Microsoft Word - CRE056BF

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.