Is caries equally distributed in adults? A population-based cross-sectional study in Norway - the TOHNN-study.

OBJECTIVES: The aim of the study was to examine the prevalence and distribution of dental caries in an adult population and identify factors associated with being caries free. MATERIAL AND METHODS: Data were collected from a randomized population sample in Northern Norway (N = 1932; 988 women; mean age 47.0 years, SD 15.3). The study included a structured questionnaire and a clinical examination. The sum of enamel and dentine caries, DS1-5, formed the main outcome measures for caries prevalence. RESULTS: Mean DMFT was 15.1 (95% CI 14.8, 15.4), mean DFT was 12.0 (CI 11.7, 12.2), and mean DT was 1.1 (CI 1.0, 1.2). The mean value for dentine caries (DS3-5) was 0.8 (CI 0.7, 0.9), and mean DS1-5 was 3.8 (CI 3.6, 4.1). Mean DS1-5 was highest in the youngest age group (mean 6.9, 95% CI 6.3, 7.6) and in rural areas (mean 5.0, CI 4.4, 5.6). The most caries-prone 20% in the youngest age group had 52% of the total number of carious lesions compared with 80% in the two oldest age groups. Tooth brushing twice daily (p = .005), drinking sugar containing soft drink (p =.029), and attending dental services every year (p < .001), were associated with being caries free. CONCLUSION: Dental caries is still a common condition, particularly in the youngest age group. Living in a rural area, low socioeconomic status, less frequent tooth cleaning and sugar containing soft drinks were associated with a higher prevalence of dental caries. The different caries distribution among adults calls for different preventive strategies at both population and individual levels.

Caries increment in young children in Skaraborg, Sweden: associations with parental sociodemography, health habits, and attitudes.

AIM: To explore parental sociodemography, oral health habits, and attitudes in relation to dental caries increment in their children. DESIGN: A longitudinal questionnaire and clinical study. The children were followed annually from age 3 years (n = 271) to 6 years (n = 243). Carious lesions of different depth were registered (initial and manifest) by four calibrated dentists. The parents filled out a questionnaire. Statistics included factor analyses, Cronbach's alpha together with bivariate and multivariate logistic regression analyses. RESULTS: Most of the parents exhibited positive health behaviour and attitudes. 'Late start of toothbrushing of child' was, however, common (≥1 year; 29%) and 'external locus of control' showed a high mean value (10,1; possible range 3-15). In a multivariate model, 'parent born abroad' (OR 3.26, 95% CI 1.85-5.76) and 'parental indulgence' (OR 3.20, 95% CI 1.37-7.51) were the most important for the development of carious lesions in the children. CONCLUSIONS: This study identified 'parent born abroad' and 'parental indulgence' as significant risk factors for caries in the age period 3 to 6 years. Identifying parents with the greatest need should be emphasized, in order to target promotion and prevention activities.

Occlusal Caries Management: Preferences among Dentists in Norway.

The aim was to measure variations in the threshold for operative treatment of occlusal caries in permanent teeth and the use of dental materials, compared with results from a similar study conducted in Norway in 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 61.3% respondents after two reminders. Restorative treatment of occlusal lesions confined to enamel was proposed by 12% of the dentists, compared with 18% in 1995 (p < 0.01). Older dentists more often than younger dentists would operatively treat enamel lesions (p < 0.01). Most dentists preferred to drill only the carious part of the fissure rather than the whole fissure both in 2009 (78.8%) and 1995 (68.3%; p < 0.01). In 2009, 91.9% preferred composite as the restorative material of choice, compared to only 39.1% in 1995. Logistic regression analyses identified higher age of the dentist as the only variable significantly associated with higher risk of restoring occlusal enamel lesions operatively. The authors conclude that especially young dentists appear to be more reluctant to remove tooth substance in 2009 compared with 1995. Composite is the dominating material of choice in 2009 and seems to have substituted the use of most other filling materials in occlusal restorations in permanent teeth.

Treatment decisions on Molar-Incisor Hypomineralization (MIH) by Norwegian dentists - a questionnaire study.

