How different do visuo-tactile criteria assess caries lesions activity status on occlusal surfaces?

OBJECTIVES: We tested the association between active caries lesions assessed by two different criteria and clinical features of these caries lesions. MATERIALS AND METHODS: Three examiners examined forty-nine 3- to 12-year-old children: one examiner used the Nyvad criteria, another examiner used the International Caries Detection and Assessment System with an additional criteria--Lesion Activity Assessment (ICDAS + LAA), and a reference examiner classified lesions regarding plaque stagnation, colour, lustre, cavities, depth and texture. Logistic regressions were used to test associations. For analyses, we grouped sound sites and inactive lesions vs active caries lesions, but also considering only inactive vs active lesions. RESULTS: Active lesions scored by both criteria were similarly associated with different clinical parameters tested, except when the sound sites were excluded from the analysis. In these cases, active lesions according to ICDAS + LAA were associated only with cavitation and texture. Texture was associated with divergences between criteria when differentiating sound or inactive lesions from active ones. Fewer divergences in differentiating active from inactive lesions were observed when lesions present lustre. CONCLUSION: Most clinical signs associated with active caries lesions were similar, but texture and severity tend to have a greater importance when using ICDAS + LAA for distinguishing caries activity status. Attention should be given to differences due to texture and lustre when using different indices.

A randomized clinical trial of the anti-caries efficacy of 5,000 compared to 1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents.

Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5,000 versus 1,450 ppm of fluoridated toothpaste (F-toothpaste) for controlling root caries in nursing home residents. The duration of the study was 8 months. Elderly disabled residents (n = 176) in 6 nursing homes in the Copenhagen area consented to take part in the study. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff. A total of 125 residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. No differences (p values >0.16) were noted in the baseline examination with regards to age, mouth dryness, wearing of partial or full dentures in one of the jaws, occurrence of plaque and active (2.61 vs. 2.67; SD, 1.7 vs.1.8) or arrested lesions (0.62 vs. 0.63; SD, 1.7 vs. 1.7) between the 5,000 and the 1,450 ppm fluoride groups, respectively. Mean numbers of active root caries lesions at the follow-up examination were 1.05 (2.76) versus 2.55 (1.91) and mean numbers of arrested caries lesions were 2.13 (1.68) versus 0.61 (1.76) in the 5,000 and the 1,450 ppm fluoride groups, respectively (p < 0.001). To conclude, 5,000 ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1,450 ppm F-toothpaste.

Measurement of histological and radiographic depth and width of occlusal caries lesions: a methodological study.

AIM: To develop a measurement method to quantify the depth and width of occlusal caries lesions. MATERIAL AND METHODS: One hundred and ten extracted permanent molars with occlusal caries lesions were selected, then visually scored by ICDAS scoring system and then sectioned mesiodistally, resulting in a facial and a lingual fraction. Digital photos and radiographs were taken from each section. By randomization, one of the sections was chosen for further examinations. First digital photos were taken. Depth and width of the lesions were marked with arrows on the images both before (H(un-col)) and after coloring (H(col)) the sections. The same types of measurements were done on the radiographs (R). The relative dentinal depth and width of the lesions were measured in the same order. RESULTS: Weighted intra- and interexaminer kappa value for ICDAS scorings varied between 0.85 and 0.90. Intraexaminer kappa for dentinal depth in 36 randomized selected teeth was calculated to 0.75 (H(un-col)), 0.91 (H(col)), 0.79 (R) and for dentinal width to 0.84 (H(un-col)), 0.96 (H(col)), 0.84 (R). Significant correlations were found between ICDAS scorings and the measurements of depth and width of lesions in H(un-col), H(col), and R (p < 0.000). The lowest difference was measured between H(un-col) and H(col) in both relative depth and width of the lesion with maximum differences up to 45% (H(un-col)-H(col)) and 73% (H(col)-R). CONCLUSION: It is possible to measure depth and width of occlusal caries lesions by means of histological and radiographic technique with acceptably high reproducibility using this method.

The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study.

