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.

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.

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).

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.

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.

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.

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.

Radiopacity of restorations and detection of secondary caries.

The aim of this study was to compare the accuracy of radiographic diagnosis of secondary carious lesions adjacent to filling materials with different radiopacities. Class II preparations were made in extracted teeth. One group of teeth (n = 49) had caries in the gingival wall, simulating secondary caries. The control teeth (n = 29) had no caries. Three posterior composite materials (P-30 and two experimental composites) with different radiopacities and amalgam were successively inserted into each cavity. After being radiographed, the "restorations" were removed and a new material inserted. The radiographs were interpreted by 11 dentists, and secondary caries was diagnosed according to a five-point confidence rating. The results obtained with the receiver operating characteristics (ROC) method showed that a semi-radiopaque restoration seemed favorable and that the best radiopacity slightly exceeded that of enamel.

Radiographic diagnoses and treatment decisions on approximal caries.

The purpose of the study was to examine the quality of radiographic caries diagnosis by dentists; the frequency of operative treatment decisions; and the frequency and pattern of proposals to fill sound surfaces. Radiographs of 68 approximal surfaces of extracted teeth were duplicated and examined by 243 dentists. A "true" diagnosis was established by direct inspection and probing. Great variation existed in diagnostic quality between dentists. Restoration therapy made up 15.6 of surfaces on average (SD = 6.5, range 0-66). Fillings were proposed for about 5% of the sound surfaces. About 25% of the dentists accounted for more than 80% of the treatment proposed for sound surfaces.

Caries prevalence in primary teeth as a predictor of early fissure caries in permanent first molars.

The study aimed to examine the validity of employing the caries experience of the primary dentition for predicting early caries in the permanent first molar fissures. Subjects consisted of 192 children who were followed for 2 yr, 91 of whom were pursued for a further year, all receiving semiannual check-ups. The caries prevalence in the primary dentition (dmft), excluding incisors, was recorded at baseline, which was the year the children became 6. Fissure caries in the permanent first molars was recorded as being confined to enamel or dentin, based on findings during cavity preparation. The correlation between dmft and the number of intact permanent first molars was -0.368 and -0.337 after 2 and 3 yr observation respectively. When the children were grouped according to their dmft, a statistically significant relationship was found between the dmft and the number of intact molars in each individual. The positive and negative predictive values as well as the sensitivity and specificity of different dmft values were calculated, and the relationship between them illustrated by the use of ROC curves. Even if there are no specific dmft values which seem obviously favorable for the purpose, these data give information relevant in planning for large scale use of fissure sealing in preventing early fissure caries in permanent first molars.

Impact of diagnostic criteria on the prevalence of dental caries in Norwegian children aged 5, 12 and 18 years.

The study aimed to investigate caries prevalence in children using a severity grading diagnostic system, and to evaluate the influence of different diagnostic thresholds on the caries data. A group of 513 children, aged 5, 12 and 18 years, were examined clinically, and with available bitewing radiographs, by four calibrated examiners. The inter- and intra-examiner reliability, assessed by a weighted kappa, varied between 0.80 and 0.95. The mean dmft/DMFT values were 3.8, 5.8 and 11.0 for the three age groups respectively, and the corresponding dmfs/DMFS values were 5.4, 9.9 and 22.6. The d/D-component constituted the major part of the dmf/DMF index in all age groups, and enamel lesions accounted for 59%, 89% and 86% of the d/D-component in the three age groups respectively. It is concluded that enamel or initial caries lesions contributed substantially to the total caries prevalence, illustrating the importance of using diagnostic criteria that include all stages of clinical caries if a total picture of the caries situation is needed.

Radiographic caries diagnosis by clinicians in Norway and Western Australia.

