Tooth-surface distribution of caries in Greek schoolchildren, using ICDAS-II index. A national pathfinder survey

Aim The objective of this cross-sectional nationwide study was to assess the caries status of Greek children, in regard to the severity and the distribution pattern of the lesions in the primary and permanent dentition at a tooth-surface level, based on ICDASII criteria. Methods Study Design: A national survey was conducted in 15 urban and 9 rural sites and about 50 subjects were examined at each location across the country. Caries data, based on ICDAS-II index, were recorded on 4,410 children aged 5, 12, and 15-years by 10 calibrated dentists. The rankings of the most affected tooth-surfaces, the most vulnerable teeth found cavitated, the right-left symmetry of caries stages and its pattern of distribution shown per jaw or dentition were determined by using descriptive statistics (SPSS v.20). Results In all age groups sound enamel surface (ICDAS-II=0, not including sealants) was the most prevalent code, reaching approximately 94% of the total tooth-surfaces examined. Incipient caries (ICDAS-II=A) was the most prevalent among the cariesaffected surfaces in the three age groups (32.1%, 60.3% and 63.4%, respectively), followed by ICDAS-II=3 (23.2%, 21.8% and 19.5%, respectively). The ICDAS-II=4,5,6 caries codes in primary dentition were found in higher prevalence as compared to the same codes in the permanent dentition of 12 and 15-year-olds. Regarding treatment, fillings were the most common finding (totally 4,059 filled surfaces), followed by fissure sealants (totally 1,443 sealed surfaces), both found mainly to permanent dentitions. The occlusal surfaces of the primary and permanent molars, especially of the lower mandibular jaw were found to be the most vulnerable sites affected. A high symmetry concerning the distribution per tooth type, surface type and stage of caries lesions was observed, with the mandibular jaw and the molars being the most affected sites detected. Conclusion Caries lesions were quite frequent in this school aged child population and the most common code of ICDAS-II observed was that of incipient enamel caries, mainly on the occlusal surfaces, indicative of the need for fissure sealant application. For those surfaces with ICDAS-II=3-6, dental care and intensive prevention programmes, both at home and office based, are needed.