Behavior and progression of early carious lesions in early childhood: a 1-year follow-up study.

PURPOSE: The purpose of this 1-year follow-up study was to evaluate the behavior/progression of early carious lesions (active noncavitated carious lesions) by surface and type of tooth in early childhood. METHODS: A total of 179 3-and 4-year-old preschoolers took part in this study. Clinical examinations were conducted by a calibrated examiner using a mirror, ball-ended probe, gauze for cleaning and drying of teeth, and artificial light. The World Health Organization criteria, with an added measurement of early carious lesions (ECLs), were employed for the caries examinations. Descriptive statistics and logistic regression were used in the statistical analysis. RESULTS: After a 1-year follow-up, the study population developed 1.60 ± 1.64 new carious lesions. Children with caries activity at baseline showed much higher risks of developing new lesions than caries-free children (odds ratio=17.3 for ECL development, OR=24.5 for cavitations/fillings). Most ECLs remained active/unchanged after 1 year, whereas approximately 36% were arrested. Approximately 10% of the ECLs became cavitated, were filled, or were missing due to caries at follow-up. ECLs turned into cavities or fillings more frequently in the posterior region. CONCLUSION: This study's findings support the conservative management of ECLs since, after 1 year, the majority of lesions were active/unchanged or were arrested on the smooth surfaces of primary teeth.

Changes in electrical resistance of sound fissure enamel in first molars for 66 months from eruption.

The purposes of this study were to investigate the enamel maturation process in the occlusal pit of sound first molars by measuring electrical resistance. Ninety-nine sound first molars in 34 children (mean age of 6.47 +/- 0.51 years) were measured electrically once every 6 months and were monitored for a maximum of 66 months. Electrical resistance increased during the posteruptive period. However, the results suggest that posteruptive enamel maturation in the occlusal pits may not be completed even 66 months after tooth eruption.

The effects of the solubility of artificial fissures on plaque pH.

Dissolution of the fissure walls may buffer acids formed in plaque and thus prevent the penetration of acids into the fissure. To test this, five volunteers wore dentin, enamel, and polyacrylate specimens with narrow grooves for 7 days to accumulate plaque. Temporal (pre- and post-glucose) and spatial (0-0.7 mm) pH profiles were recorded in the grooves in a flow-through reactor with pH microsensors. Mineral loss was assessed by transverse microradiography. We observed that resting pH did not differ among substrata. The median pH 1 hr post-glucose at the bottoms of dentin, enamel, and polyacrylate grooves was 6.7, 6.2, and 5.7, respectively (p < 0.01). On subject level, lesions formed in dentin correlated with pH changes in polyacrylate, where no buffering of acids due to mineral dissolution occurred. We conclude that fluoride-deficient tissue at the bottom of a fissure is at increased risk for caries, if acids are not buffered near the entrance to the fissure.

Time-dependent decrease and seasonal variation of the porosity of recently erupted sound dental enamel in vivo.

Recently erupted teeth are more sensitive to dental caries than teeth that have remained free from caries lesions for a few years after eruption. It has been hypothesized that this may be ascribed to differences in enamel porosity. The objective of the present work was to assess the time-dependence of electrical conductance, as an indication of porosity, of occlusal enamel in recently erupted permanent molar teeth. Fifty children aged 5-15 years of age, receiving regular dental care at six-month intervals, participated in the study when their first molar teeth (in 5- to 6-year-olds) or their second molar teeth (in 11- to 15-year-olds) had not been exposed to the oral environment for more than six months. On the first semi-annual check-up after eruption of a first or second molar, baseline diagnostic measurements, i.e., visual inspection and electrical conductance measurements (ECMs), were made at three or four pre-defined sites in the fissures. Subsequently, data collection was repeated every six months for three years. Sites were excluded from ECMs when a caries lesion was observed at a site by visual inspection. After 36 months, there were 257 sites in teeth considered sound upon visual examination. The ECM values of these sound sites showed a clear decrease with time after the first examination. The conductance decreased on average from 0.13 (Momega)(-1) to 0.059 (Momega)(-1). Since the conductance is assumed to be proportional to the porosity of the enamel, the latter decreased by a factor of 2.2 over the 36-month period. The results furthermore indicated a higher conductance for maxillary than for mandibular enamel. Almost all sites in that sample appeared to be in teeth that were observed for the first time during the months September to December. Electrical conductance, and therefore enamel porosity, of the sites showed a periodic variation with season of observation: In the fall, the conductance was higher than in the spring. This implies that a dentist should be more prudent in the fall than in the spring when indicating restorative treatment of an incipient caries lesion.