In connection with continuing education courses in Norway and Western Australia (WA), dealing with caries diagnosis and treatment decisions, pre-tests were conducted. The pre-tests involved 433 dentists in Norway (ND), and 62 dentists (WAD) and 108 dental therapists (WAT) in WA, altogether 603 clinicians. Radiographs of 68 approximal surfaces were to be diagnosed and a treatment proposal was requested for each surface. ND showed the best overall diagnostic quality measured by the area beneath ROC-curve (P < 0.00001). The frequency of false-positive diagnoses (over-registrations) on sound surfaces varied between 7.1% (ND) and 11.9% (WAT) while the frequency of true-positive scores for lesions in the outer half of dentine varied from 57.4% (ND) to 48.1% (WAT). The mean numbers of restorations suggested by the three groups of clinicians were: ND: 14.3; WAD: 13.0; and WAT: 14.5. None of the differences was statistically significant. The proportion of sound surfaces proposed filled varied considerably between the groups, from 4.3% among Norwegian dentists to 10.6% among WAT (P < 0.0001). Of the lesions penetrating the outer half of dentine, the ND group would have restored 34.5% and the Australian clinicians somewhat fewer: WAD 25.6% and WAT 26.5%. The 11.3% of the ND who proposed more than two fillings on sound surfaces were responsible for 51.2% of the total number of filling proposals on sound surfaces. The corresponding numbers in the Australian group were 19.4% (WAD) and 33.3% (WAT) who made 73.6% and 75.7% of the restorative proposals on sound surfaces respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiographic interpretation and treatment decisions among dental therapists and dentists in Western Australia.

All dentists and dental therapists employed in the Community Dental Services in Western Australia were invited to participate in a questionnaire study to find out about their use of radiographs and opinions and knowledge about the diagnosis of approximal caries. Replies were received from 45 dentists (95.1%) and 207 dental therapists (84.0%). Most dentists would not restore a lesion before it appeared on radiograph to have reached the dentine, while therapists were more likely to consider a restoration for a lesion just in enamel. Sixty percent of all respondents thought that a cavity was present when the radiographic lesion was confined to enamel. Fifty-seven percent of dentists thought that an average lesion took at least 12 months to progress from outer enamel to dentine, while a majority of dental therapists thought this would take less than 12 months. Radiographs were not frequently taken by the participants. Operators' opinions about cavity formation were the most important predictor of choice of treatment. In general, these participant's responses were similar to those provided by Norwegian and Dutch respondents in similar surveys conducted 5-6 yr ago, but the present participants worked in an optimally fluoridated area and might therefore have been expected to have adopted more cautious criteria for restorative treatment. Differences between dentists and dental therapists were generally not great. The results suggest that calibration of the operators in the service would offer benefits.

Vertical angulation of the X-ray beam and radiographic diagnosis of secondary caries.

The purpose of this study was to assess to what extent angulation of an X-ray beam could affect the quality of diagnoses of caries adjacent to restorations with different radiopacities. Amalgam and composite class II restorations with and without secondary caries were done in extracted teeth. The teeth were radiographed using four different vertical angulations -0, 5, 10, and 15 degrees. Eight dentists diagnosed caries lesions on these radiographs. The best diagnostic outcome was found for the composite restorations radiographed at 10 degrees vertical angulation. Diagnosis was generally better for lesions marginal to composites compared to amalgams. The quality of secondary caries diagnosis in connection with amalgam was not significantly affected by variations in vertical angulation from 0 up to 15 degrees.

Variation in radiographic interpretation and restorative treatment decisions on approximal caries among dentists in Norway.

Of a random sample of dentists in Norway (n = 741), 83% responded to a questionnaire about their use of radiographs in and their opinions and knowledge about the diagnosis of approximal caries. There was great disparity in criteria for initiation of restorative treatment of approximal caries based on radiographic appearance. Two thirds of the dentists would do restorative treatment of lesions confined to enamel, the others would wait until lesions had reached the dentin before treatment was commenced. The criteria for restoration based on radiographic appearance was best correlated with the dentists' opinions about cavity formation. About 20% of the variation in criteria among dentists was explained by the radiographic appearance dentists associated wih the presence of a cavity. The majority of the dentists believed that approximal caries progressed faster than is indicated by progression studies. The interval between recall examinations using radiographs was not consistently shorter for dentists who decided to carry out operative caries treatment at a relatively advanced stage.

