual and tactile oral exami-nation. Many bacteriological cariesactivity tests have been developedto avert this difficulty. They areclassified into two types: countmethods3-5 and evaluation of bacte-rial virulence.6-8 Borgström and col-leagues9 reported that the mostcommon method used to identifycaries-susceptible people is esti-mating the number of cariogenicbacteria such as lactobacilli andmutans streptococci in saliva orplaque samples taken from thepatient. However, the power of bac-terial counts to explain and predicta person’s risk of developing carieshas not been sufficient. Borgströmand colleagues’ recommendationwas to evaluate one virulencefactor, such as acidogenicity ofthese bacteria, in attempting toidentify a caries-susceptible person.

The Cariostat (Dentsply-Sankin,Tokyo) caries activity test is a col-

A B S T R A C T

ARTICLE

4

Dr. Nishimura is an assistant professor, Behavioral Pediatric Dentistry, Okayama University, 2-5-1 Shikata-cho, Okayama City, Okayama, 700-8525, Japan, e-mail “[email protected]”. Address reprint requests to Dr. Nishimura.Dr. Oda is a clinical fellow, Behavioral Pediatric Dentistry, Okayama University, Japan.Dr. Kariya is an assistant professor, Behavioral Pediatric Dentistry, Okayama University, Japan.Dr. Matsumura is an associate professor, Behavioral Pediatric Dentistry, Okayama University, Okayama, Japan.Dr. Shimono is a professor, Behavioral Pediatric Dentistry, Okayama University, Japan.

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Using a caries activity test to predict cariesrisk in early childhoodMichiko Nishimura, DDS, PhD; Takashi Oda, DDS; Naoyuki Kariya, DDS, PhD; Seishi Matsumura, DDS, PhD; Tsutomu Shimono, DDS, PhD

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JADA, Vol. 139 http://jada.ada.org January 2008 63Copyright ©2008 American Dental Association. All rights reserved.

orimetric test developed by Shimono and Sobue in1974.10 The test medium contains sucrose and twokinds of pH indicators to display the continuouspH decrease of the test medium caused by micro-organisms gathered in the patient’s plaquesample. The microorganisms in the dental plaquemetabolize sucrose and produce acids that react tothese pH indicators, thus leading tocolorimetric change. Someresearchers have reported strongcorrelations between pH and thecaries activity test score.11-13

Nishimura and colleagues14

reported positive correlationsbetween caries activity test scoreand the counts of mutans strepto-cocci and lactobacilli. Dental cariesis well-known as having a numberof causes.1 Therefore, a correct diag-nosis depends on the acquisition of additionaldata including information on caries activity,lifestyle and oral hygiene habits.

We determined to conduct a two-year longitu-dinal study to show the caries-reflective and -predictive abilities of the Cariostat test, and toinclude the predicted screening indexes based onprevious caries activity test results and lifestylefactors that influence caries activity. Someresearchers have already reported the cariesactivity test’s predictive value.11,15,16 However,

there are no studies to show current and pre-dicted screening indexes for each score of cariesactivity tests. A predictive and precise caries riskassessment is absolutely necessary to enable theclinician to evaluate a patient’s caries risk anddevelop a treatment plan that focuses on prevention.

SUBJECTS AND METHODS

Subjects. The subjects were 1,208children born in 2000. These chil-dren underwent health exami-nations at 18 months, 2 years and31⁄2 years of age at Kurashiki-CityPublic Health Center, Kurashiki-City, Japan. We excluded two of the1,208 children because they did notreceive the caries activity test at 18months of age. We had already

excluded from this study children taking any kindof medication during any of their two cariesactivity test sampling periods.

Methods. Oral examination. The 18-month, 2-year and 31⁄2-year-old children’s examinations

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64 JADA, Vol. 139 http://jada.ada.org January 2008

ABBREVIATION KEY. dft: Decayed and filled teeth.dt: Decayed teeth. NPV: Negative predictive value.PPV: Positive predictive value. ROC: Receiver oper-ating characteristic. SP: Specificity. SRCC: Spearmanrank correlation coefficient. ST: Sensitivity.

