ICDAS Adaptation for Early Childhood Caries: An Epidemiological Study in 11 Latin American Countries

The assessment of epidemiological information on the oral health of children younger than 6 y in the region of the Americas is challenging due to methodological differences. An International Association for Dental Research Regional Development Project supported researchers from 11 Latin American countries in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Panama, Paraguay, Peru, Uruguay, and Venezuela to train and conduct standardized epidemiological studies of dental caries in children <6 y of age.

To assess the feasibility of an International Caries Detection and Assessment System (ICDAS)-adapted protocol in early childhood caries (ECC) epidemiological studies and provide comparable data.

Eleven researchers from the selected countries were standardized using the following simplified criteria and protocol aimed to reduce the time of evaluation: (1) starting the examination with the detection of caries lesions, (2) eliminating ICDAS category 1 (as no air for drying), (3) applying one code for tooth surfaces with the same clinical finding (e.g., missing), and (4) using a customized data entry form. The 11 researchers trained and standardized 10 to 15 local examiners in each country and conducted cross-sectional studies in convenience samples of preschool children aged 12 to 71 mo living in disadvantaged communities according to each country's criteria.

A total of 4,535 children were included in the present analysis. There were notable differences by country and age. For example, the d_2-6 prevalence in the 12- to 23-mo group varied between 13% in Venezuela and 48% in Argentina, while the d_5-6 prevalence varied between 0% in Venezuela and 18% in Argentina. In general, the occurrence of more severe clinical presentations increased with age.

There was a considerable variation in the prevalence of dental caries in the 11 countries. The wide variation with age indicates the need to report ECC estimates by detection threshold and individual age groups. The ICDAS-adapted protocol is suitable for ECC epidemiological studies.Knowledge Transfer Statement:The results of this study show the high occurrence and variation of early childhood caries (ECC) in Latin American children, which shows the need for more detailed and comprehensive surveillance efforts in this age group. The ICDAS-adapted protocol facilitates data entry and the recording of clinical observations for epidemiological studies in young children by reducing examination time. We have contributed to the standardization of ECC data collection in Latin America by using common ICDAS-adapted criteria.