title: Improved ability of biological and previous caries multimarkers to predict caries disease as revealed by multivariate PLS modelling.
abstract: BACKGROUND
  Dental caries is a chronic disease with plaque bacteria, diet and saliva modifying disease activity. Here we have used the PLS method to evaluate a multiplicity of such biological variables (n = 88) for ability to predict caries in a cross-sectional (baseline caries) and prospective (2-year caries development) setting.
  
  
  METHODS
  Multivariate PLS modelling was used to associate the many biological variables with caries recorded in thirty 14-year-old children by measuring the numbers of incipient and manifest caries lesions at all surfaces.
  
  
  RESULTS
  A wide but shallow gliding scale of one fifth caries promoting or protecting, and four fifths non-influential, variables occurred. The influential markers behaved in the order of plaque bacteria > diet > saliva, with previously known plaque bacteria/diet markers and a set of new protective diet markers. A differential variable patterning appeared for new versus progressing lesions. The influential biological multimarkers (n = 18) predicted baseline caries better (ROC area 0.96) than five markers (0.92) and a single lactobacilli marker (0.7) with sensitivity/specificity of 1.87, 1.78 and 1.13 at 1/3 of the subjects diagnosed sick, respectively. Moreover, biological multimarkers (n = 18) explained 2-year caries increment slightly better than reported before but predicted it poorly (ROC area 0.76). By contrast, multimarkers based on previous caries predicted alone (ROC area 0.88), or together with biological multimarkers (0.94), increment well with a sensitivity/specificity of 1.74 at 1/3 of the subjects diagnosed sick.
  
  
  CONCLUSIONS
  Multimarkers behave better than single-to-five markers but future multimarker strategies will require systematic searches for improved saliva and plaque bacteria markers.
authors.affiliation: Department of Odontology/Cariology, Umeå University, 901 87 Umeå, Sweden. ake.nordlund@odont.umu.se
authors.forename: Ake
authors.initials: A
authors.lastname: Nordlund
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Carina
authors.initials: C
authors.lastname: Källestål
authors.forename: Thorild
authors.initials: T
authors.lastname: Ericson
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.forename: Nicklas
authors.initials: N
authors.lastname: Strömberg
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000175:diagnosis*; D003732:Dental Caries Activity Tests; D003773:Dental Plaque / Q000382:microbiology; D004037:Diet, Cariogenic; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D016018:Least-Squares Analysis; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry / Q000382:microbiology; D012680:Sensitivity and Specificity; D013295:Streptococcus mutans / Q000302:isolation & purification
chemical_list: D015415:Biomarkers