Total observed caries experience: assessing the effectiveness of community-based caries prevention

Objectives: To compare common measures for dental caries in longitudinal caries research in support of a new measure, the Total Observed Caries Experience (TOCE). Methods: TOCE was calculated as the total number of decayed or filled teeth ever observed. TOCE was compared to dmft, DMFT, and the prevalence of untreated decay using data from a 4-year, cluster randomized community-based caries prevention program. Outcomes were analyzed using generalized estimating equations and assessed change over time and effects across treatment groups. Results: For TOCE and DMFT, the risk of caries over time increased. In contrast, risks decreased for dmft and the prevalence of untreated decay, driven largely by decayed primary teeth being exfoliated. Effects across treatment groups showed increased risk for some outcomes and attenuated risks in others; however, treatment effects for TOCE were more in line with expected results when compared with controls. Conclusions: TOCE accounts for caries on primary and permanent dentition and is not subject to bias due to exfoliation. It can be used as a robust measure to evaluate community-based caries prevention programs.