Need of non-operative caries treatment in 16-year-olds from Northern Norway.

AIM: To assess the prevalence of proximal enamel lesions, the need for non-operative caries treatment and the quality of dental restorations in 869 students aged 16 years from Northern Norway. METHODS: All first year upper secondary school students in Tromsø and Balsfjord municipalities were invited to participate in an oral- and general health project (Fit Futures). The attendance rate was 90%, and all subjects born in 1994 (449 males and 420 females) were included in the present study. Dental caries was registered according to a 5-graded scale (1-2 = enamel lesions; 3-5 = dentinal lesions). Scores from 1 to 4 were used to register the quality of restorations (1 = good; 2 = acceptable; 3 = poor; 4 = unacceptable). RESULTS: Only 6% of the 16-year-olds were completely caries-free. There were 84% of the participants with proximal enamel lesions. A majority of them had either previously restored teeth (35%) or both restored teeth and untreated dentinal caries lesions (34%). When using the D-value of the DMFS-index as a diagnostic criterion, 39% of the participants were in need of restorative treatment. When proximal enamel lesions were included in the diagnosis, the number of participants in need of restorative and/or non-operative caries treatment was 85%. Over 1/3 of the participants presented with at least one restoration below an acceptable quality level. CONCLUSIONS: Dental caries is still a major health problem affecting the total teenage population. A non-operative treatment strategy should be considered relevant in order to reduce the need for restorative treatment.

Variation in caries treatment proposals among dentists in Norway: the best interest of the child.

AIM: To explore variation in treatment-related-decisions for severe caries in children among dentists in the Public Dental Service (PDS) in Norway. It was also to evaluate the treatment choices in relation to the best interest of children and a child's rights to enjoy the highest standard of health care. METHODS: A pre-coded questionnaire was sent electronically to all general dental practitioners (GDPs) working in the PDS in eight counties in Norway (n = 611). The questionnaire included two case scenarios to reflect common dental conditions related to severe caries among 5-year-old children. Paediatric dentists and paediatric students were invited to validate the different treatment options. Frequency distributions and statistical analyses were carried out using Chi square statistics. RESULTS: The response rate was 65% (n = 391) among the GDPs. A majority of the GDPs preferred a new appointment with behaviour management techniques (BMT) to a child presenting pulpitis and pain. Dentists educated outside the Nordic region would use restraint more often as a treatment alternative when the child was in pain than Nordic-educated dentists (p\0.05). Dentists with less than 10 years of experience preferred BMT and sedation more often when the child was in pain than their older colleagues, who, however, preferred a waiting approach and no immediate treatment if the child was not in pain(p\0.05) [corrected]. CONCLUSIONS: Use of BMT and sedation is related to region of education and years of experience. Awareness of ethical principles with the child´s best interest in mind, should receive increased attention.

Dental erosion: Prevalence and severity among 16-year-old adolescents in Troms, Norway.

AIM: To study the prevalence, distribution and severity of dental erosion among 16-year-old adolescents in the Troms region of Norway. MATERIALS AND METHODS: Study design: The participants were recruited through the Tromsø-study ("Fit Futures"), and 392 16-year-olds were examined for dental erosion using clinical intraoral photographs. Three calibrated clinicians used the Visual Erosion Dental Examination (VEDE) system to register and grade the dental erosive wear. RESULTS: More than one third (38%) of the participants showed dental erosion on at least one tooth surface, 18% were limited to the enamel, while 20% of the adolescents showed erosive wear extending into the dentine. The occlusal surfaces of the lower first molars, and the palatal surfaces of the maxillary incisors were the most often and most severely affected. Of the participants showing dental erosion, 93% exhibited "cuppings" on the molars, with 48% limited to the enamel and 52% extending into the dentine. The highest prevalence of "cuppings" (73%) was found on the first lower molars, especially the mesiobuccal cusp of the teeth. The prevalence and severity of dental erosion was found to be higher in male than in female participants (p < 0.0001). CONCLUSION: The results from this study indicate a high prevalence and severity of dental erosion among adolescents in Troms and stress the importance of information, early and effective diagnostics and implementation of prevention strategies.

Canines are affected in 16-year-olds with molar-incisor hypomineralisation (MIH): an epidemiological study based on the Tromsø study: "Fit Futures".