Posteruptive changes of electrical resistance values in fissure enamel of premolars.

In studies about 15-25% of the caries-free teeth proved to have as low electrical resistance values as carious teeth, due probably to incomplete enamel maturation. It was the aim of the present prospective clinical study to investigate, if an increase in electrical resistance values could be observed after the eruption of premolars. The electrical resistance measurements were performed in children who were patients of the Dental School of the University of Marburg, Germany. The first measurement was made when a premolar was erupting or when it had erupted within 12 months before. The electrical resistance measurements were repeated every 3-6 months until the 24th posteruptive month. The measuring device consisted of an AC ohmmeter modified by Gente indicating the real component of the impedance and employing a frequency of 500 Hz and an amplitude of about 1 microA. For erupting teeth a mean resistance value of 17+/-15 kohm was computed when the contact fluid had been NaCl (A). The corresponding values were 72+/-51 kohm when distilled water (B) had been applied and 392+/-374 kohm when the initially saliva-coated teeth had briefly been dried (C). The mean resistance values of the premolars increased continuously from the eruption up to the 15th posteruptive month. This observation was independent of the three modes of measuring that had been used. It is concluded that enamel maturation leads to an increase in electrical resistance. To improve accuracy of caries diagnosis with electrical resistance measurements, the posteruptive age of teeth should be taken into account. In addition, electrical resistance measurements offer the opportunity to observe enamel maturation in vivo noninvasively.

Histological validation of electrical resistance measurements in the diagnosis of occlusal caries.

Diagnosis of occlusal caries is difficult from visual and radiographic examination. The use of electrical resistance measurement has been described previously and reported to be a potentially sensitive alternative technique. This is possibly due to the decreased resistance of carious pits and fissures. The aim of this study was to validate a prototype electrical caries monitor for the diagnosis of caries in pits and fissures in vitro using a microfocal radiographic technique. Thirty discrete sites were investigated in 10 extracted molar teeth. Electrical resistance measurements were recorded at each site and thick sections (approximately 0.65 mm) prepared for microfocal radiography. Microfocal radiography indicated that six sites were sound, 10 had enamel caries and 14 dentine caries. At a resistance value of 2.2 M(OMEGA), below which a site was regarded as carious and above which it was regarded as sound, electrical resistance measurements proved sensitive (92%) and specific (100%). Quantification of mineral content indicated that mineral loss in enamel may influence resistance measurement more than lesion depth.

Electrical conductance of fissure enamel in recently erupted molar teeth as related to caries status.

Pit-and-fissure caries lesions contribute greatly to the caries incidence in permanent molar teeth in children. To date, the diagnosis of occlusal caries is still performed mainly by visual inspection, periodically aided by bite-wing radiography. However, in detecting small occlusal carious lesions, these methods perform inadequately, especially in low caries prevalence populations or individuals. The use of electrical conductance measurements (ECMs) has been evaluated to improve the diagnosis of small occlusal carious lesions. The aim of this study was to monitor the electrical conductance of fissure enamel in recently erupted molar teeth and to relate these measurements to the caries status. 50 children aged 5-15 years, having first or second permanent molars that were not exposed to the oral environment for more than 6 months, participated in the study. The diagnostic systems evaluated were visual inspection and ECMs. Following baseline data recording, diagnostic measurements were repeated three times within 18 months. Data were collected at predefined sites in the fissures. 18 months after baseline recording, 179 sites at 60 molar teeth in 27 children were judged to require a sealant based on visual inspection. After removal of carious tissue, two examiners jointly decided on the status of decay as per the criteria: 0 = no caries or caries limited to enamel, and 1 = caries involving dentine. The sensitivity of ECM continued to increase with time after a slight initial dip, whereas the specificity continuously increased after baseline measurements as a result of the decreasing amount of false-positive diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Posteruptive age dependency of cariogenic changes in enamel of permanent teeth of children.

During a cariogenic attack at the enamel surface a white spot can be formed (initiation) or disappear (regression) or remain the same (stabilisation). In the present clinical study it was shown that at least regression and stabilisation depend significantly on the posteruptive age and may be associated therefore with changes in porosity or mineral composition in the young enamel surface after eruption. In contrast, the progression of a white spot towards a cavity, which took place in this study almost exclusively in the fissures, does not change with posteruptive age. An explanation for this may be that in such white spots remineralization is less effective due to retention of acids in the fissures. On the other hand, rapid development of a cavity from sound enamel within half a year decreased with posteruptive age.