0

0 100

3.03.2

3.03.8

3.7

0

1.4

09.1

1.029.9 19.0

1.528.12.0 2.5

7.0

2.56.923.3

2.027.21.5

29.21.00.5

8.2

18-Month-OldChildrenn = 1,206

2-Year-OldChildrenn = 1,206

NotSignificant

Figure 1. The differences between the distributions with caries activity test results at the 18-month and 2-year time points (the Wilcoxonsigned rank test was used).

A correct diagnosis ofcaries depends on the

acquisition of dataincluding information

on caries activity,lifestyle and oralhygiene habits.

Copyright ©2008 American Dental Association. All rights reserved.

included an oral exami-nation, a caries activitytest and counseling byKurashiki-City publicdental hygienists that wasbased both on responses toquestionnaires regardingpatients’ lifestyles and onprevious caries activity testresults. Each examiner wasblinded as to previouscaries activity test results.Initial caries (white-spotlesions) was not counted asa caries lesion. The cariesactivity test was not performed at the 31⁄2-year-old children’s oral examination.

The health examinationsof 18-month- and 31⁄2-year-old children are routineand are sanctioned by theJapanese government,while the examinations of2-year-old children areadditional ones carried out at Kurashiki-City. Theroutine government-sanctioned examinationsbegan in 197717; Kurashiki-City’s 2-year oral exami-nations began in 1988.Each examiner assesseddental caries according tothe criteria of the JapaneseMinistry of Health andWelfare’s Health PolicyBureau, so this was an integrated study of dif-ferent systems. The same dentists, members ofthe Dental Society of Kurashiki-City, carried outthe examinations in 18-month- and 31⁄2-year-oldchildren; the 2-year-old children were examinedby pediatric dentists (M.N. and T.O.) of OkayamaUniversity (Japan). Calibration of the oral exami-nations was impossible because of the differentsystems. However, the authors nevertheless con-sidered this study to be important in predictingindividual caries risk on the basis of currentcaries activity test results. The same pediatricdentists gathered plaque samples for the cariesactivity test from the 18-month and 2-year-oldchildren. There was no institutional review board

at Okayama University at the time the study wasconducted; the examinations were performedunder the auspices of the government andKurashiki-City’s health program. Furthermore,Kurashiki-City completely sealed subjects’ pri-vate information and then released the data to usin coded form.

The caries activity test. The examiners collectedplaque samples from the maxillary buccal cervicalsurfaces using sterile cotton swabs. The exam-iners ran the swab along the tooth surface fivetimes in a swiping motion before placing it in anampule containing 2 milliters of the Cariostat testmedium. Dental hygienists incubated thismedium at 37°C for 48 hours. They assigned a

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JADA, Vol. 139 http://jada.ada.org January 2008 65

TABLE 1

Screening indexes of each caries activity test score at every age, based on test results for 18-month-oldand 2-year-old children.AGE (YEARS) CARIES ACTIVITY TEST SCORE

0.5 1.0 1.5 2.0 2.5

* ST: Sensitivity.† SP: Specificity.‡ PPV: Positive predictive value.§ NPV: Negative predictive value.

18-Month-Old Caries ActivityTest Score as a Cutoff Point18-month-old childrenST*SP†

Validity (ST+SP)PPV‡

NPV§

2-year-old childrenSTSPValidity (ST+SP)PPVNPV

31⁄2-year-old childrenSTSPValidityPPVNPV

2-Year-Old Caries ActivityTest Score as a Cutoff Point2-year-old childrenSTSPValidityPPVNPV

31⁄2-year-old childrenSTSPValidityPPVNPV

0.870.131.001.2498.70

0.920.131.059.2094.80

0.940.161.1034.8083.80

0.960.101.069.3096.60

0.950.171.1233.9081.90

0.870.441.341.9099.60

0.720.451.1711.1094.40

0.660.441.1037.7074.50

0.780.401.1816.0095.00

0.690.421.1136.7074.60

0.660.621.281.9099.20

06.200.641.2614.0094.60

0.490.671.1641.3073.10

0.590.691.2815.0094.50

0.460.721.1844.0073.50

0.400.901.304.8099.20

0.230.911.1419.4092.50

0.180.941.1258.1070.50

0.320.911.2324.8093.40

0.280.931.2150.4069.90

0.330.971.3012.8099.10

0.110.981.0930.0092.00

0.080.991.0779.5068.80

0.160.961.1230.9092.70

0.080.971.0558.2068.80


caries activity test score with reference to fourstandard colors. The same hygienists evaluatedeach of these scores as follows: score 0 (pH 5.8-7.2), 1.0 (pH 5.4 ± 0.3), 2.0 (pH 4.8 ± 0.3) and 3.0(pH < 4.4). In this study, we used a modified scalein which the intervals between 0-1.0, 1.0-2.0 and2.0-3.0 were divided into halves. The same dentalhygienist evaluated all caries activity test results.We sent the test results to the subjects by mail.