BACKGROUND: The study aimed to explore the variability between the treatment decisions dentists make for MIH-affected teeth. METHODS: In 2009, a pre-coded questionnaire was sent electronically to all dentists employed by the Public Dental Service (PDS) in Norway (n = 1061). The questions were related to treatment of MIH-affected teeth, including three patient cases illustrated by photographs and written case descriptions. RESULTS: Replies were obtained from 61.5 % of the respondents after two reminders. In the first case, showing a newly erupted first permanent molar with moderate hypomineralization and no disintegration of the surface enamel, the preferred treatment among the majority of the respondents (53.5 %) was application of fluoride varnish, while 19.6 % would seal the fissure with GIC material. In the second case, showing a severely damaged first permanent molar in a six year old child, more than half of the respondents (57.5 %) would place a conventional glass ionomer restoration and 10.5 % would use a stainless steel crown (SSC). In the third case, showing a severely damaged permanent first molar in a nine year old child, 43.8 % of the dentists would remove only the parts with soft, damaged enamel; while 35.2 % would remove more and 21.0 % would remove all affected enamel and leave the cavity margins in sound enamel. CONCLUSIONS: The survey shows that there is a wide disparity between clinicians' views on how MIH affected teeth should be treated. In a severely affected first permanent molar, only a minority of dentists would remove as much tooth substance as needed to get the full benefit of the acid etch pattern in sound enamel.

Five-minute Apgar score ≤ 5 and Molar Incisor Hypomineralisation (MIH) - a case control study.

BACKGROUND: The aetiology of molar incisor hypomineralisation (MIH) is unclear. The asymmetric distribution of MIH in the dentition may indicate that an insult of short duration that affects ameloblasts at a vulnerable stage could be a causative factor. Apgar ≤ 5 at 5 min may indicate asphyxia (hypoxic-ischemic insult) during birth. It was hypnotised that low Apgar score during birth may cause MIH. The present study aimed to examine a possible association between Apgar ≤ 5 at 5 min and the occurrence of MIH. METHOD: Two study groups were selected for examination. The cases comprised 67 children aged 8-10 years born with Apgar score equal to or below 5 after 5 min. The control group comprised 157 age-matched healthy children. First permanent molars, second primary molars and all permanent incisors were examined in all children. Clinical examination was undertaken by two calibrated examiners and intraoral close-up photographs of the teeth were later evaluated by three calibrated and blinded clinicians. Demarcated opacities, post-eruptive breakdown, atypical restorations and extractions due to MIH, according to the criteria of the European Association of Paediatric Dentistry, were assessed. RESULTS: The prevalence of MIH did not differ between the two groups. A chi-square test failed to confirm any statistically significant relationship between 5-min Apgar scores and MIH occurrence. In addition, there was no statistically significant relationship between the number of affected first permanent molars in cases and controls. CONCLUSION: There was no association between Apgar ≤ 5 at 5 min and the occurrence of MIH.

Posterior composites and new caries on adjacent surfaces - any association? Longitudinal study with a split-mouth design.

BACKGROUND: The aim of this longitudinal study was to compare caries incidence in sound approximal surfaces adjacent to newly placed composite restorations with the caries incidence in corresponding surfaces in contralateral teeth without any restorations in contact; and to assess risk factors for dentine caries development on adjacent and control surfaces. METHODS: Data from a practice-based study, where 4030 posterior approximal restorations placed in permanent teeth by clinicians working in a Public Dental Health Service in Norway, were used. The study was approved by the Regional Committee for Medical Research Ethics. The present study is based on a subsample of patients with a sound surface adjacent to a newly placed composite posterior approximal restoration. All individuals who had intact corresponding contralateral pairs of teeth in the same jaw, were included. At the end of the follow-up period, the study restorations and their adjacent surfaces were evaluated clinically and radiographically. Status of the contralateral tooth pair at baseline and end point was based on recordings from routine dental examinations, retrospectively extracted from the electronic dental records. RESULTS: One hundred and ninety three patients (mean age 15.0 years, SD = 3.4) met the inclusion criteria. The surfaces were followed on average for 4.8 years. Follow-up observations revealed that 41 % of adjacent surfaces remained sound, compared with 67 % of the control surfaces (p < 0.001). Restorations were placed in 17 % of adjacent surfaces, compared with 3 % of the control surfaces (p < 0.001). In multivariate logistic regression analysis adjacent surfaces in maxillary teeth had increased risk for dentine caries development (OR 3.1, CI 1.3-7.3). CONCLUSIONS: Caries incidence in intact approximal surfaces adjacent to newly placed composite posterior approximal restorations was significantly higher compared with the contralateral control surface without a restoration in contact. Adjacent surfaces in maxillary teeth had increased risk for dentine caries development.

