THE ASSESSMENT OF NURSING CARIES AND ITS RELATIONSHIP TO HIGH CARIES IN THE PERMANENT DENTITION

The prevalence of nursing caries has been found to be high in populations of Native American children, unlike other US population groups. Comparisons among studies are difficult because a variety of operational definitions of the syndrome have been used. This study had two goals. First, a retrospective dental record audit was conducted for a Native American population attending Head Start in 1977-78, to compare the prevalence rates of nursing caries obtained by using different nursing caries classification schemes. Second, we studied the relationship of prior nursing caries to current high caries level determined by a clinical exam in the same children approximately ten years later (N = 88). As expected, different classification schemes yielded different prevalence rates. Classification of nursing caries by buccal or lingual caries in the maxillary incisors found 45 percent of the children with the disorder, vs 61 percent if measured by three or more carious maxillary incisors, or 76 percent if two or more carious maxillary incisors. Nursing caries in these Head Start children, defined by caries on the buccal or lingual surfaces of the maxillary incisors, showed no increased risk of greater-than-or-equal-to 5 DMFT at age 15. The Head Start children classified as having nursing caries by two or more, or three or more, decayed maxillary anterior teeth had relative risks (RR) of 1.6 (95% Cl 1.1, 2.4) and 1.4 (95% Cl 1.0, 1.9) for high caries (DMFT greater-than-or-equal-to 5) ten years later, whereas the RR for children with a dmft greater-than-or-equal-to 5 was 2.4 (95% Cl 1.4, 4.3). The classification of nursing caries by carious maxillary incisors appears to depict the overall caries experience in the primary dentition of these Native American Head Start children, rather than specifically nursing caries. The maxillary incisor classifications demonstrated a positive relationship to the presentation of high caries in the permanent dentition, which was not found when nursing caries was measured by buccal or lingual caries of the maxillary incisors.