Progressão de lesões cariosas não cavitadas em adolescentes de Porto Alegre - RS

Abstract

Inactive non-cavitated (INC) caries lesions, by definition, are considered as "arrested" lesions, being understood as scars from past episodes of caries activity. On the other hand, active non-cavitated (ANC) caries lesions are under mineral loss and require some intervention to control their progression. The objective of this study was to analyze the clinical behavior of INC and ANC caries lesions among schoolchildren of Porto Alegre, RS, in order to verify the validity of the caries activity assessment criterion. An epidemiological survey was carried out to evaluate the oral health conditions of 12-year-old schoolchildren. In this survey, 1,528 schoolchildren were examined between September 2009 and December 2010, composing a representative sample of the population of 12-year-old schoolchildren in the municipality. Between August 2012 and May 2013 (mean follow-up time of 2.5 years), 801 schoolchildren were reexamined and thus a longitudinal component was obtained. Data collection included the application of questionnaires and clinical examination, which included gingival bleeding index, professional cleaning, drying and recording of dental caries index (non cavitated and cavitated, inactive and active lesions). The primary outcome of this study was progression, defined as the presence of dark shadow from dentin, cavity, restoration or extraction in the final exam. The association between the predictor variables and the outcome was evaluated through negative binomial regression models (unadjusted and adjusted) generated with generalized estimating equations, following a hierarchical approach. The status of the dental surface at the baseline (sound, INC or ANC) was considered the main predictor variable. A total of 19,438 permanent teeth and 46,238 dental surfaces were included in the study. Progression rates of 1.0%, 9.0%, and 12.6% were observed for sound surfaces, INC lesions and ANC lesions, respectively. The risk analysis showed that inactive and active carious lesions presented an approximately 5-fold increased risk of progression than sound surfaces throughout the study (IRR=5.35, 95%CI=4.20-6.80 and IRR=4.97, 95%CI=3.44-7.19, respectively). It can be concluded that the progression pattern of inactive and active non-cavitated carious lesions was similar in this population of adolescents from Porto Alegre-RS, being significantly higher than the sound surfaces.