Archived Comments for:
The distribution of burden of dental caries in schoolchildren: a critique of the high-risk caries prevention strategy for populations
Pentti Alanen, Institute of Dentistry, University of Turku, Finland
7 February 2006
I have read this article with surprise. In the answer to the reviewers the authors state: "We have highlighted that the major burden of future disease occurs in the groups at lowest risk..."I think you should write: "We have shown that the major burden of future disease DID 20-25 YEARS AGO OCCUR IN THE 7-11-YEAR-OLD AGE GROUPS SUSPECTED to be at lowest risk..."
How do you know that your results can be generalised to current populations, caries increment figures, distribution and polarisation of decay, current preventive measures, and current identification of risk subjects? The age group 7 years is the most difficult one in these respects.
Competing interests
I have no competing interests.
response
Paul Batchelor, UCL
13 February 2006
We would like to thank Professor Pentti Alanen for the question raised on our paper. The author implies that a number of features of the caries process have changed since the data used in our analyses were gathered. They have not. Except for a marked decline all other features are similar. The caries prevalence and incidence rates in our study are very similar to those found currently in the vast majority of the world’s industrial populations. Second, the preventative measures used today are the same as those used in our study, namely the use of fluoride and fissure sealants.
As we have shown in previous papers, the distribution of caries within all populations shares common features: the mean and variance at all levels of caries are mathematically linked. This feature is independent of the fluoride status or age of the child1,2. Finally, the ‘high risk’ approach as a means of tackling caries has also been discredited by numerous authors. For example, Hausen3 and Holst4.
On the basis of the evidence presented, we do not consider that there is any reason whatever to change what we have said.
References
1. Batchelor P, Sheiham A. The limitations of a 'high-risk' approach for the prevention of dental caries. Community Dent Oral Epidemiol. 2002 Aug;30(4):302-12.
2. Batchelor PA, Sheiham A. Grouping of tooth surfaces by susceptibility to caries: a study in 5-16 year-old children. BMC Oral Health. 2004 Oct 28;4(1):2.
3. Hausen H. Caries prediction--state of the art. Community Dent Oral Epidemiol. 1997 Feb;25(1):87-96.
4. Holst D. Causes and prevention of dental caries: a perspective on cases and incidence. Oral Health Prev Dent. 2005;3(1):9-14.
Competing interests
none
Incorrect figure/graph placement
Karzan Amin, University of Gothenburg
29 November 2011
According to the text Figure 1 is showing; the initial percentage distribution and subsequent mean 4-year DMF-S increment in Group 1(Initial DMF-S = 0.61), but the bar-graph represents the results for Group 4 (compare the 4-year mean caries increment for children initially with DMF-S of 0). Vice versa Figure 4 is showing the graph representing Group 1. Figure 2 is showing a graph of Group 3 (not Group 2 as stated), and Figure 3 is showing a graph representing Group 2.
Furthermore if we look at the bar-graph for Group 3 (which is misplaced onto Figure 2), the DMF-S bar for children with an initial DMF-S of 7 or more is incorrectly depicted. It shows a bar corresponding to 3% when it should be 7% (which is higher than its neighbouring DMF-S 5-6 subgroup), as stated in the text.
Some questions to the authors
7 February 2006
I have read this article with surprise. In the answer to the reviewers the authors state: "We have highlighted that the major burden of future disease occurs in the groups at lowest risk..."I think you should write: "We have shown that the major burden of future disease DID 20-25 YEARS AGO OCCUR IN THE 7-11-YEAR-OLD AGE GROUPS SUSPECTED to be at lowest risk..."
How do you know that your results can be generalised to current populations, caries increment figures, distribution and polarisation of decay, current preventive measures, and current identification of risk subjects? The age group 7 years is the most difficult one in these respects.
Competing interests
I have no competing interests.
response
13 February 2006
We would like to thank Professor Pentti Alanen for the question raised on our paper. The author implies that a number of features of the caries process have changed since the data used in our analyses were gathered. They have not. Except for a marked decline all other features are similar. The caries prevalence and incidence rates in our study are very similar to those found currently in the vast majority of the world’s industrial populations. Second, the preventative measures used today are the same as those used in our study, namely the use of fluoride and fissure sealants.
As we have shown in previous papers, the distribution of caries within all populations shares common features: the mean and variance at all levels of caries are mathematically linked. This feature is independent of the fluoride status or age of the child1,2. Finally, the ‘high risk’ approach as a means of tackling caries has also been discredited by numerous authors. For example, Hausen3 and Holst4.
On the basis of the evidence presented, we do not consider that there is any reason whatever to change what we have said.
References
1. Batchelor P, Sheiham A. The limitations of a 'high-risk' approach for the prevention of dental caries. Community Dent Oral Epidemiol. 2002 Aug;30(4):302-12.
2. Batchelor PA, Sheiham A. Grouping of tooth surfaces by susceptibility to caries: a study in 5-16 year-old children. BMC Oral Health. 2004 Oct 28;4(1):2.
3. Hausen H. Caries prediction--state of the art. Community Dent Oral Epidemiol. 1997 Feb;25(1):87-96.
4. Holst D. Causes and prevention of dental caries: a perspective on cases and incidence. Oral Health Prev Dent. 2005;3(1):9-14.
Competing interests
none
Incorrect figure/graph placement
29 November 2011
According to the text Figure 1 is showing; the initial percentage distribution and subsequent mean 4-year DMF-S increment in Group 1(Initial DMF-S = 0.61), but the bar-graph represents the results for Group 4 (compare the 4-year mean caries increment for children initially with DMF-S of 0). Vice versa Figure 4 is showing the graph representing Group 1.
Figure 2 is showing a graph of Group 3 (not Group 2 as stated), and Figure 3 is showing a graph representing Group 2.
Furthermore if we look at the bar-graph for Group 3 (which is misplaced onto Figure 2), the DMF-S bar for children with an initial DMF-S of 7 or more is incorrectly depicted. It shows a bar corresponding to 3% when it should be 7% (which is higher than its neighbouring DMF-S 5-6 subgroup), as stated in the text.
Competing interests
None declared