This study aimed to determine the reliability and accuracy of the ICDAS and radiographs in detecting and estimating the depth of proximal lesions on extracted teeth. The lesions were visible to the naked eye. Three trained examiners scored a total of 132 sound/carious proximal surfaces from 106 primary teeth and 160 sound/carious proximal surfaces from 140 permanent teeth. The selected surfaces were first scored visually, using the 7 classes in the ICDAS. They were then assessed on radiographs using a 5-point classification system. Reexaminations were conducted with both scoring systems. Teeth were then sectioned and the selected surfaces histologically classified using a stereomicroscope (×5). Intrareproducibility values (weighted kappa statistics) for the ICDAS for both primary and permanent teeth were >0.9, and for the radiographs between 0.6 and 0.8. Interreproducibility values for the ICDAS were >0.85, for the radiographs >0.6. For both primary and permanent teeth, the accuracy of each examiner (Spearman's correlation coefficient) for the ICDAS was ≥0.85, and for the radiographs ≥0.45. Corresponding data were achieved when using pooled data from the 3 examiners for both the ICDAS and the radiographs. The associations between the 2 detection methods were measured to be moderate. In particular, the ICDAS was accurate in predicting lesion depth (histologically) confined to the enamel/outer third of the dentine versus deeper lesions. This study shows that when proximal lesions are open for inspection, the ICDAS is a more reliable and accurate method than the radiograph for detecting and estimating the depth of the lesion in both primary and permanent teeth.

Treatment of proximal superficial caries lesions on primary molar teeth with resin infiltration and fluoride varnish versus fluoride varnish only: efficacy after 1 year.

This split-mouth study aimed to assess the efficacy of resin-infiltrated lesions covered by fluoride varnish (FV) versus FV treatment only of proximal lesions on deciduous molar teeth. The study lasted for 1 year. Children with 2 or more superficial proximal lesions on deciduous molar teeth detected on bitewing radiographs were included. After written parental consent, two lesions in each of 50 children were randomly allocated to one of two treatments: resin infiltration followed by FV (2.26% F) application (test lesion) versus only FV (control lesion). The ICDAS scores of the selected lesions were recorded by 2 clinicians before the treatments (weighted kappa for inter- and intra-examiner agreement >0.79). FV was applied to both test and control lesions 6 and 12 months after the first treatment. After 1 year ICDAS scores were obtained for 42 children and radiographs for 39. One external examiner not familiar with the study scored the radiographs twice (weighted kappa 0.88). Baseline mean age of the children was 7.17 +/- (SD) 0.68 and mean def-s was 8.1 +/- (SD) 6.9. After 1 year the ICDAS scores of 31% of the test lesions and 67% of the control lesions had progressed (p < 0.01). Radiographically, 23% of the test lesions and 62% of the control lesions had progressed (p < 0.01). Thus, the clinical and radiographic therapeutic effect of both resin infiltration/FV over FV alone was >35% and significant. To conclude, resin infiltration in conjunction with fluoride varnish seems promising for controlling proximal lesion progression on deciduous molar teeth.

Sealing distal proximal caries lesions in first primary molars: efficacy after 2.5 years.

BACKGROUND: The prevalence of proximal caries in primary molar teeth is high in many countries. AIMS: (1) To study by means of a split-mouth design the 1- and 2.5-year efficacy of sealing proximal lesions vs. flossing instructions (control) on primary molar teeth. (2) To assess children's behaviour and pain perception during the procedure. METHODS: Ninety-one 4- to 6-year-old children from Bogotá, Colombia participated. Participants had to have at least two proximal lesions scored according to the following radiographic classification system: radiolucency (1) in enamel outer half, (2) restricted to enamel-dentine junction, or (3) restricted to dentine outer third. Baseline, 1- and 2.5-year follow-up bitewing radiographs were taken. Test and control lesions were randomly selected. After temporary separation test lesions were sealed (adhesive). Parents/caregivers received a flossing leaflet for their children. Progression of the lesions was assessed by means of independent reading of conventional bitewing radiographs. RESULTS: One-year (n = 73) test vs. control lesion progression was 27.4 vs. 50.7%, respectively (p < 0.01, McNemar's test), and 2.5-year (n = 56) test vs. control lesion progression was 46.4 vs. 71.4%, respectively (p < 0.01). The dropouts did not differ from those who remained in the study regarding relevant caries baseline data. More than 88% of the participants presented positive to definitively positive behaviour and very low or low pain intensity at both first and second appointments. CONCLUSION: The sealing technique was superior to flossing instructions both after 1 and 2.5 years of follow-up and the majority of the participants had no anxiety or pain during the treatment.

Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth.

This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems--the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity assessment (ICDAS-LAA)--were compared using 763 primary molars of 139 children aged 3-12 years. The examinations were performed by 2 calibrated examiners. A subsample (n = 50) was collected after extraction and histology with 0.1% red methyl dye was performed to validate lesion depth and activity. The reproducibility of the indices was calculated (kappa test) and ROC analysis was performed to assess their validity and related parameters were compared using McNemar's test. The association between the indices and with the histological examination was evaluated using Spearman's correlation coefficient (r(s)). Visual criteria showed excellent reproducibility both regarding severity (NY: 0.94; ICDAS-II: 0.91) and activity (NY: 0.90; LAA: 0.91). The NY and LAA showed good association in caries activity assessment (r(s) = 0.88; 95% CI = 0.86-0.89; p < 0.001). Nevertheless, considering only cavitated lesions, this association was not significant (p > 0.05). Concerning the severity, both indices presented similar validity parameters. At D2 threshold, the sensitivity was higher for NY (NY = 0.87; ICDAS = 0.61, p < 0.05). Regarding activity status, NY showed higher specificities and accuracies. In conclusion, NY and ICDAS-II criteria are comparable and present good reproducibility and validity to detect caries lesions and estimate their severities, but the LAA seems to overestimate the caries activity assessment of cavitated lesions compared to NY.

Sealants in dentistry: outcomes of the ORCA Saturday Afternoon Symposium 2007.

Sealants are a successful tool in caries prevention, but their role in preventive strategies after the caries decline has to be discussed. A survey of paediatric departments across Europe revealed that indications for pit and fissure sealants vary considerably, both nationally and internationally. Evidence for effectiveness of sealants in controlling caries in posterior teeth implies that sealants should be an integrated part of management of pit and fissure caries. Still, the indication for occlusal sealants seems to be shifting from primary prevention to a therapeutic decision for caries management of lesions in enamel and the outer part of the dentine. Sealants are also an interesting concept for caries management in approximal surfaces. Clinical trials suggest that novel techniques of sealing or infiltrating approximal lesions show promise. However, approximal sealing techniques are as complex to apply and time-consuming as approximal fillings. The article proposes guidelines for teaching on the use of sealants.

Plaque, caries level and oral hygiene habits in young patients receiving orthodontic treatment.

OBJECTIVE: To assess plaque, caries, and oral hygiene habits amongst patients receiving fixed-orthodontic treatment at the Dental-Clinic, Universidad-El-Bosque, Bogotá, Colombia. BASIC RESEARCH DESIGN: Test-group: 74 12-29-year-olds receiving fixed-orthodontic treatment; reference-group: 63 12-29-year-olds before they started the orthodontic treatment. Visual examinations (one examiner) recorded the following: Ortho-plaque-Index (OPI) expressed per patient as good, fair and poor-oral-hygiene. Caries was scored with the modified-ICDAS-II criteria as: 0-sound; 1B/1W-brown/white-opacity-after-air-drying; 2B/2W-brown/white-opacity-without-air-drying; 3-microcavity; 4-underlying-shadow; 5/6-distinct/extensive-cavity. Filled/missing surfaces due-to-caries and caries-lesions on buccal surfaces at three sites around the brackets were recorded. A 7-item self-administered oral-hygiene habits' questionnaire was used. RESULTS: Chi-square test revealed that the oral-hygiene level was significantly better in the reference group compared to the test group (p < 0.05). The traditional mean DMF-S was 6.7 +/- 6.3 in the test- and 6.2 +/- 5.9 in the reference-group (p > 0.05). When adding modified-ICDAS-II lesions scores 1-4, the figure increased to 23.6 +/- 9.4 in the test- and to 13.6 +/- 10.3 in the reference-group (p < 0.001). A total of 96% had > or = 1 white-opacity in the test group versus 56% in the reference group (P < 0.001). In the test-group the buccal-surfaces accounted for most white-opacities and close to 1/3 of these lesions on the upper-anterior teeth were located around the brackets. The questionnaire disclosed that 58% in the test- vs. 44% in the reference-group did not accept having dental caries lesions during the orthodontic treatment. CONCLUSIONS: The results showed a high prevalence of white-opacities related to orthodontic appliances and indicate the need to implement preventive programmes at the dental clinic.