AIM: This was to determine the prevalence, distribution of affected teeth and severity of MIH in adolescents from Northern Norway. METHODS: It was part of a cross-sectional health survey Fit Futures including 16-year-olds from two neighbouring municipalities, Tromsø and Balsfjord. RESULTS: The prevalence of MIH was 13.9% (110 of 794). The maxillary first permanent molars (FPMs) were 1.6 times more frequently affected than in the mandible (P < 0.001). The FPMs on the right side were 1.2 times more often affected than the FPMs on the left side (P = 0.038). The maxillary incisors were 2.5 times more often affected than the incisors in the mandible (P < 0.001). The proportions of participants whose canines and incisors were involved were 22.8 and 41.8%, respectively. Altogether 201 FPMs were affected; 54.0% of these had opacities only, 24.3% had posteruptive breakdown (PEB), 18.8% had atypical restorations, and 3.0% had been extracted due to MIH. The buccal surfaces were most often affected in FPMs. More severe lesions were found in the mandibular FPMs compared with the maxillary FPMs (P = 0.002). In the lower canines, only opacities were recorded, while in the upper jaw 13.0% of the affected canines showed PEBs. The distribution of MIH in the dentition was not symmetrical. CONCLUSION: The prevalence of MIH (13.9%) in the study population of 16-year-olds from Northern Norway is consistent with previous Scandinavian reports. The distribution pattern shows that one participant in four with MIH had at least one affected canine. Further studies are needed to describe the localisation of defects on the enamel surface and to relate these findings to enamel thickness and the duration of amelogenesis.

Dentists' self-perceived stress and difficulties when performing restorative treatment in children.

AIM: This was to explore factors associated with dentists' difficulties doing restorative treatment in children, in particular (1) stress, (2) clinical experience, (3) use of conscious sedation, and (4) use of local analgesia. METHODS: A precoded questionnaire (QuestBack) was sent electronically to all dentists working in the Public Dental Service (PDS) in eight counties in Norway. Chi-square statistics, McNemar's test and bivariate logistic regression analyses were used. RESULTS: A total of 611 dentists received the questionnaire and 391 (65 %) returned the completed form. Self-reported stress was most frequent among dentists when treating patients aged 3-5 years and was statistically significantly associated with the dentists' self-reported difficulties doing restorative treatment. Among dentists with ≤ 10 years experience about 60 % reported stress treating the youngest patients compared with 44 % among the more experienced dentists. Self-perceived stress and working experience was not associated with use of local analgesia and sedation. CONCLUSIONS: The frequency of self-perceived stress among dentists when undertaking restorative treatment decreased with increasing patient age from 3 to 18 years. When treating preschool children, a small group of dentists frequently or always experienced this as stressful work. The use of local analgesia or conscious sedation was not related to dentists' stress. Dentists reported less frequently use of local analgesia and conscious sedation in children younger than 10 years. Undergraduate and continuous education and support in the use of local analgesia and conscious sedation is essential to provide optimal dental care for this patient group.

Caries increment in primary teeth from 3 to 6 years of age: a longitudinal study in Swedish children.

AIM: To longitudinally follow and analyse caries prevalence and development in primary dentition in Swedish preschool children from 3 to 6 years of age. STUDY DESIGN: A longitudinal clinical study. METHODS: Three hundred 3-year-old children in the Public Dental Service were consecutively included. The children underwent annual clinical examinations at 3, 4, 5 and 6 years of age, performed by four calibrated dentists in clinical settings. Initial (d1-2) and manifest (d3-5) lesions were registered at surface and tooth level. Radiographs were taken when indicated and possible. STATISTICS: Chi-squared test was used for group comparisons. Friedman's test, Wilcoxon non-parametric test and logistic regression analyses explored caries development over the years. RESULTS: The parents of 271 children agreed to their children participating in the study (total dropout rate at 6 years, 10.3%). At baseline, 27.3% of the children had carious lesions (d1-5 mean 0.98, SD ± 2.44), and only 50.6% of the children were totally caries-free at 6 years (d1-5 mean 1.88, SD ± 2.81). Initial carious lesions made up the greater share at all ages. The greater part of the caries increment occurred between 3 and 4 years of age (p < 0.001). Having initial and/or manifest carious lesions at 3 years of age was a significant explanatory factor for new lesions at 6 years of age (OR 2.29; 95% CI 1.58-3.31). CONCLUSION: Children with an early caries experience had a high risk of further disease progression. Oral health promotion and prevention programmes should target small children and their carers.

Caries risk assessment. A systematic review.

OBJECTIVE: To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. STUDY DESIGN: A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. RESULTS: Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. CONCLUSIONS: Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

Registration of dental erosive wear on study models and intra-oral photographs.

