Deep carious lesions and their management among Finnish adolescents: a retrospective radiographic study.

OBJECTIVE: The objective of this retrospective study was to find out (i) the prevalence of deep carious lesions, both untreated and previously treated, among 14- and 15-year olds and (ii) how deep carious lesions were managed in a Finnish public health care setting. MATERIALS AND METHODS: A random sample of 278 patients was taken from 3990 patients at the oral health care of the City of Helsinki. Radiographic subsample consisted of patients with bitewing and periapical radiographs (n = 128, 46% of the total sample). Deep carious lesions (extending to at least the inner half of dentine), deep restorations, direct pulp cappings, root canal treatments, and extractions in permanent premolars and molars were recorded from the radiographs. Patients with untreated deep carious lesions were followed up for 24 months. RESULTS: In the total sample 12% had at least one untreated deep carious lesion, 10% at least one deep restoration, and 19% at least one untreated or previously treated deep carious lesion. The follow-up cohort included 48 deep carious lesions in 26 patients. Complete excavation was the most frequently chosen method (81% for lesions reaching the inner half of dentine and 56% the inner third or deeper), followed by stepwise excavation (19% and 37%, respectively). CONCLUSIONS: One-fifth of 14-15-year-olds had at least one untreated or previously treated deep carious lesion. The choice for the carious tissue removal did not follow the current recommendations for less invasive methods. CLINICAL RELEVANCE: Continuing education is needed to improve the diagnostics and management of deep carious lesions.

Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland.

OBJECTIVES: To find out which management methods are preferred by dentists in Finland for a deep carious lesion or a pulp exposed during carious tissue removal in adult patients. MATERIALS AND METHODS: An electronic questionnaire consisting of 25 questions was sent to 1000 randomly sampled dentists in Finland. The response rate was 32%. RESULTS: Less invasive excavation strategies (stepwise or selective removal) were preferred by 64% for an asymptomatic deep lesion, while 34% chose nonselective removal to hard dentine. In the presence of an asymptomatic pulpal exposure, vital pulp therapy was preferred, as 71% of the respondents chose direct pulp capping (DPC) or partial pulpotomy, compared to root canal treatment (26%). Mineral trioxide aggregate (MTA) and calcium hydroxide-based materials were both chosen by 40% for vital pulp therapy. In the management of a deep carious lesion, less invasive excavation strategies were significantly associated with having clinical guidelines vs. no guidelines at the practice [odds ratio (OR) 3.5, confidence interval (CI) 1.4-9.0]. MTA was favored over other DPC materials significantly more often by those who had attended continuing education courses during the last 3 years (OR 2.8, CI 1.2-6.5). CONCLUSIONS: Less invasive management strategies have been adopted into clinical practice by the majority of dentists in Finland. There is a need to encourage the use of MTA in the case of a pulpal exposure. CLINICAL RELEVANCE: The results of this study can be utilized in continuing education, to raise awareness of management strategies supported by present scientific evidence.

Pit and fissure sealants in dental public health - application criteria and general policy in Finland.

BACKGROUND: Pit and fissure sealants (sealants) are widely used as a non-operative preventive method in public dental health in Finland. Most children under 19 years of age attend the community-organized dental health services free of charge. The aims of this study were to find out to what extent sealants were applied, what the attitudes of dental professionals towards sealant application were, and whether any existing sealant policies could be detected among the health centres or among the respondents in general. The study evaluated changes that had taken place in the policies used during a ten year period (1991-2001). METHODS: A questionnaire was mailed to each chief dental officer (CDO) of the 265 public dental health centres in Finland, and to a group of general dentists (GDP) applying sealants in these health centres, giving a total of 434 questionnaires with 22 questions. The response rate was 80% (N = 342). RESULTS: A majority of the respondents reported to application of sealants on a systematic basis for children with increased caries risk. The criteria for applying sealants and the actual strategies seemed to vary locally between the dentists within the health centres and between the health centres nationwide. The majority of respondents believed sealants had short- and long-term effects. The overall use of sealants decreased towards the end of the ten year period. The health centres (N = 28) choosing criteria to seal over detected or suspected enamel caries lesion had a DMFT value of 1.0 (SD +/- 0.49) at age 12 (year 2000) compared to a value of 1.2 (SD +/- 0.47) for those health centres (N = 177) applying sealants by alternative criteria (t-test, p < 0.05). CONCLUSION: There seems to be a need for defined guidelines for sealant application criteria and policy both locally and nationwide. Occlusal caries management may be improved by shifting the sealant policy from the traditional approach of prevention to interception, i.e. applying the sealants over detected or suspected enamel caries lesions instead of sealing sound teeth.

Comparing the caries-preventive effect of two fissure sealing modalities in public health care: a single application of glass ionomer and a routine resin-based sealant programme. A randomized split-mouth clinical trial.

AIM: The aim of this study was to compare the caries-preventive effect of two types of sealant modalities and to evaluate whether the caries-preventive effect is related to sealant retention. A hypothesis was tested in which a glass ionomer sealant, once applied to the occlusal surface, was able to protect the fissure from caries even if the sealant appeared lost at visual inspection. DESIGN: A 3-year randomized split-mouth trial evaluating two sealant modalities was performed at a public health centre in Finland. A chemically curing glass ionomer cement (GIC) and light-curing resin-based (RB) sealant material were applied randomly to the permanent second molars. Sealant application as a routine treatment procedure was carried out to 599 children in the age group of 12-16 years. Caries rate of the sealed teeth and sealant retention with both materials were analysed by a modified McNemar's test. The effectiveness, rate difference, and relative risk with both sealant materials were measured. RESULTS: The difference in caries rate between the two modalities was highly significant. When compared to the GIC sealant method, the effectiveness of RB sealant method was 74.1% and the rate difference 3.2% (95% CI 1.44%, 4.98%). The relative risk for RB-sealed surfaces vs. GIC-sealed surfaces of having detectable dentin caries was 0.26 (95% CI 0.12, 0.57). The retention rate of sealants was higher with RB than GIC (P < 0.001). The effectiveness of the retention rate for RB sealants was 94.8% and the rate difference 87.2% (95% CI 83.86%, 90.50%). The relative risk during the 3-year study period of having a defective or lost RB sealant was 0.052 (95% CI 0.036, 0.075) when compared to having a defective or lost GIC sealant. CONCLUSION: It is concluded that in preventing dentin caries a RB sealant programme including resealing when necessary was more effective than a single application of GIC. The original hypothesis was thus falsified.