Swedish study refines identification of high-risk children

Dental Tribune International

Mon. 26 January 2026

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UPPSALA, Sweden: Over a decade of national data has shed new light on the developmental trajectories of dental caries in Swedish children and adolescents. The findings indicate that, while most remain caries-free, a small group experiences a high burden of disease. The study demonstrates a combined approach that includes trajectory analysis and caries-specific measures of childhood caries experience to better characterises early disease patterns and improve identification of children most likely to benefit from preventive care.

The study was motivated by the recognition that caries persists disproportionately among a small group of children and that this pattern is often obscured by population averages. It thus aimed to improve identification of children and adolescents with the highest caries burden. The research followed 165,365 individuals aged 10 and 20 using data from the Swedish Quality Registry for Caries and Periodontal Disease over a ten-year period. Caries experience was assessed through decayed and filled tooth surfaces in both primary and permanent dentition.

Using longitudinal caries records, a three-trajectory model assigned individuals to high, moderate or low caries trajectories based on how their disease progressed. Among 20-year-olds, differences between these trajectories widened over time, consistent with cumulative caries experience, and substantial increases in disease burden occurred among those in the high group. By comparison, those in the low group displayed almost no progression across the decade.

In children aged 10, however, this expected widening of trajectories was not observed, reflecting limitations in applying the model to caries development in primary and mixed dentition. For this younger group, additional metrics offered sharper resolution. The specific affected caries index, which includes only those who have experienced caries, consistently produced higher values than traditional indices did and was especially informative in early childhood, when most children were caries-free and disease was concentrated in a small subgroup. A point prevalence measure at age 6 also identified those more likely to develop caries later in childhood. The authors note that earlier caries in the primary teeth strongly correlated with later disease, underlining the importance of surveillance in the preschool years.

The results of the study synergise with earlier work showing that the oral health-related quality of life is adversely affected in Swedish preschool children with caries, particularly among children with untreated caries. The current study demonstrates that, although Swedish oral health continues to improve at the population level, a distinct minority carries a disproportionate risk of dental disease. Identifying these groups earlier and more precisely may enable more effective prevention and resource allocation in paediatric oral health services.

The article, titled “Caries experience among children and adolescents from a longitudinal Swedish national registry study over a 10-year period”, was published on 7 January 2025 in Acta Odontologica Scandinavica.