In vitro comparison of Nyvad's system and ICDAS-II with Lesion Activity Assessment for evaluation of severity and activity of occlusal caries lesions in primary teeth.

This in vitro study of occlusal surfaces on primary molars aimed to: (1) evaluate the reproducibility of the Nyvad and ICDAS-II visual systems in detecting caries; (2) to test the accuracy of the systems in estimating lesion depth, and (3) to examine the association between the Nyvad system and the Lesion Activity Assessment system, an adjunct to ICDAS-II. Two samples of extracted primary molars (sample 1, n = 38; sample 2, n = 69) were evaluated independently by 2 examiners. In this in vitro study, evaluation of plaque in the Nyvad system was not possible. Histology (sample 2) was used to validate lesion depth. Area under ROC curves (A(z)), sensitivity, specificity and percent agreement of both systems were calculated at D1, D2 and D3 thresholds. Both systems showed kappa for intra- and inter-examiner agreement >0.86 and good correlation with histology: Spearman rho = 0.73 (Nyvad) and 0.78 (ICDAS-II). They presented similar performances except that ICDAS-II showed significantly higher sensitivity (Nyvad 0.89; ICDAS 0.92) and A(z) (Nyvad 0.85; ICDAS 0.90) for the D1 threshold. The correlation between the systems for lesion activity (Cramer's V) was 0.71. Therefore, both visual systems are reliable and can estimate caries lesion depth on primary teeth. Under in vitro conditions, there is no major difference between the Nyvad system and Lesion Activity Assessment in assessing caries activity.

Accuracy and reproducibility of conventional radiographic assessment and subtraction radiography in detecting demineralization in occlusal surfaces.

Subjective interpretation of paired digital radiographic images viewed side by side to assess occlusal lesion progression, arrest or remineralization is difficult. The aim of this study was to compare the accuracy and reproducibility of a digital subtraction radiography technique and visual assessment of paired digital images in detecting changes in mineral content within occlusal cavities. Forty molar teeth with occlusal cavities were placed in arches and baseline digital radiographs taken. Nineteen teeth were randomly selected and had acid placed in the cavities and digital images taken after 3, 6, 12, 18 and 24 h of acid exposure. Paired baseline images and those taken at the various time intervals were examined side by side and assessed for demineralization by five examiners. Subtraction images prepared from the paired images were assessed in the same way. One fifth of the images were re-examined to determine intra-examiner reproducibility. After 12 h or longer the diagnostic accuracy (mean area under the ROC curve = 0.92-0.98 for subtraction radiography), intra-examiner and inter-examiner reproducibility for detection of demineralization from the subtraction images was significantly better than viewing the paired images side by side (p < 0.01). The subtraction radiography system used was found to be more accurate and reproducible than visual assessment of paired digital images. As such the technique shows promise for monitoring occlusal lesion progression in clinical studies.

Frequency and distribution patterns of sealants among 15-year-olds in Denmark in 2003.

AIMS: To provide information on the frequency and distribution patterns of sealants in the Public Dental Health Service for Children (PDHSC) in Denmark. A further aim was to determine whether there was a correlation between DMF-S and sealants. DESIGN: A cross sectional survey using data from 15-year-old Danes in 2003. SAMPLE AND SUBJECTS: The sample consisted of 50 randomly selected municipalities from the 204 municipalities with public clinics. Thirty-nine municipalities (78%) forwarded useful data. A total number of 3,184 15-year-olds were involved in the study. RESULTS: The mean DMF-S was 2.97 (SD = 1.40) and 42% had a DMF-S = 0. The mean number of sealants was 3.06 (SD = 1.60). Two-thirds of all participants had one or more sealed surfaces. At the individual level the correlation coefficient (rs) between sealants and DMF-S was -0.05 (p < 0.01). The mean number of sealants in one municipality was 0.26, in another 6.00. The surfaces most often sealed, were the occlusal surfaces on permanent second molars (35%), closely followed by the occlusal surfaces on permanent first molars (32%). Sealants on premolars were rare (1.5%). At the municipality level there was no significant correlation between mean DMF-S, % 15-year-olds with a DMF-S = 0 and mean number of sealants (rs = 0.02 (p = 0.90) and rs = 0.06 (p = 0.73), respectively). CONCLUSION: The data indicate a high use of sealants on molar teeth, a very large inter-municipality variation, no correlation between sealants and DMF-S. These findings suggest that there are no clear guidelines for use of sealants in the PDHSC in Denmark.