Questionnaires. We administered question-naires to the subjects’ parents or guardians toevaluate which factors regarding the patients’lifestyles made them susceptible to caries. Wemailed these questionnaires to subjects along witha notification of their examination date. The sub-ject’s parents or guardians completed the ques-tionnaire and brought it to the Kurashiki-CityPublic Health Center on the day of the child’sscheduled examination. The questions were as follows:dDo you check and brush your child’s teeth?dHow many times a day does your child ingestsucrose-containing foods?dDo you determine the total time of your child’ssucrose-containing food intake?

dDoes your child continue to breast-feed or drinkliquids other than water through a bottle?

Predicted screening indexes. The 18-monthcaries activity test results of children aged 2 and31⁄2 years were predictive of the children’s eitherbeing caries-free or experiencing caries. We cal-culated predicted screening indexes on the basisof 18-month-old caries activity test results byusing discriminate analysis for screeningindexes. We calculated 31⁄2-year-old children’s pre-dicted screening indexes on the basis of 2-year-olds’ caries activity test results in a similarmanner.

Statistical methods. We analyzed the datareleased by the Kurashiki-City Public HealthCenter. We used Spearman rank correlation toevaluate the relationship between the cariesactivity test of the subject’s oral condition at 18months and 2 years of age, as well as the predic-tive ability of the caries activity test. We used theWilcoxon signed rank test to analyze the differ-ences between caries activity test result distribu-tions at 18 months and 2 years. Furthermore, weused the Mann-Whitney U test to analyze thecaries activity test result distributions between

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Figure 2. Receiver operating characteristic (ROC) curves of 18-month-old and 2-year-old children and predicted curves based on the cariesactivity test results at both ages.

1.0

1.0

1.01.00

0

00

SPECIFICITY

SEN

SIT

IVIT

Y

Meaningless Area

18-Month-Old Children’s ROC

2-Year-Old Children’s Predicted ROC

Based on 18-Month-Old Children’s

Caries Activity Test Results

3.5-Year-Old Children’s Predicted ROC

Based on 18-Month-Old Children’s


3.5-Year-Old Children’s Predicted ROC

Based on 2-Year-Old Children’s


2-Year-Old Children’s ROC


caries-experienced and caries-free groups at bothages. We used discriminate analysis to createscreening indexes for the results of the cariesactivity test. Screening indexes include sensi-tivity (ST), specificity (SP), validity (ST plus SP),positive predictive value (PPV) and negative pre-dictive value (NPV). ST is the probability that atrue high-risk child is predicted to be at high risk.SP is the probability that a true low-risk child is predicted to be at lowrisk. PPV is the probability that achild is truly at high risk when he orshe is predicted to be at high risk.NPV is the probability that a child istruly at low risk when he or she ispredicted to be at low risk. We usedthe χ2 test to investigate which fac-tors regarding the subject’s lifestylemade him or her susceptible tocaries. We considered a P value ofless than .05 to be significant.

RESULTS

There were no significant differences in the dis-tributions between caries activity test resultswhen the children were 18 months old and 2years old (Figure 1). Table 1 shows the screeningindexes of 18-month-old children and the 2- and31⁄2-year-old children’s predicted indexes based onthe 18-month-old caries activity test results.Table 1 also shows the screening indexes of 2- and 31⁄2-year-old children’s predicted indexes

based on the 2-year-old caries activity testresults. Validity beyond 1.0 was accepted andused for the screening test. The validity of cariesactivity test score 0.5 was only 1.0, so we did notuse this score as a cutoff point for dividing chil-dren into different caries-risk groups. Receiveroperating characteristic (ROC) curves showed theresults of screening indexes except for PPV and

NPV. None of the curves for STand SP was drawn in the mean-ingful area. (The meaningful areais beyond a diagonal line and themeaningless area is below a diag-onal line. A diagonal line showsthe validity of 1.0, so this line isincluded in the meaningless area.)The 2-year-olds’ current and pre-dicted curves based on the 18-month-old caries activity testresults were not the same. How-ever, both curves were located

beyond the diagonal line. Both predicted curvesfor the 31⁄2 year-olds based on their caries activitytest results at the other ages were drawn close toeach other (Figure 2).

