Swedish study refines identification of children at high risk of dental caries

Uppsala, Sweden. Over a decade of national data has provided new insights into the trajectories of dental caries development in Swedish children and adolescents. The results indicate that while most children remain caries-free, a small group experiences a high caries burden. The study demonstrates that combining disease trajectory analysis with caries-specific measures of childhood caries experience enables more precise identification of early disease patterns and better detection of children who are most likely to benefit from preventive care.

Research objectives and rationale for the approach

The study was initiated by the recognition that dental caries disproportionately affects a small group of children, and this pattern is often obscured by average population-level statistics. The primary objective was to improve the identification of children and adolescents with the highest caries burden.

The study analyzed data from 165,365 individuals aged 10 and 20 years, sourced from the Swedish Quality Registry for Caries and Periodontal Diseases over a ten-year period. Caries experience was assessed based on the number of decayed and filled tooth surfaces in both the primary and permanent dentitions.

Analysis of caries development trajectories

Based on longitudinal records, a three-trajectory modeling approach was applied, wherein participants were categorized into high, moderate, and low caries trajectory groups based on disease progression.

Among 20-year-olds, the differences between trajectories increased over time, which aligns with the cumulative nature of dental caries. The high-risk group showed a significant increase in caries burden, while participants in the low trajectory demonstrated virtually no disease progression over the ten-year period.

Specifics of assessment in younger children

In children aged 10, the anticipated divergence of trajectories was not observed, reflecting the limitations of applying this model to caries development in the primary and mixed dentition. For this age group, additional metrics proved to be more informative.

The specific affected caries index, which considers only children with existing caries, consistently demonstrated higher values compared to traditional indices. It proved particularly useful in early childhood, when most children are caries-free, and the disease is concentrated in a small subgroup.

Additionally, the point prevalence of caries at age 6 helped identify children who were more likely to develop caries at an older age. The authors emphasize that early caries in primary teeth is closely correlated with subsequent disease, highlighting the crucial role of monitoring during the preschool period.

Association with quality of life and clinical implications

The obtained results complement previous studies, showing that oral health-related quality of life significantly deteriorates in Swedish preschool children with caries, particularly when untreated lesions are present.

Despite the overall improvement in dental health at the population level in Sweden, this study confirms that a clearly defined minority of children bear a disproportionately high risk of dental disease. Earlier and more accurate identification of these groups could contribute to more effective prevention and rational allocation of resources in pediatric dental care.

Publication of the study

The article titled “Caries experience among children and adolescents from a longitudinal Swedish national registry study over a 10-year period” was published on January 7, 2025, in the journal Acta Odontologica Scandinavica.