Effect of dental plaque age and bacterial composition on the pH of artificial fissures in human volunteers.

Changes in sucrose-induced plaque pH profiles and the microbial composition of occlusal tooth surface fissures were analyzed using wire telemetry and bacterial culturing techniques. Four human volunteers wore appliances containing artificial fissures constructed with ion-sensitive field-effect transistor (ISFET) electrodes for 1, 2 and 4 days; 1 subject kept the electrode for 3 weeks. After monitoring the plaque pH response at the base of the fissure to a 10% (w/v) sucrose rinse the plaque was removed and analyzed for total viable bacteria, total and specific streptococci, lactobacilli and Actinomyces spp. One-day-old plaque showed a rapid drop in plaque pH to a minimum of 4.8 +/- 0.2, with 2-day-old plaque showing the most acidogenic pH profile (minimum pH 4.6 +/- 0.2). The 4-day-old plaque response was less acidogenic (minimum pH 5.0 +/- 0.3) than the results from days 1 and 2. Responses from 13- and 21-day-old fissure plaques showed greatly decreased acidogenic responses (day 21 minimum pH 5.7). Viable bacteria recovered from the fissure increased from approximately 4 x 10(6) colony-forming units on day 1 to 1.2 x 10(7) on days 2 and 4 and 1.7 x 10(7) on day 21. Streptococci (greater than 50%) and Actinomyces (greater than 10%) dominated in the fissure plaques and their levels were related to minimum pH. Since fissure plaque of all ages tested contained high concentrations of acidogenic bacteria, the decreased acidogenic response at the base of fissures with increasing plaque age suggests that maturing fissure plaques provide an increasingly greater diffusion barrier to fermentable carbohydrates.

Mineral loss during etching of enamel lesions.

This study was aimed at determining the amount of mineral removed from incipient enamel lesions during acid etching. The rationale being that fissures which are scheduled for sealing will often have undetected demineralized regions. Lesions were formed in bovine enamel specimens using either an acidified gelatine gel or a lactate buffer containing methane hydroxy diphosphonate. Different parts of each lesion were acid-etched either for a 1- or for a 2-min period in 36% H3PO4 or served as control. Mineral content profiles were recorded on thin sections using computerized microradiography to determine the mineral loss resulting from acid etching. The results show that during etching a layer at the outer surface is removed completely. The thickness of this layer was greater for lesions when compared with sound enamel and depended on the lesion characteristics (porosity and fluoride content). The amount of mineral removed from the deeper layers of the lesion was very small; and in the innermost part of the lesions the mineral profiles of the control and acid-etched areas coincide. These observations indicate that the effect of etching is essentially restricted to a thin outer layer, irrespective of the porosity of the underlying tissue. Although the thickness of the etched-off layer was different between the two types of lesions, these findings were made for both types studied. In practical terms this implies that etching of enamel lesions does not cause an excessive mineral loss throughout the lesion.

Comparison of in vivo human dental plaque pH changes within artificial fissures and at interproximal sites.

Ion-sensitive field-effect transistor (ISFET) pH electrodes were used to monitor changes in plaque pH at the base of artificial occlusal surface fissures and at interproximal sites. Bovine enamel was used to construct fissures (1.5 x 0.1 x 1.0 mm) containing a small ISFET electrode. The fissures were fixed to carrier appliances and worn by 4 human volunteers. After plaque accumulation for 4 days changes in pH were monitored by wire telemetry following 1-min rinses with 10% solutions of either sorbitol or sucrose. Results were compared to data obtained from interproximal sites in the same subjects. Responses to sorbitol in the fissure and on the proximal surfaces were minimal and showed no significant difference in minimum pH (5.9 +/- 0.4 and 6.1 +/- 0.3, respectively) and area under pH 7.0. The response to sucrose at the two sites was very different revealing unique pH profiles which were statistically significantly different with regard to minimum pH (5.0 +/- 0.3, fissure and 4.3 +/- 0.2, proximal) and area under pH 5.7. Thus, the acidogenic potential of fermentable carbohydrate at two caries-prone sites in the human dentition is significantly different and conclusions based on interproximal telemetry measurements may not be applicable to occlusal surface fissures.