There were positive correlations between cariesactivity test results and mean number of cariousteeth at 18 months and 2 years of age. The 2-yearcaries activity test results showed a stronger cor-relation with the mean number of decayed teeththan did the 18-month results (Table 2). None ofthe children had filled teeth at either of those

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TABLE 2

Relationship between caries activity test results and actual meannumber of carious teeth and caries prevalence at each test.SUBJECTS’ CARIESACTIVITY, BY AGE ATCARIES ACTIVITY TEST

CARIES ACTIVITY TEST SCORE

0.50 1.0 1.5 2.0 2.5 3.0

SRCC* P VALUE

* SRCC: Spearman rank correlation coefficient.† dt: Decayed teeth.‡ SD: Standard deviation.§ Mean caries prevalence. No children had filled teeth. Mean caries prevalence was 32.4 percent when patients were 31⁄2 years old.

There were significant correlations between caries activity test scores and mean number of current dt.

18 Months Mean dt† (SD‡)

Caries prevalence (%)

No. of children

2 YearsMean dt (SD)

Caries prevalence (%)

No. of children

0 (0)

0

45

0.24(0.66)11.8

17

0.02(0.13)

1.8

110

0.04(0.24)

2.0

99

0 (0)

0

367

0.13(0.66)

5.1

354

0.05(0.41)

1.8

221

0.13(0.57)

6.0

331

0.02(0.25)0.88

339

0.28(0.91)10.0

269

0.05(0.43)

1.1

85

0.51(1.32)20.5

83

0.38(1.04)12.8

39

0.92(1.72)30.9

55

0.07

1.2§

0.176

8.7§

< .05

< .01

There were positivecorrelations between

caries activity testresults and meannumber of cariousteeth at 18 monthsand 2 years of age.


ages. Table 2 shows the caries prevalence at eachcaries activity test point. Caries prevalence washigher at 18 months than at any other cariesactivity test point. The 2-year-olds’ caries preva-lence increased according to the caries activitytest results. Table 3 shows the mean number of 2- and 31⁄2-year-olds’ decayed and filled teeth (dft)at every caries activity test point in comparisonwith previous test results. Previous caries activitytest results significantly predicted future cariesincidence. The 18-month-old caries activity testresults predicted 2- and 31⁄2-year caries incidencesmore strongly than the 2-year caries activity testresults predicted the 31⁄2-year test results.

Table 3 also shows the future caries prevalencebased on previous caries activity test results. In2-year-old children, the actual and predictedcaries prevalences were similar from cariesactivity test score 0.5 to scores 2.0 and 3.0, but

the actual caries prevalence was higher than thepredicted one at caries activity test scores 0 and2.5. The 31⁄2-year-olds’ predicted caries prevalencebased on the 18-month and 2-year caries activitytest scores were well-matched except for the 18-month caries activity test score of 3.0. A child whohad a caries activity test score of 3.0 when he orshe was 18 months old would have a higher prob-ability of carious teeth at 31⁄2 years of age thanwould a 2-year-old child who had a 3.0 cariesactivity test score.

We analyzed the responses to the lifestylequestions for behaviors that would put children atrisk of developing caries. We observed a signifi-cant difference between the children who report-edly continued breast-feeding or received any-thing other than water through a bottle throughthe age of 18 months. Additionally, we observed asignificant difference regarding the frequency of

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TABLE 3

Relationship between caries activity test results and predicted meannumber of decayed and filled teeth and caries prevalence.SUBJECTS’CARIES STATUS

CARIES ACTIVITY TEST SCORE

0.50 1.0 1.5 2.0 2.5 3.0

SRCC* P VALUE

* SRCC: Spearman rank correlation coefficient. There were significant correlations between the caries activity test results and predicted mean numberof decayed and filled teeth (dft).

