Associations between dental treatment in the primary and permanent dentitions using insurance claims data.

Purpose: The purpose of this study was to assess the associations between dental treatment in the early primary dentition and later treatment in the primary and permanent teeth. Methods: Delta Dental Plan of Michigan insurance claims data on 9,886 children who were born in 1990 and were covered by dental insurance from 1990–1998 were used. Risk ratios (RR), screening test measures of sensitivity (SN) and specificity (SP), and evidence-based dentistry research measures of Likelihood Ratio (LR) and Number Needed to Treat (NTT) were calculated. Results: Primary anterior tooth treatment at ages 0-3 was weakly associated (RR=1.43, 95% C.I.=1.23, 1.65) with treatment of the permanent first molars at ages 6-8 and had SN, SP, LR, and NNT values of 7.4, 95.3, 1.57, and 12 respectively. Primary posterior tooth treatment at ages 4-8 was more strongly associated with future permanent first molar treatment with a RR of 2.44 (95% C.I. = 2.26, 2.64) and SN, SP, LR, and NNT values of 65.9, 61.7, 1.72, and 6. Conclusions: For this population, early childhood treatment in the primary anterior teeth was a weak predictor of future permanent first molar treatment. Primary posterior teeth treatment, while still not a strong predictor, was better than primary anterior teeth in predicting permanent tooth treatment. Caries treatment at ages 4-8 in the primary teeth was better than treatment at ages 0-3 in predicting permanent first molar treatment. (Pediatr Dent 22:469-474, 2000) It has recently been recommended that the terms “early childhood caries” (ECC) and “severe early childhood caries” (S-ECC) be used to describe dental caries in infants and toddlers, with S-ECC referring specifically to children with atypical, progressive, acute, or rampant patterns of dental caries. The associations between ECC or S-ECC and future caries development is of importance both to the researcher and to the clinician. For the researcher, this information could aid in the understanding of the etiological factors involved in the caries process. Do the factors that cause this condition persist into later life and lead to future caries in the primary and permanent dentitions, or is ECC a unique clinical entity that only affects the primary teeth in these children? For the clinician, this information could aid in caries risk assessment that is part of the decision making process in developing a preventive strategy for a patient. Despite extensive previous research, there are still many questions regarding the risk factors for dental caries both in the primary and permanent dentitions. Previous carious experience, as well as various biological, psychosocial, and behavioral factors, have been shown to be associated with caries prevalence and incidence. Predictive multifactoral models, however, have only been able to explain a rather small percentage of variance in future caries experience with relatively low R values. Several studies have looked at the associations between ECC experience and future primary and permanent tooth caries. The ability to predict future caries from a history of ECC was not clear-cut nor consistent, with the results varying with the populations studied, the definitions of caries, and the analytical methodology used. This project utilizes longitudinal dental insurance claims data to investigate the associations between early childhood primary tooth treatment, later childhood primary tooth treatment, and permanent tooth treatment. The dataset is unique in its scale and its representation of treatment actually done in clinical practice.