Prevalence of dental caries among 16-year-olds in Troms County, Northern Norway.

The investigation documents caries prevalence and associated factors in a sample of16-year- olds from Troms County, Northern Norway. DMFT/S-values were 4.2/6.1, indicating dental health being similar to the south of Norway and the rest of Scandinavia. No ethnic differences were recorded. Out of a total of 22 tested variables, the following nine showed an independent strong association (p=0,001) with prevalence of dental caries: parental education, tooth brushing frequency, parental control of oral hygiene in young age, dental fear, self-rated dental health, BMI, self-rated general health, use of smokeless tobacco, and initial approximal caries. The final multivariate regression analysis indicated that use of smokeless tobacco, dental fear, self-rated dental health and initial approximal caries showed a strong independent association with prevalence of manifest dental caries. In addition, parental education and sugar consumption appeared to be of importance. Sedentary lifestyle with low level of physical activity or hours spent in front of a TV/computer screen did not show any correlation with prevalence of dental caries. Tooth brushing frequency, gingival bleeding, obesity and aspects of general health showed a strong bi-variate association that disappeared when controlling for other variables in a multivariate regression model.The results highlight the importance of including attitude and lifestyle modifiable factors in oral and general health education approaches. Additionally, focus should be set on the management of dental fear in the context of targeted oral health strategies. Fi- nally, it would be beneficial to include initial approximal caries, life style factors, and perception and attitudes to general as well as dental health in caries prediction models.

Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice.

A survey conducted in 2002 among French general dental practitioners (GPs) showed variations between treatment decisions and a tendency towards early restorative intervention for caries. The aims of the present questionnaire survey were to investigate, among a random sample of 2,000 French GPs, the management decisions for occlusal lesions in 2012 and to compare the results to those obtained in 2002. The response rate was 41.9%. The majority of the respondents (60.7%) would postpone their restorative decisions until the lesion was in the dentin, based on clinical and radiographic examinations. Almost 68% of the respondents suggested that the cavity preparation should be limited to the lesion (vs. a preparation extending to the occlusal fissure), and 81.6% chose composite as restorative material for the earliest lesion requiring restoration in a 20-year-old patient with his/her caries risk factors under control. Statistical analysis (χ(2) and logistic regression) showed that the management decisions were influenced by certain demographic characteristics (gender, clinical experience and participation in cariology courses). When comparing the 2002 and 2012 responses, it appears that even if French GPs still tend to intervene surgically for occlusal lesions, which could benefit from noninvasive care such as therapeutic sealants, the restorative threshold has been delayed to later stages of carious progression (p < 0.0001). Moreover, the 2012 respondents were less likely to open the fissure system than the 2002 respondents (p = 0.032), and less amalgam restorations would have been placed in 2012 (p < 0.0001). Furthermore, the results showed that the variability observed in 2002 toward caries management decisions was persisting in 2012.

Dentists' self-estimation of their competence to treat avulsion and root fracture injuries.