Clinical behaviour of glass ionomer restorations in primary teeth.

OBJECTIVE: To compare a silver-reinforced glass ionomer material (cermet) with a resin-modified glass ionomer in minimal Class II preparations in primary teeth. METHODS: Matched pairs of primary molars with approximal caries that required operative treatment were used. Each cavity was filled with either Vitremer or Ketac-Silver. The restorations were followed for at least 36 months and examined annually using bitewing radiographs and clinical inspections. Impressions were taken at each recall and models were examined microscopically. RESULTS: After 36 months, one of the resin-modified glass ionomer (RMGI) restorations and 13 (26.5%) of the silver cermet restorations had failed. The RMGI failed because of secondary caries, while most of the failures of the silver cermet fillings were marginal defects alone or in combination with secondary caries. The median survival time (MST) for the silver cermet restorations was 37 months. The RMGI restorations had a MST exceeding 42 months, but MST could not be calculated exactly because of the low failure rate during the study period. CONCLUSIONS: The resin-modified glass ionomer had the overall best performance of the two materials under comparison. The silver cermet material cannot be recommended for Class II restorations in primary teeth.

Diagnosis of secondary caries and crevices adjacent to amalgam.

Teeth with Class II amalgam fillings (n = 77) were mounted in blocks in approximal contact and radiographed. Fifteen dentists examined radiographically the gingival area of the fillings/teeth and 2 weeks later they examined the teeth visually and by probing. The diagnoses were then validated by the authors using stereomicroscopic examination of the fillings/tooth surfaces and longitudinal sections of the teeth. The teeth were divided into three groups: fillings without failure (controls), fillings with secondary caries and fillings with crevices. The rate of false positive diagnoses (secondary caries) was reduced from 12 to 3 per cent when the radiographical examination was supplemented with 'clinical' findings; similarly, the rate of secondary caries detection and detection of crevices increased from 47 to 64 per cent and 8 to 47 per cent, respectively. Clinical examination in addition to radiographical interpretation improves the quality of secondary caries diagnosis. The results indicate that the diagnosis of small, secondary, caries lesions is uncertain, and that many crevices are wrongly diagnosed as secondary caries.

Class II amalgams: interobserver variations in replacement decisions and diagnosis of caries and crevices.

Teeth with Class II amalgam fillings (n = 77) were mounted in blocks in approximal contact and radiographed. Fifteen dentists examined the teeth radiographically, visually and by probing and were asked to decide whether or not replacement fillings were required. The diagnoses were validated by the authors using stereomicroscopic examination of the fillings/tooth surfaces and longitudinal sections of the teeth. During validation the teeth were divided into three groups: fillings without failure (controls), fillings with secondary caries (S1-S3) and fillings with crevices (C1-C2). The number of replacement decisions varied from 27 to 49. On average, 5.3 per cent of the controls were suggested as requiring replacement but the variation between dentists was great. For the small secondary carious lesions, S1, there was a consistency between the number of positive diagnoses and replacement decisions for all but four dentists. Of these fillings, 36 per cent were suggested as requiring replacement on average, while the values for S2, S3, C1 and C2 surfaces were 68.9, 92.1, 20.8 and 52.2 per cent, respectively. The variations in diagnoses and replacement decisions between the dentists were greater for the S2 lesions than the S3 lesions. The dentist who was most eager to re-restore fillings suggested that 75 per cent of the fillings with the small crevices (C1) and 100 per cent with the large crevices (C2) should be replaced. Conversely, one dentist would not replace any of the fillings with small crevices (C1) and only 17 per cent of those with large crevices. The dental profession needs guidelines for the standardisation of clinical decisions based on treatment philosophy.