Detection and monitoring of early caries lesions: a review.

AIM: To review the current evidence base of detecting and monitoring early carious lesions in children and adolescents and a rationale proposed to ensure that such lesions are identified and appropriately managed. METHODS: The systematic literature search identified initially a review by Gomez and co-workers from 2013 and this still represents the current state of the science in relation to caries detection and monitoring. The review described among others, visible detection systems, image-based detection systems and point-measurement approaches. RESULTS: The current evidence base suggests that while there are numerous devices or technology-enabled detection systems, the use of a careful, methodical visual inspection of clean, dry teeth, supplemented where indicated by radiographic views, remains the standard of care in caries detection and diagnostics. Further, it is possible by means of existing visible and radiographical systems to monitor lesions over time. Using low-cost intra-oral cameras facilitates the recording of lesion appearance in the patient record and may be of significant benefit in monitoring early lesions over time following their detection. This benefit extends to the clinician and the patient for whom it may be a useful educational and motivational tool. CONCLUSIONS: Recommendations are presented that can be adopted and adapted to local circumstances and that are both substantiated by evidence and promote a clear, simple and consistent approach to caries detection, diagnosis and monitoring in children and adolescents. The diagnoses (initial, active; moderate, active and extensive, active) are linked to appropriate management options within primary care.

Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) encourages prevention and arrest of active dental caries. Therefore, the present guidance provides evidence- and clinically-based recommendations for detecting and diagnosing early/non-cavitated caries lesions, risk assessment and disease management. METHODS: A search of different databases was conducted using all terms related to the subject. Relevant papers were identified after a review of their titles, abstracts or full texts. Three workshops were held during the corresponding EAPD interim seminar in Brussels in 2015. Several statements were agreed upon and, furthermore, gaps in our knowledge were identified. RESULTS: Following the systematic reviews and outcomes of the seminars, it was concluded that visual and radiographic caries detection should be utilised as a basic diagnostic approach to locate, assess and monitor non-cavitated caries lesions in primary and permanent teeth. As another important evaluation step, a caries risk assessment should be performed at a child's first dental visit, and reassessments should be performed on a regular basis. It is widely accepted that non-cavitated caries lesions can be managed non-invasively in the majority of cases. The spectrum of measures includes a low cariogenicity tooth-friendly diet, daily and appropriate management of the biofilm, home and within the dental office/surgery usage of fluorides as well as sealing techniques. CONCLUSION: The detection and management of non-cavitated caries is an essential aspect of preventive dentistry. Therefore, the EAPD encourages oral health care providers and caregivers to implement preventive practices that can arrest early caries and improve individual and public dental health.

Visual Inspection for Caries Detection: A Systematic Review and Meta-analysis.

We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.

Improving clinical visual detection--potential for caries clinical trials.

It has been the norm in caries clinical trials to measure caries increment by several different caries-recording systems, including the crude DMF-S/T index. However, there is a reserved attitude as to whether to subdivide the non-cavitated lesions and use arrested lesions in clinical trials. This has been due to the belief that it is not possible to achieve reliable data of the early stages of the disease (Radike, 1972). However, recently, Ekstrand et al.(1997, 1998) showed that it was possible: (1) to differentiate between different stages of non-cavitated occlusal lesions, (2) to differentiate between active and inactive occlusal lesions, and (3) to predict the depth of the lesion. In at least 4 other clinical studies, the reproducibility of recording initial active lesions, cavitated active lesions, and arrested lesions was found to be adequate (Carvalho et al., 1989; Nyvad et al, 1999; Ekstrand et al., 2000; Machiulskiene et al., 2001). Since caries today is a more slowly developing disease in many countries in the world, this will result in prolongation of the duration of the clinical trial, which will increase the costs. As indicated above, there is now sufficient evidence that caries can be clinically diagnosed accurately and reliably in earlier stages as well as in an arrested stage. If such stages of caries are used as outcome variables in caries clinical trials, they may have a positive influence on the trials' duration and costs.

Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption.

The occlusal surfaces of partly and fully erupted first right permanent molars were examined with respect to the occurrence and distribution of plaque and dental caries in a group of 57 six- to eight-year-old children. The children were classified into four groups ranging from one tooth partially erupted to full occlusion. Occlusal plaque was recorded at two levels of examination: (1) visible plaque and (2) detailed mapping by means of a plaque detector system. Dental caries was recorded after professional cleaning. The recording of plaque was repeated after 48 hr without oral hygiene. The findings showed a significant reduction in the easily detectable plaque in fully erupted teeth, compared with the three groups representing partly erupted teeth. The detailed mapping of plaque showed a clear pattern of preferential locations related to the macromorphology of the occlusal surfaces, and revealed reduction in the frequency of thick plaque accumulation in the fully erupted teeth. The proportion of active lesions was reduced in fully erupted teeth, and arrested lesions were mainly observed in the same group. This indicated that erupting teeth are more likely to develop dental caries, due to favorable conditions for plaque accumulation. Functional usage of teeth in addition to improved access for toothbrushing promoted arrestment of lesions initiated during eruption.

Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars.

The aim of this study was to evaluate a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 6-8-yr-old children with their permanent right first molars in different stages of eruption. Data from the program were compared with previous data recorded in a similar sample of children. After 1 yr the majority of children in the study group had their permanent right first molars in full occlusion. A significant decrease of surfaces with easily detectable plaque and an increase of surfaces without plaque was observed. The proportion of arrested lesions increased and active enamel lesions decreased. Fissure sealing was only needed in two teeth in contrast to more than 2/3 of molars in a comparable sample of children. The program proved to be an efficient alternative to fissure sealing in preventing occlusal caries in erupting teeth.

Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars.

The aim of the study was to describe the 3-yr results of a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 children 6-8 yr old with their permanent right first molars in different stages of eruption. The results were compared with record data from 58 children of the same age who had received a traditional caries treatment program including fissure sealing (control group). After 1 yr a significant reduction of occlusal surfaces with visible plaque was noted in the study group as well as an increased proportion of arrested lesions. These results were maintained after 2 and 3 yr. Ten (9%) teeth were sealed and one filled during the study period. Examination of record data in the control group over a 3-yr period revealed that 76 (65%) first molars were sealed and 7 (6%) were filled. During the first year 1/3 of the children in the study group needed 5-6 recall visits, whereas in the following period all children were only seen 1-4 times. In contrast, 50% of the children in the control group needed 5-6 recalls in the 3rd yr. Our data indicate that professional care for erupting teeth on an individual basis has a long-term effect on occlusal surfaces as well. The alternative technique required less clinical time than the traditional application of sealants.

Restorative caries treatment patterns in Danish 20-year-old males in 1986 and 1991.

This study examines the restorative caries treatment pattern in Danish 20-year-old military conscripts in 1986 and 1991. The study groups comprised 85 and 164 males born in 1966 and 1971, respectively. The examination was performed as a part of the routine for each conscript according to directions from Dental Service, Danish Defense Forces and included surface recording of fillings on all teeth except third molars. Two bitewing radiographs were taken of all conscripts in the 1986-group and of those who gave permission (59) in the 1991-group. The mean number of filled surfaces was 10.2 and 8.8 in 1986 and in 1991, respectively. 80% of the occlusal surfaces on permanent first molars were filled in the 1986-group and filled or sealed in the 1991-group in contrast to 45% of permanent second molars. Data from maxillary molars indicated a tendency to placement of fillings related to tooth specific morphology whereas extended fillings involving the entire occlusal surface dominated on mandibular molars. The X-ray examination disclosed that the majority of approximal molar surfaces were classified as sound in both study groups. Less than 1% of the approximal molar surfaces were recorded as having lesions penetrating deep into the dentin. In 1981 and in 1986 the participants in the study groups were 15 yr old. In these years the mean number of filled surfaces in Danish children amounted to 11.0 and 6.9 respectively, which indicates that very few lesions in need of operative treatment developed from age 15 to age 20 in both study groups.