AIM: The purpose of this study was to evaluate the knowledge of Norwegian dentists on avulsion and root fracture injuries. METHOD: An electronic questionnaire (QuestBack) was sent in 2012 to all dentists (n = 255) employed in the Public Dental Service (PDS) in three counties of Norway. The dentists were asked to state whether they felt they had sufficient competence to treat avulsion and root fractures immediately and long term. Based on international guidelines, the authors achieved a consensus for ideal treatment. Based on two cases, the clinicians were to assess their own competence. They were classified into either a 'sufficient competence' (SC) group or an 'insufficient competence' (ISC) group. The data were evaluated by descriptive statistics and chi-square bivariate analysis. RESULTS: The response rate was 64%, 95 dentists (62%) in the SC group and 58 (38%) in the ISC group. Significantly more young dentists responded (P < 0.001). Correct treatment (reposition and splint) for a one-day-old fracture in the middle third of the root with luxation of the coronal fragment was chosen more often by the SC group compared with the ISC group (P = 0.03), but estimating the long-term prognosis, there was no difference (P = 0.14). In a case with a previous avulsion injury and obvious signs of pulp necrosis and external infection-related root resorption, the majority (n = 97, 63%) would choose root canal treatment with a Ca(OH)2 dressing which was considered correct treatment, but fewer than half of the clinicians (40%) diagnosed the external infection related to root resorption which was visible on a radiograph. There was no difference between the groups (P = 0.81). CONCLUSION: The study shows that overall knowledge among Norwegian dentists is good, but more knowledge on detecting and diagnosing external root resorption is needed. Self-estimation of own competence does not reflect level of knowledge.

Validation of the Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries".

OBJECTIVES: To translate and validate a Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" as a method of collecting information about treatment decisions on caries management in Chilean primary health care services. MATERIALS AND METHODS: The original questionnaire proposed by Espelid et al. was translated into Spanish using the forward-backward translation technique. Subsequently, validation of the Spanish version was undertaken. Data were collected from two separate samples; first, from 132 Spanish-speaking dentists recruited from primary health care services and second, from 21 individuals characterised as cariologists. Internal consistency was evaluated by the generation of Cronbach's alpha, test-retest reliability was evaluated by Cohen's kappa, convergent validity was evaluated by comparing the total scale scores to a global evaluation of treatment trends and discriminant validity was evaluated by investigating the differences in total scale scores between the Spanish-speaking dentist and cariologist samples. RESULTS: Cronbach's alpha indicated an internal consistency of 0.63 for the entire scale. Cohen's kappa correlation coefficient expressed a test-retest reliability of 0.83. Convergent validity determined a Pearson's correlation coefficient of 0.24 (p < 0.01). The comparison of proportions (chi-squared) indicated that discriminant validity was statistically significant (p < 0.01), using a one-tailed test. CONCLUSIONS: The Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" is a valid and reliable instrument for collecting information regarding treatment decisions in cariology. CLINICAL RELEVANCE: The clinical relevance of this study is to acquire a reliable instrument that allows for the determination of treatment decisions in Spanish-speaking dentists.

Adjunct methods for caries detection: a systematic review of literature.

OBJECTIVE: To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries. STUDY DESIGN: A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach. RESULTS: Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis. CONCLUSIONS: There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.

Longevity of posterior dental restorations and reasons for failure.

Tooth-coloured restorative materials are being used increasingly more often in Class II preparations in permanent teeth. Using a practice-based study design, we aimed to assess the survival time of Class II restorations and to identify factors relevant to their longevity. Class II restorations (n = 4,030), consisting of resin composites (81.5%), compomers (12.7%), amalgams (4.6%), and glass-ionomer cement restorations (1.2%), were placed in 1,873 patients with a median age of 15 yr. In total, 92.7% of restorations were placed due to primary caries and 5.8% were replacements. After an average follow-up period of 4.6 yr, 61.6% of the restorations were successful, 11.2% had failed, and 27.2% were not available for evaluation (owing to patient drop-out). The mean annual failure rate was 2.9% for resin-composite restorations and 1.6% for amalgams. For resin-composite restorations, secondary caries was the most common reason for replacement (73.9%), followed by loss (8.0%), fracture (5.3%), and marginal defects (2.4%). Multilevel Cox-regression analyses identified young age of the patient, high previous caries experience, deep cavities, and saucer-shaped preparation technique as predisposing to shorter longevity of resin-composite restorations. One brand of resin composite had a shorter survival time than the others.

Salivary flow rate and oral findings in Prader-Willi syndrome: a case-control study.

