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A Re-analysis of Caries Rates in a Preventive Trial using Poisson Regression Models
P.P. Hujoel
Department of Dental Public Health Sciences, School of Dentistry, SM-35, University of Washington, Seattle, Washington 98195, Department of Epidemiology, School of Public Health and Community Medicine
P.J. Isokangas
Department of Community Dentistry, Institute of Dentistry, University of Turku, Finland
J. Tiekso
Department of Community Dentistry, Institute of Dentistry, University of Turku, Finland
S. Davis
Department of Epidemiology, School of Public Health and Community Medicine, Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Program in Epidemiology, and University of Washington, Seattle
R.J. Lamont
Department of Oral Biology, University of Washington, Seattle
T.A. DeRouen
Department of Dental Public Health Sciences, School of Dentistry, SM-35, University of Washington, Seattle, Washington 98195, Department of Biostatistics, University of Washington, Seattle
K.K. Makinen
Department of Biological and Material Sciences, University of Michigan, Ann Arbor, Michigan 48109
The analysis of caries incidence in clinical trials has several challenging features: (1) The distribution of the number of caries onsets per patient is skewed, with the majority of patients having few or no cavities; (2) the number of surfaces at risk varies (i) over time and (ii) between patients, due to eruption and exfoliation patterns, dental diseases, and treatments ; (3) surfaces within a patient differ in their caries susceptibility, and (4) caries onsets within a patient are correlated due to shared host factors. Recent statistical developments in the area of correlated data analyses permit incorporation of some of these characteristics into the analyses. With Poisson regression models, the expected number of caries onsets can be related to the number of surfaces at risk, the time they have been at risk, and surface- and subject-specific explanatory variables. The parameter estimated in these models is an epidemiological measure of disease occurrence: the disease incidence rate (caries rate) or the rate of change from healthy (sound) to diseased (carious). Differences and ratios of these rates provide standard epidemiological measures of excess risk. To illustrate, Poisson regression models were used for exploratory analyses of the Ylivieska xylitol study.
Key Words: Dental Caries • Models • Statistical, Xylitol
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Journal of Dental Research, Vol. 73, No. 2,
573-579 (1994)
DOI: 10.1177/00220345940730021401
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