BACKGROUND: Clinical photographs and study models may provide permanent records of dental erosion and be useful supplements to clinical registration. AIM: To assess the reliability and validity of registrations on clinical photographs and study models performed by a group of examiners. METHODS: Thirty tooth surfaces were selected and assessed clinically, using the visual erosion dental examination system. The chosen surfaces provided the whole range of dental erosions including sound surfaces. The tooth surfaces were photographed and impressions were obtained for preparation of study models. Thirty-three dentists examined and scored the selected surfaces both on photographs and study models. RESULTS: The quality of diagnosis (AUC, area under curve) was slightly higher using photographs as compared to study models. The difference was statistically significant when the validation criterion was erosion, assuming dentine exposure. The inter-method agreement on photographs and study models versus the clinical evaluation were approximately in the same range with a mean κw of 0.48 and 0.43, respectively. When comparing study models with photographs the mean κw was 0.52. The intra-examiner agreement was strong/substantial for both (photographs mean κw = 0.63 and study models mean κw = 0.60). STATISTICS: Linear weighted Cohen's kappa (κw) was used to evaluate inter-method and intra-examiner agreement. Receiver operating characteristic and area under the curves were used to express diagnostic quality according to a clinical examination. CONCLUSION: The results indicated that photographs were as good as study models for recording erosive lesions.

Changes in the treatment concept for approximal caries from 1983 to 2009 in Norway.

The aim was to measure variations in threshold for operative treatment of approximal caries in permanent teeth and the use of restorative materials, compared with results from studies conducted in Norway in 1983 and 1995. In 2009, a precoded questionnaire was sent electronically to 3,654 dentists with E-mail addresses in the member register of the Norwegian Dental Association. The questions were related to caries, treatment strategies and choice of dental materials. Replies were obtained from 61% of the dentists after two reminders. Restorative treatment of approximal lesions confined to enamel, based on radiographic appearance, was proposed by 7% of the dentists, compared with 66% in 1983 and 18% in 1995. Younger dentists, significantly more often than older, would defer operative treatment of approximal lesions until the lesion was visible in dentine. While tunnel preparation most often was the preparation of choice in 1995 (47%), saucer-shaped preparation was most favoured in 2009 (69%). Tunnel preparation was only preferred by 4% of the dentists. Resin composite was the restorative material preferred by 95%, compared with 16% in 1995. The corresponding values for conventional glass ionomer cement (GIC) were 1 versus 22%, for resin-modified GIC 1 versus 7%, and for a combination of GIC and resin composite 2 versus 22%. Compomer was preferred by 1% of the respondents. The authors conclude that treatment concepts for approximal caries have changed considerably during the last 26 years. In 2009, only 7% of dentists reported that they would treat approximal caries operatively before the lesion reached dentine.

Reliability of two clinical scoring systems for dental erosive wear.

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (kappa(w)). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean kappa(w) values were found for VEDE (kappa(w) = 0.77) compared with BEWE (kappa(w) = 0.69). When scoring the surfaces in the clinical examination the mean kappa(w) values for the two systems were equal (kappa(w) = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) has long recognised the necessity of promoting further research and knowledge regarding the dental defect described as molar-incisor-hypomineralisation (MIH). Following the establishment by EAPD of the defect diagnostic criteria in 2003, the publication of various papers and a whole issue assigned to the defect in the European Archives of Paediatric Dentistry (2008), an Interim Seminar and Workshop on MIH was organized in Helsinki in 2009. RESULT: The outcome of this event is the present consensus paper on the prevalence, diagnosis, aetiology and treatment for children and adolescents presenting with MIH. A clear diagnostic proposal and a treatment decision-making guide are presented together with suggestions on aetiology and guidance for future research. CONCLUSION: MIH is an important clinical problem that often concerns both the general dental and specialist paediatric dentists; the present 'best clinical practice guidance' aims to further help clinicians dealing with the condition.

Caries preventive effect of fluoride in milk, salt and tablets: a literature review.

