Supplementary Material for: Initial caries lesions in preschool children are not a risk factor for caries in adolescents

Caries experience in primary teeth has been highlighted as the most important single risk factor for caries development in the subsequent permanent teeth, but at cavitated stages. This 10-year cohort study aimed to evaluate whether children with only initial caries lesions in the primary teeth could also have a higher risk for caries incidence in permanent teeth. We evaluated Brazilian preschoolers aged 1 to 5 years in 2010 (T1) and re-evaluated them 2 (T2), 7 (T3), and 10 (T4) years later. Dental caries in primary and permanent teeth was assessed through the International Caries Detection and Assessment System (ICDAS). For the primary dentition (T1 and T2), the participants were categorized according to caries severity in the first two assessments into children with (i) no caries, (ii) only initial caries lesions (ICDAS scores 1 and 2), (iii) at least one moderate lesion (ICDAS scores 3 and 4), and (iv) extensive caries lesions (ICDAS scores 5 and 6). We also created a dichotomous variable considering only extensive lesions. Demographic and socioeconomic data were also collected. For the permanent dentition (T3 and T4), the participants were re-evaluated for extensive caries lesions after 7 and 10 years of follow-up. The outcome variables were the number of decayed, extracted, and filled surfaces of permanent teeth (D3MFS) and the occurrence of any extensive lesion (caries incidence) after 10 years. Associations were evaluated through negative binomial and Poisson regression analyses, respectively. Incidence rate ratios (IRR) and Relative Risks, along with 95% confidence intervals (95%CI), were derived. At the baseline, 639 children were included, and 429 were reassessed after 10 years (67.2% of retention rate). Children with only initial or moderate caries lesions did not have a higher risk of caries in permanent teeth. By contrast, children with extensive caries lesions were more likely to develop caries in the permanent dentition than children without caries (IRR, 95% CI = 2.90, 1.98 to 4.23). This higher risk was more clearly demonstrated when the caries experience was used as a dichotomous variable (IRR, 95% IC = 4.02, 2.38 to 6.78). In conclusion, children with only initial caries lesions do not have a higher risk of developing dental caries in the permanent dentition by adolescence.

乳牙龋病经历被认为是后继恒牙龋病发生的最重要单一危险因素，但既往研究多聚焦于龋洞形成阶段的乳牙龋。本项为期10年的队列研究旨在评估：仅罹患乳牙早期龋损的儿童，是否同样具有更高的恒牙龋病发生风险。本研究于2010年（T1时间点）纳入1至5岁的巴西学龄前儿童，并分别在随访第2年（T2）、第7年（T3）及第10年（T4）对其进行再次评估。研究采用国际龋病检测与评估系统（International Caries Detection and Assessment System, ICDAS）对乳牙及恒牙的龋病状况进行评估。针对乳牙列（T1及T2时间点），研究人员根据前两次评估的龋病严重程度，将受试者分为四类：(i) 无龋患儿；(ii) 仅存在早期龋损（ICDAS评分为1、2分）患儿；(iii) 存在至少1处中度龋损（ICDAS评分为3、4分）患儿；(iv) 存在广泛性龋损（ICDAS评分为5、6分）患儿。本研究同时构建了仅纳入广泛性龋损的二分类变量。研究同时收集了受试者的人口学及社会经济学相关数据。针对恒牙列（T3及T4时间点），研究人员在随访第7年及第10年时，对受试者的广泛性龋损情况进行再次评估。本研究的结局变量包括：10年随访后恒牙的龋坏、拔除及充填牙面数（D3MFS），以及任意广泛性龋损的发生情况（即恒牙龋病发生率）。研究分别采用负二项回归与泊松回归分析评估变量间的关联，并推导得出发病率比（Incidence Rate Ratios, IRR）、相对危险度（Relative Risks, RR）及95%置信区间（95%CI）。基线时本研究共纳入639名儿童，随访10年后仍有429名儿童完成评估，随访保留率为67.2%。仅存在早期龋损或中度龋损的患儿，其恒牙罹患龋病的风险并未显著升高。与之相反，存在广泛性龋损的患儿相较于无龋患儿，更易发生恒牙龋病（IRR=2.90，95%置信区间：1.98~4.23）。当将龋病经历以二分类变量形式纳入分析时，这一风险升高的关联表现得更为显著（IRR=4.02，95%IC=2.38~6.78）。综上，仅存在乳牙早期龋损的儿童，在青春期阶段并不会面临更高的恒牙龋病发病风险。