BACKGROUND. Prader-Willi syndrome (PWS) is a rare complex multisystemic genetic disorder. AIM. The objective of this study was to provide a systematic assessment of whole saliva secretion and oral manifestations associated with PWS. DESIGN. Fifty individuals (5-40 years) with PWS and an age- and sex-matched control group were included. Whole saliva was collected. All participants underwent an anamnestic interview. Radiological and dental clinical examinations were carried out to identify hypodontia, dental caries, enamel defects and gingival inflammation. RESULTS. Mean whole salivary flow rate was 0.12 ± 0.11 mL/min in the study group compared with 0.32 ± 0.20 mL/min in the control group (P < 0.001). Hypodontia was significantly more common in PWS (P < 0.001), and dental caries in the age group >19 years was significantly lower in PWS (P = 0.04) compared with the controls. There was no significant difference in the prevalence of dental caries in the primary dentition or in the frequency of enamel defects in the permanent dentition between the two groups. Median Gingival Index was significantly higher in the Prader-Willi group compared with the controls (P = 0.02). CONCLUSIONS. Low salivary flow is a consistent finding in PWS. Nevertheless, despite dry mouth and dietary challenges, dental caries is not increased in Norwegian individuals with PWS.

Severe tooth wear in Prader-Willi syndrome. A case-control study.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare complex multsystemic genetic disorder characterized by severe neonatal hypotonia, endocrine disturbances, hyperphagia and obesity, mild mental retardation, learning disabilities, facial dysmorphology and oral abnormalities. The purpose of the present study was to explore the prevalence of tooth wear and possible risk factors in individuals with Prader-Willi syndrome. METHODS: Forty-nine individuals (6-40 years) with PWS and an age- and sex-matched control group were included. Tooth wear was evaluated from dental casts and intraoral photographs and rated by four examiners using the Visual Erosion Dental Examination (VEDE) scoring system and the individual tooth wear index IA. In accordance with the VEDE scoring system, tooth wear was also evaluated clinically. Whole saliva was collected. RESULTS: Mean VEDE score was 1.70 ± 1.44 in the PWS group and 0.46 ± 0.36 in the control group (p < 0.001). Median IA was 7.50 (2.60-30.70) in the PWS group and 2.60 (0.90-4.70) among controls (p < 0.001). In the PWS group tooth wear correlated significantly with age (VEDE; r = 0.79, p < 0.001, IA; r = 0.82, p < 0.001) and saliva secretion (VEDE; r = 0.46, p = 0.001, IA; r = 0.43, p = 0.002). Tooth grinding was also associated with tooth wear in the PWS group, as indicated by the mean VEDE 2.67 ± 1.62 in grinders and 1.14 ± 0.97 in non-grinders (p = 0.001) and median IA values 25.70 (5.48-68.55) in grinders and 5.70 (1.60-9.10) in non-grinders (p = 0.003). Multivariate linear regression analysis was performed with tooth wear as the dependent variable and PWS (yes/no), age, tooth grinding and saliva secretion as independent variables. PWS (yes/no), age and tooth grinding retained a significant association with tooth wear, VEDE (p < 0.001) and log IA (p < 0.001). The only factor significantly associated with tooth wear in the control group was age. CONCLUSIONS: Our study provides evidence that tooth wear, in terms of both erosion and attrition, is a severe problem in Prader-Willi syndrome. There is therefore considerable need for prosthodontic rehabilitation in young adults with PWS.

Restorative treatment decisions of Croatian university teachers.

This study aimed to identify differences in diagnostic criteria and restorative treatment among Croatian university teachers. The questionnaire was distributed to 120 Croatian university teachers in Zagreb and Rijeka. Responses were collected from 59 (49.2%) university teachers. Treatment thresholds for hypothetical approximal and occlusal caries, as well as most favored types of restorative techniques and materials were assessed. The majority (34%) of the respondents would intervene for an approximal caries lesion at the enamel-dentin junction. The leading strategy for occlusal caries was postponing operative treatment until the caries lesion was in the outer third of dentin and removing caries tissue only. Composite resin was the predominant material of choice for restoration of approximal and occlusal caries (70% and 81% respectively). More than half (54%) of Croatian university teachers believed the radiographs underestimated the depth of the caries lesion compared with clinical finding. Findings of this study should be a guideline for Croatian university teachers for a more consistent and modern teaching on the subject of caries management.