BACKGROUND: There are a number of studies in the literature about the effectiveness of fluoride in tablets, fluoride added to frequently-consumed food like milk, or to food additives like salt, in prevention of dental caries. This literature has been evaluated in different evidence based reviews. AIM: The scope of this paper was to identify the most recent evidence-based reviews on the effect in caries prevention from added fluoride in milk, salt and fluoride tablets/drops including newer RCT studies, and to synthesize the findings into practice guidelines. The key question was as follows: Does regular use of fluoride in milk, salt and fluoride tablets/ drops prevent dental caries among children and adolescents? METHODS: MEDLINE, EMBASE and EBM reviews (Cochrane database of systematic reviews) were searched using modified filters from a Cochrane review. One evidence-based report on fluoridated milk was identified. Salt fluoridation was covered by three HTA reviews. One Cochrane protocol on the caries preventive effect of fluoridated salt was identified. RESULTS: Very few studies of good quality were identified in general. Two studies on fluoridated milk were tabulated and seven studies dealing with fluoride tablets/ drops were analysed. One study showed a 78% reduction in caries in newly erupted permanent teeth among 8 year olds after 3 years with fluoridated milk. For primary teeth one study showed 31% caries reduction. The differences between fluoride-group and control were statistically significant. The reduction in caries prevalence in the fluoride tablet group compared with a negative control varied from 81% (carious surfaces in permanent teeth erupted in the study period) to 49% in DMFS for all permanent teeth. No RCT studies on fluoridated salt were identified. CONCLUSION: There is limited evidence that F tablets and drops are effective, and compliance is a key factor. There are good reasons to believe that fluoride in different applications and formulas does work as caries preventive agents under supervision. There is a need for new, well-designed studies within this field, but the use of negative controls without any fluoride exposure is difficult due to ethical reasons. In particular new research is needed concerning possible caries preventive effect of fluoridated milk and salt.

The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age - a longitudinal study.

OBJECTIVES: To explore a possible relationship between the caries experience and pattern in the primary dentition at 5 years of age and the permanent dentition at 10 years of age. Further, to examine the possibility of predicting children in a caries-risk group at 5 years verified at 10 years of age. MATERIALS AND METHODS: A sample of 186 children (90 males) were clinically examined as 5-year-olds and re-examined as 10-year-olds by calibrated dentists. A five-graded diagnostic system including enamel caries was used. Bitewing radiographs were taken. A true risk group of children at 10 years were defined as those with at least one dentin or filled lesion on the mesial surface of 6-year molars, and/or on incisors, and/or total DMFS (decayed, missing, and filled surfaces) more than 1 SD above the mean. The prediction was measured in terms of OR (odds ratio), sensitivity/specificity, and receiver operating characteristic curves. RESULTS: Statistically significant correlations (r=0.5) were found between the caries experience in the two dentitions as well as between the primary second molars at baseline and the permanent teeth at 10 years. 'Primary second molars' and 'all primary molars' were the most powerful predictors for allocation into the risk group (24% of the sample). The highest achieved sum of sensitivity and specificity, 148%, was attained at a cut-off point above two carious surfaces in enamel and/or dentin in primary second molars. CONCLUSIONS: Statistically significant relationship in disease between the dentitions was found. More than two surfaces with caries experience in primary second molars are suggested as a clinically useful predictor at 5 years of age for being at high risk at age 10.

Caries patterns in an urban preschool population in Norway.

AIM: This was to describe the prevalence, severity and distribution of caries in a preschool population in Oslo, Norway, and to compare the findings in subgroups according to immigrant status and age. Furthermore, the present data should serve as a baseline for longitudinal studies. METHODS: The participating children (n = 775), chosen from 7 clinics in the Public Dental Health Service, were of various socioeconomic backgrounds and immigrant status (IM, immigrant group-mother of non-western origin or WN, western native group-mother of western background). The study design was descriptive cross-sectional. The caries examinations were carried out by calibrated examiners, and a detailed 5-graded caries diagnosis system including incipient caries was used. Radiographs (BW) were taken of the 5-year-old children. RESULTS: The percentage of caries free children, aged 3 years (mean 3.0) and 5 years (mean 4.8) were 80.1% and 48.0% respectively. The subgroup of immigrant children showed a considerably higher caries prevalence, it was more often affected by severe caries and experienced an earlier onset of the disease than the subgroup of western native children. The most marked skewness of the caries data was seen within the WN group, especially at 3 years of age. CONCLUSIONS: The present study has revealed disparities in dental health associated with ethnic origin seen at the age of 3. The disparities in dental health are still evident at 5 years of age, but then caries is more common for the whole population.

Caries in primary teeth at 5 and 10 years of age: a longitudinal study.

