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Estimating Caries Risk in Unsealed-Permanent Molars Among Young Adults With Data From Repeated National Surveys and a
Susan O Griffin1, Mei Lin1, Shillpa Naavaal2
1Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Objective:
Demonstrate and evaluate methodology to estimate annual probability a sound-unsealed molar develops caries (AP) among US adults, aged 21 and 25 years.
Methods:
A synthetic birth cohort was created with National Health and Nutrition Examination Survey data from 2001 to 2004 and 2011 to 2014. The synthetic birth cohort was born between 1982 and 1989 and was aged 15 to 19 years in 2001-2004 and 25 to 29 in 2011-2014. Caries increment (difference in per-person decayed, missing and filled molars (DMF) between adolescence and young adulthood) obtained from the synthetic birth cohort was used to estimate AP not adjusted for the presence of sealants. Adjusted estimates were obtained by inputting information on sound-sealed, sound-unsealed and DMF molars among adolescents and DMF among young adults from the synthetic cohort and sealant retention from the literature into a Markov model. AP was estimated by solving for the AP that yielded the DMF for the synthetic cohort in young adults. To evaluate Markov-model performance, longitudinal data from five caries effectiveness trials were used to estimate true AP and adjusted AP. One-way sensitivity analyses of model parameters were also conducted.
Results:
The adjusted AP (0.038) was notably higher than the unadjusted AP (0.031). The average and median percentage deviation of adjusted APs relative to their true values were, respectively, 10.1% and 7.1%. The most influential model parameters were DMF in adulthood and annual retention.
Conclusion:
This methodology provides reasonable estimates of AP that can be used in cost-effective analyses of providing sealants to young adults.
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