† SD: Standard deviation.‡ dt: Decayed teeth.§ N/A: Not applicable.

2-Year-Old Children’s CariesStatus Based on18-Month-OldChildren’s CariesActivity TestResultsdft (SD†)Caries prevalence(%)

31⁄2-Year-Old Children’s CariesStatus Based on18-Month-OldChildren’s CariesActivity TestResultsdt‡ (SD)Caries prevalence(%)No. of children

31⁄2-Year-Old Children’s CariesStatus Based On2-Year-Old Children’s CariesActivity TestResultsdft (SD)Caries prevalence(%)No. of children

0.11 (0.53)4.4

0.29 (0.76)15.6

45

0.29 (0.69)17.6

17

0.13 (0.56)1.8

0.64 (2.05)15.5

110

0.56 (1.39)15.1

99

0.13 (0.65)5.7

1.02 (2.16)29.2

367

0.88 (2.08)28.0

354

0.10 (0.45)5.0

0.97 (2.03)32.6

221

1.01 (2.27)28.4

331

0.29 (0.92)12.1

1.58 (3.10)35.2

339

1.62 (2.88)39.0

269

0.42 (1.15)14.1

2.45 (3.45)45.9

85

2.77 (4.28)48.2

83

1.15 (2.01)30.0

4.46 (4.53)86.9

39

3.91 (4.07)68.5

55

0.147

0.202

0.223

N/A§

< .001

< .01


sucrose intake and total time of sucrose intakethrough 2 years of age. There were no dataregarding the act of parents’ brushing of the chil-dren’s teeth at 2 years of age. However, there wasa significantly high rate of caries in childrenwhose parents brushed the children’s teeth andwho had a high sucrose intake at 31⁄2 years of age(Table 4).

DISCUSSION

Other researchers have investigated the reflectiveand predictive abilities of the caries activity test.Matsumura and colleagues17 reported that thecaries activity test could screen high cariesactivity in children aged 1 year to 15 years, andthey found a significant correlation between thecaries activity test scores and number of decayedteeth for each age. Sutadi and colleagues11 andTsubouchi and colleagues15 reported that thecaries activity test had high screening indexesthrough their longitudinal studies in groups withhigh caries prevalence (more than 70 percent).Koroluk and colleagues16 reported the screeningindexes of caries activity test, and their resultswere almost the same as ours. They used the

same screening test but produced differentscreening indexes. The caries prevalence of thesubjects in the study by Koroluk and colleagueswas 33.3 percent; in our study, it was 32.4 per-cent. The subjects’ caries prevalence influencedthe screening indexes.

The greatest difference between our study andother studies is that ours shows the screeningindexes regarding each score. It is important toestablish the screening indexes of each score forclinicians and researchers because they then canfix a cutoff point for patients on the basis of theshown screening indexes. High ST and low SPmean that there is a high probability of true posi-tives and false negatives. Low ST and high SPmeans that there is a high probability of falsepositives and true negatives. Therefore, the prac-titioners can determine a cutoff point for theirpatients under the following circumstances: ifpatients’ caries prevalence is high, ST is morethan SP; if patients’ caries prevalence is low, SPis more than ST. However, the test score that hasthe highest validity generally is considered to bethe cutoff point.

Caries is a complex chronic disease,18 and the

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TABLE 4

The distribution of caries activity test results and answers to questionsregarding oral habits and lifestyle of caries-experienced and caries-freechildren.*SUBJECTS QUESTIONS P VALUE

.536, NS†

.372, NS

.235, NS

< .05

No data< .05

< .05

< .05

< .05< .05

< .05

No data

* The distributions of caries activity test results of caries-experienced and caries-free children were analyzed by means of the Mann-Whitney U test. There were significant differences of P < .01 (U value, 5,453) and P < .001 (U value, 37,742) at 18 months of age and 2 years of age,respectively. The distribution of answers to questions regarding oral habits and lifestyle and their relationship with caries experience was analyzed by means of the χ2 test.

† NS: Not significant.