AIM: This was to explore the caries development in the primary dentition in children aged 5 and later when they were 10, with an emphasis on the caries increment according to type of teeth and surfaces. METHODS: The study was a prospective, longitudinal survey where the children were examined in 1993 when they were 5 years of age (n=217) and re-examined in 1998 when they were 10 (n=186). Caries was examined clinically and with radiographs by calibrated dentists based on a caries diagnostic grading system from 0 to 5. Primary incisors were excluded from the registrations at 10 years of age, while teeth exfoliating during the period were included, based on notes from the dental records. RESULTS: Intra- and inter-examiner reliability ranged from kappa 0.62 to 0.90. Dmfs at 5 years was 5.4 (incisors included) and 7.4 at 10 years (incisors excluded, other exfoliated teeth included). The mean caries increment during the age period showed no significant difference between children with and without caries at 5 years of age. Molar-approximal lesions dominated the increment, and when such lesions were diagnosed at 5 years of age, there was an increased risk for more severe caries (dentine lesions) during the period. CONCLUSION: The caries increment in the primary dentition is considerable for the majority of children during the age period 5-10 years. Even if a risk assessment based on the prevalence of approximal caries at 5 years of age may be useful for deciding individual recall intervals, the results of this study seem to suggest frequent check-ups are needed for the whole population.

EAPD guidelines for use of radiographs in children.

Guidelines in dental radiology are designed to avoid unnecessary exposure to X-radiation and to identify individuals who may benefit from a radiographic examination. Every prescription of radiographs should be based on an evaluation of the individual patient benefit. Due to the relatively high frequency of caries among 5 year old children it is recommended to consider dental radiography for each child even without any visible caries or restorations. Furthermore, radiography should be considered at 8-9 years of age and then at 12-14, that is 1-2 years after eruption of premolars and second molars. Additional bitewing controls should be based on an overall assessment of the caries activity/risk. The high-risk patient should be examined radiographically annually, while a 2-3 years interval should be considered when caries activity/risk is low. Routine survey by radiographs, except for caries, has not been shown to provide sufficient information to be justified considering the balance between cost (radiation and resources) and benefit.

A comparison of radiographic occlusal and approximal caries diagnoses made by 240 dentists.

Radiographs of occlusal (n = 20) and approximal (n = 24) surfaces of extracted teeth were examined by 240 dentists before participating in continuing education courses dealing with caries diagnosis and treatment decisions. The radiographic caries diagnoses were treated in accordance with the receiver operating characteristic (ROC) technique, in which the area beneath the ROC curve (A, value) indicates the quality of the observations. The frequencies of false positives made in dentin radiographically were higher for approximal (20.7%) than for occlusal caries (12.3%). The quality of pooled radiographic diagnoses of occlusal dentin lesions for all observers was significantly better than diagnoses of approximal caries in dentin. A statistically significant relationship between the observer's qualities of diagnosis of caries on approximal and occlusal surfaces (P = 0.045) was found. For diagnosis of dentin caries on approximal surfaces the mean Cohen kappa was 0.74 (standard deviation (s), 0.12; range, 0.39-0.95), and the corresponding values for occlusal surfaces were 0.70 (s, 0.14; range, 0.25-0.98). In the material under study the dentists were at least as good at diagnosing dentin caries occlusally as approximally. To avoid overtreatment, the observer's diagnostic threshold should ideally be adjusted towards strict criteria when a positive diagnosis is synonymous with a filling. The diagnostic thresholds were stricter in diagnosing occlusal surfaces than for approximal surfaces, indicating a more optimal strategy among dentists while diagnosing occlusal dentin lesions in a population with low caries prevalence.

Restorative treatment decisions on occlusal caries in Scandinavia.

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.

Swedish dentists' decisions on preparation techniques and restorative materials.

This study aimed at mapping the preparation techniques and restorative materials that Swedish dentists are using for primary approximal and occlusal carious lesions. It involved sending a pre-coded questionnaire to a random sample of 923 dentists, with eight items concerning approximal and occlusal restorative preparation techniques and dental materials. Responses were received from 651 (70.5%) dentists. To restore a primary approximal carious lesion in an adolescent with low caries activity and good oral hygiene, the tunnel preparation was chosen by 48% of the dentists, the saucer-shaped preparation by 32%, and the traditional Class II preparation by 20%. The most common preparation technique for restoring an occlusal carious lesion was removal of the carious part only, which was chosen by 74% of the dentists. For a lower second molar with a minor occlusal caries lesion combined with a suspected dentin lesion as judged radiographically, about half of the dentists chose to restore the carious part only and 27% would seal the rest of the fissure system in addition. For a similar lesion with no obvious radiolucency in the dentin, about 1/3 chose the 'no treatment' alternative, 1/3 fluoride treatment, and the rest fissure sealing or other techniques. Composite was used most often and amalgam least often for both approximal and occlusal carious lesions.