Supplementary Material for: Differential unmet needs and experience of restorative dental care in trajectories of dental caries experience: a birth cohort study.

Dental caries is a chronic and cumulative disease but little has been reported on the continuity of the disease and its treatment through life. Group-based multi-trajectory modelling was used to identify developmental trajectories of untreated carious tooth surfaces (DS), restored tooth surfaces (FS), and teeth extracted due to caries (MT) from ages 9 to 45 years in a New Zealand longitudinal birth cohort, the Dunedin Multidisciplinary Health and Development Study (n=975). Associations between early life risk factors and trajectory group membership were examined by specifying the probability of group membership according to a multinomial logit model. Six trajectory groups were identified and labelled: ‘low caries rate’; ‘moderate caries rate, maintained’; ‘moderate caries rate, unmaintained’; ‘high caries rate, restored’; ‘high caries rate, tooth loss’; and ‘high caries rate, untreated caries’. The two moderate-caries-rate groups differed in count of FS. The three high-caries-rate groups differed in the relative proportion of accumulated DS, FS, and MT. Early childhood risk factors associated with less favourable trajectories included higher dmfs scores at age 5, lack of exposure to community water fluoridation during the first five years of life, lower childhood IQ, and low childhood socioeconomic status. Parent self-ratings of their own or their child’s oral health as ‘poor’ were associated with less favourable caries experience trajectories. Children who had clinical signs of dental caries together with a parent rating of child’s oral health as poor were more likely to follow a less favourable caries trajectory. Higher deciduous dentition caries experience at age 5 years was associated with less favourable caries trajectories, as were children whose parents gave ‘poor’ ratings of their own or their child’s oral health. These findings highlight the considerable intergenerational continuity in dental caries risk and experience from early childhood to midlife. Subjective measures of child oral health are informative and might aid as predictors of adult caries experience in cases where childhood dental clinical data were not available.

龋病（dental caries）是一种慢性累积性疾病，但目前关于该疾病及其治疗在个体一生中的连续性研究鲜有报道。本研究依托新西兰达尼丁多学科健康与发育研究（Dunedin Multidisciplinary Health and Development Study，n=975）这一纵向出生队列，采用群组多轨迹建模方法，识别了9岁至45岁期间未治疗龋损牙面（untreated carious tooth surfaces, DS）、充填牙面（restored tooth surfaces, FS）以及因龋拔除的牙（extracted due to caries, MT）的发育轨迹。通过构建多项logit模型（multinomial logit model）确定群组归属概率，分析了早期生命危险因素与轨迹群组归属之间的关联。研究共识别出6个轨迹群组并分别命名："低龋病发生率组""维持性中等龋病发生率组""非维持性中等龋病发生率组""高龋病发生率-充填组""高龋病发生率-牙丧失组"以及"高龋病发生率-未治疗龋损组"。两个中等龋病发生率群组的差异在于FS的计数；三个高龋病发生率群组的差异则在于累积DS、FS及MT的相对占比。与不良轨迹相关的早期儿童危险因素包括5岁时较高的乳牙龋失补牙面（dmfs）评分、出生后前5年未暴露于社区饮水氟化（community water fluoridation）、儿童期智商较低以及儿童期社会经济地位低下。父母自评自身或子女口腔健康状况为"较差"，与较差的龋病患病轨迹相关。同时存在龋病临床体征且父母自评子女口腔健康较差的儿童，更易走向不良的龋病患病轨迹。5岁时乳牙列（deciduous dentition）较高的龋病患病情况，以及父母自评自身或子女口腔健康较差的儿童，同样与不良龋病轨迹相关。本研究结果凸显了龋病风险与患病情况从儿童早期到中年的显著代际连续性。在儿童期牙科临床数据缺失的情况下，儿童口腔健康的主观评价具有参考价值，可作为成人龋病患病情况的预测指标。