18-Month-Old Children (n = 1,206):Caries-Experienced (High-Risk) Children (n = 9); Caries-Free (Low-Risk) Children (n = 1,197)

2-Year-Old Children (n = 1,206): High-Risk (n = 105); Low-Risk (n = 1,101)

31⁄2-Year-Old Children (n = 1,206):High-Risk (n = 391); Low-Risk (n = 815)

1: Do you check and brush your child’s teeth?2: How many times a day does your child ingestsucrose-containing foods?3: Do you determine the total time of your child’ssucrose-containing food intake?4: Does your child continue to breast-feed or drinkliquids other than water through a bottle?

1: Do you check and brush your child’s teeth?2: How many times a day does your child ingestsucrose-containing foods?3: Do you determine the total time of your child’ssucrose-containing food intake?4: Does your child continue to breast-feed or drinkliquids other than water through a bottle?

1: Do you check and brush your child’s teeth?2: How many times a day does your child ingestsucrose-containing foods?3: Do you determine the total time of your child’ssucrose-containing food intake?4: (not included in 31⁄2 year-old children’s questionnaires)


constantly alternating process of demineraliza-tion and remineralization19 on the tooth surfacesis the most clinically important process. There-fore, a caries activity test is considered better inscreening for caries potential than for caries expe-rience. It is important that the clinician screen forcaries potential, especially before finding carieson the tooth. Therefore, the test validity beyond1.0 is a prerequisite condition, because the basicgoal in dentistry and medicine is to prevent theinitiation of disease and its further development.In this study, a caries activity test score at 18months of age not only reflected the 18-month-oldcaries status but also predicted the child’s cariesstatus at 2 and 31⁄2 years of age. We saw the sameresults with the 2-year-old caries activity testscores. Furthermore, 2- and 31⁄2-year-old screeningindexes were predicted on the basis of the 18-month-old caries activity test scores, and 31⁄2-year-old screening indexes were predicted on the basisof the 2-year-old caries activity test scores. The31⁄2-year-olds’ predicted screening indexes basedon the 18-month-olds’ and 2-year-olds’ cariesactivity test scores were similar because the twopredicted ROC curves were similar. This meansthat there were no significant differences in thedistributions of the 18-month-olds’, 2-year-olds’and 31⁄2-year-olds’ caries activity test scores.

ROC curves generally are used to comparescreening tests targeted at the same disease. AnROC curve is drawn by connecting the coordi-nates on an ROC curve plane with a normalcurve. However, in this study we used a straightline instead of a normal curve to clarify the rela-tionship of the curves’ ups and downs. Re-searchers and clinicians must adopt a cutoff pointthat is based on exact scientific evidence. To ourknowledge, this study is the first study to showthe screening indexes at each caries activity testpoint. A researcher or clinician can use the cariesactivity test to diagnose caries susceptibility onthe basis of exact scientific evidence. An ultimatedecrease in the prevalence of caries makes itimperative that the 18-month-old caries activitytest result be improved. Investigation of 31⁄2-year-olds’ lifestyles may be useful for caries preventionin the future. Oral examinations of six-month-oldinfants, especially involving instruction of parentsregarding appropriate oral hygiene practices, isconsidered to be effective in caries prevention.Tooth eruption and change of feeding method(from breast or bottle to weaning) occur in manychildren at this age. Pediatric dentists and dental

hygienists can give parents or guardians informa-tion regarding children’s oral hygiene, diet andlifestyle factors that lead to higher caries rates.Parental awareness can prevent children fromdeveloping caries.20-22 Intake of fermentable carbo-hydrates, particularly sucrose, is well-known as acaries risk factor. The American Academy of Pedi-atric Dentistry’s recommendations includeparental oral hygiene such as parents’ brushing ofchildren’s teeth,21 and some researchers havereported that intake of liquid other than water isnot acceptable.20,22,23 Therefore, the questions inthis study were important, and the informationconcerning early childhood caries found in theresults of our study can be effective in improving18-month-olds’ caries activity test results.

CONCLUSIONS

The caries activity test succeeded in predicting31⁄2-year-old children’s caries risk assessmentbased on 18-month and 2-year test results. Earlyweaning, less sucrose intake and toothbrushingby parents lowered a child’s caries risk. It alsomay be useful to show screening indexes of notonly each score of the caries activity test but alsoof other caries activity tests so that clinicians andresearchers can determine a cutoff point. ■

The authors are greatly indebted to Joel H. Berg, MS, for his kindsuggestions and sophisticated English instruction.