Do public health nurses in Norway promote information on oral health?

BACKGROUND: (i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses. METHODS: This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway. RESULTS: The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent. CONCLUSION: Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.

Tracking of parents' attitudes to their children's oral health-related behavior-Oslo, Norway, 2002-04.

OBJECTIVES: To investigate dental beliefs and attitudes of a diverse group of parents from their children when they were aged 3 and 5 years old and to identify possible mediators for a group composed of the parents with the most negative dental attitudes. MATERIAL AND METHODS: Data were collected by parental questionnaire when the children were aged 3 years in 2002 and again 2 years later. The inclusion criteria were children with mothers from Norway (N group) or non-Western countries (IM(1) group). Questionnaires were extensive and had previously been used in a multicenter study. Three composite attitudinal variables relating to oral hygiene, diet and parental indulgence were calculated and an "attitudinal risk group" identified. The association between those variables and the assignment to the group was measured by odds ratio (bivariate and multiple logistic regression). RESULTS: The N parents' dental attitudes were significantly more positive in 2004 when their children were 5 years old than when they were 3 years old (p < 0.0001), but this was not the case among immigrant parents. "Education" and "Immigrant status" [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-7.0; and OR 2.8, CI 1.1-7.3, respectively] were significantly associated with the defined "attitudinal risk group". CONCLUSIONS: Only dental attitudes among N parents were significantly more positive in 2004 than in 2002. Not having higher education and being of non-Western background were associated with belonging to the "attitudinal risk group". Culturally tailored programs of dental health education are needed to promote more positive attitudes to oral health.

Survey of Croatian dentists' restorative treatment decisions on approximal caries lesions.

AIM: To assess Croatian dentists' restorative treatment decisions on approximal caries lesions, including treatment threshold and restorative methods and materials. METHODS: Croatian translation of the questionnaire assessing restorative treatment decisions on approximal caries, previously validated and used in Norway and Sweden, was distributed to a random sample (n=800) of Croatian dentists. A total of 307 (38%) dentists answered the questionnaire. The assessed variables were treatment threshold for hypothetical approximal caries lesion and the most favored types of restorative techniques and materials. RESULTS: A third of the respondents (39%, 95% confidence interval [CI], 34-44%) would intervene for an approximal caries lesion at the dentin-enamel junction, but a larger proportion (42%; 95% CI, 36-48%) would treat a caries lesion confined to the enamel. For restoration of approximal caries, the majority (66%; 95% CI, 61-71%) would use composite resin. CONCLUSION: Croatian dentists tend to restore approximal caries lesions when the lesions are confined to the enamel and their development can still be arrested.

Factors influencing dentists' choice of amalgam and tooth-colored restorative materials for Class II preparations in younger patients.

OBJECTIVE: To identify factors associated with dentists' decisions on choice of restorative material in children and adolescents. MATERIAL AND METHODS: In the period 2001-2004, 27 dentists in the Public Dental Health Service in Norway placed 4030 Class II restorations in 1912 patients. The reason for placement, previous caries experience (DMFT), oral hygiene, and characteristics of the cavity were recorded. RESULTS: The most frequently used material was resin composite (81.5%), followed by compomer (12.7%), amalgam (4.6%), and glass ionomer cement (1.2%). Tooth-colored restorations were more frequently placed than amalgam in younger patients (p=0.017). Female patients received fewer amalgam restorations than male patients (p=0.006). Amalgam was more often used in patients with high DMFT (p<0.001) and more commonly in treatment of deeper dentine caries than caries near the dentino-enamel border (p=0.021). Amalgam was more frequently placed in molars than in premolars (p<0.001). In a logistic regression model, gender, DMFT, caries severity, and tooth type were significantly related to choice of material. CONCLUSION: Dentists' choices of restorative material indicate that the majority prefer amalgam in more challenging restorations with respect to caries activity, lesion depth, and tooth type. The findings indicate that in a period when the use of amalgam was phasing out, resin composite was the predominant material of choice for Class II restorations in children and adolescents.