Majority of New Onset of Dental Caries Occurred from Caries-Free Students: A Longitudinal Study in Primary School Students

We examined Rose's axiom that a large number of people exposed to a small risk may generate more cases than a small number exposed to a high risk, using data on caries incidence. This longitudinal study was based on the records of annual dental checks conducted in primary schools in Okinawa, Japan. Participants were students aged 6-11 years at baseline in 2014, and a follow-up survey was conducted after one-year. The outcome variable was the increased number of decayed, missing, and filled teeth (DMFT). The predictor variable was the baseline DMFT score. Gender, grade, and affiliated school variables were adjusted. A negative binomial regression model was used to obtain the estimated increase of DMFT score. Among 1542 students, 1138 (73.8%) were caries-free at baseline. A total of 317 (20.6%) developed new caries during the follow-up. The predicted number of new carious teeth in a caries-free students and students with DMFT = 1 at baseline were 0.26 (95% CI, 0.22-0.31) and 0.45 teeth (95% CI, 0.33-0.56), respectively. However, among the total of 502 newly onset of carious teeth, 300 teeth (59.7%) occurred from the caries-free students at baseline. Hence, prevention strategies should target the low-risk group because they comprise the majority of the population.