1. Reich E, Lussi A, Newbrun E. Caries-risk assessment. Int Dent J1999;49(1):15-26.

2. Koch G. Importance of early determination of caries risk. Int DentJ 1988;38(4):203-10.

3. Larmas M. A new dip-slide method for counting of salivary lacto-bacilli. Proc Finn Dent Soc 1975;71(2):31-5.

4. Matsukubo T, Ohta K, Maki Y, Takeuchi M, Takazoe I. A semi-quantitative determination of Streptococcus mutans using its adherentability in a selective medium. Caries Res 1981;15(1):40-5.

5. Jordan HV, Laraway R, Snirch R, Marmel M. A simplified diag-nostic system for cultural detection and enumeration of Streptococcusmutans. J Dent Res 1987;66(1):57-61.

6. Snyder ML. A simple colorimetric method for the diagnosis ofcaries activity. JADA 1941;28:44-9.

7. Alban A. An improved Snyder test. J Dent Res 1970;49(3):641.8. Maki Y, Yamamoto H, Matsukubo T, Takazoe I, Sibuya M, Asama

K. Prevalence and caries activity test scored Resazurin disk method. JDent Health 1984;34(2):18-26.

9. Borgström MK, Sullivan A, Granath L, Nilsson G. On the pH-lowering potential of lactobacilli and mutans streptococci from dentalplaque related to the prevalence of caries. Community Dent Oral Epi-demiol 1997;25(2):165-9.

10. Shimono T, Sobue S. A new colorimetric method for caries diag-nosis. Dent Outlook 1974;43(6):829-35.

11. Sutadi H, Huey JC, Nishimura M, Matsumura S, Shimono T. Thedetermination of the predictive value of caries activity test and its suit-ability for mass screening in Indonesia. Pediatr Dent J 1992;2(1):73-81.

12. Huey JC, Nishimura M, Matsumura S, Shimono T. Comparison ofmutans streptococci count methods and Cariostat test for caries riskassessment. Pediatr Dent J 1995;5(1):31-42.

13. Rodivic OD. A longitudinal study of approximal caries in primarymolars: predictive value of Cariostat. Pediatr Dent J 1996;6(1):125-34.

14. Nishimura M, Bhuiyan MM, Matsumura S, Shimono T. Assess-ment of the caries activity test (Cariostat) based on the infection levelsof mutans streptococci and lactobacilli in 2- to 13-year-old children’s

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70 JADA, Vol. 139 http://jada.ada.org January 2008Copyright ©2008 American Dental Association. All rights reserved.

dental plaque. ASDCJ Dent Child 1998;65(4):248-51, 229.15. Tsubouchi J, Yamamoto S, Shimono T, Domoto PK. A longitu-

dinal assessment of predictive value of a caries activity test in youngchildren. ASDC J Dent Child 1995;62(1):34-7.

16. Koroluk L, Hoover JN, Komiyama K. The sensitivity and speci-ficity of a colorimetric microbiological caries activity test (Cariostat) inpreschool children. Pediatr Dent 1994;16(4):276-81.

17. Matsumura S, Shimono T, Morisaki I, Shimono T, Sobue S.Dental caries experience and dental caries activity by new caries sus-ceptibility test (CARIOSTAT) by the children in Okinawa prefecture(Tarama Island of Miyako). Jpn J Ped Dent 1980;18:612-7.

18. Hunter PB. Risk factors in dental caries. Int Dent J 1988;38(4):211-7.

19. Silverstone LM. Remineralization phenomena. Caries Res1977;11(supplement 1):59-84.

20. Johnsen DC, Gerstenmaier JH, Schwartz E, Michal BC, ParrishS. Background comparisons of pre-31⁄2-year-old children with nursingcaries in four practice settings. Pediatr Dent 1984;6(1):50-4.

21. Febres G, Echeverri EA, Keene HJ. Parental awareness, habits,and social factors and their relationship to baby bottle tooth decay.Pediatr Dent 1997;19(1):22-7.

22. American Academy of Pediatric Dentistry. Clinical guideline oninfant oral health care. Pediatr Dent 2004;26(7):67-70.

23. Tinanoff N, O’Sullivan DM. Early childhood caries: overview andrecent findings. Pediatr Dent 1997;19(1):12-6.

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