Long-term follow-up of inactive occlusal caries lesions: 4-5-year results.

OBJECTIVE: To assess the clinical behavior of inactive caries lesion on the occlusal sites of permanent molars over 4-5 years and to estimate the risk for progression of caries-inactive sites compared with sound ones. METHODS: Clinical examinations were conducted at baseline (n = 258) and after 4-5 years and included the recording of dental plaque and dental caries at the occlusal surfaces and the eruption stage of each permanent molar. RESULTS: One hudred ninety-three schoolchildren were followed (response rate of 74.8%), totalizing 1152 teeth. Of the children, 30.6% (n = 59) presented at least one molar containing an active lesion, filling, or that had been extracted; according to the activity criterion, inactive lesions presented around a twofold increased risk for caries progression than sound surfaces (OR = 2.34 95%CI = 1.51-3.62). Thirteen percent (n = 25) of the children presented at least one molar progressing to dentine cavity, filling, or extraction; according to the severity criterion, inactive caries lesions presented a significantly higher risk for progression when compared with sound surfaces (OR = 2.69, 95% CI = 1.50-4.83). CONCLUSION: The vast majority of lesions (85-90%) identified as inactive enamel caries at baseline did not progress over 4-5 years. Despite this fact, it was possible to detect an increased risk for caries progression in caries-inactive occlusal sites compared with the sound ones. CLINICAL RELEVANCE: Considering the low progression rates, inactive caries lesions do not need a specific caries-controlling treatment and should be monitored longitudinally in the same manner as sound surfaces.

Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth.

OBJECTIVE: To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. METHODS: A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. RESULTS: Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73-12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. CONCLUSION: The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. CLINICAL RELEVANCE: Our findings suggest that only a small proportion of UDS would demand restorative treatment.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial.

OBJECTIVE: This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5 years. METHODS: At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination). RESULTS: This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18 months or 3 years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p < 0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08]. CONCLUSION: PCR significantly reduced the occurrence of pulp necrosis when compared with SW. CLINICAL RELEVANCE: This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

OBJECTIVE: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. METHODS: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. RESULTS: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545). CONCLUSION: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. CLINICAL RELEVANCE: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

One-year evaluation of inactive occlusal enamel lesions in children and adolescents.

OBJECTIVES: The aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1 year and to estimate the risk of caries incidence and progression on these surfaces. METHODS: This prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1 year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function. RESULTS: Twenty-two children (11 %) presented "caries progression" (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6 %) or with inactive enamel lesion (3.9 %) at the baseline examination (χ (2) test, p = 0.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (OR = 0.98, 95 % CI = 0.40-2.38). CONCLUSION: Within the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions. CLINICAL RELEVANCE: Occlusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period.

Managing Carious Lesions: Consensus Recommendations on Terminology.

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided.Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease. The termdental caries managementshould be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereascarious lesion managementcontrols the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions' clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal.

The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according toselective removal to firm dentine.In deep cavitated lesions in primary or permanent teeth,selective removal to soft dentineshould be performed, although in permanent teeth,stepwise removalis an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.

Association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars.

OBJECTIVE: This study aimed to evaluate the association between two visual criteria in assessing non-cavitated caries lesion activity on occlusal surfaces of permanent molars. MATERIALS AND METHODS: Thirty-nine patients with at least one permanent molar with non-cavitated caries lesion on the occlusal surface were selected. Molars were assessed according to their activity status following two criteria: ICDAS-LAA and a qualitative criterion based on clinical characteristics. RESULTS: The results showed that the LAA criterion seems to overestimate caries activity. A weak association between both criteria in assessing caries lesion activity and low specificity for ICDAS-LAA was observed. CONCLUSIONS: The ICDAS-LAA criterion is not suitable to assess non-cavitated caries lesion activity on occlusal surfaces of permanent molars because it assesses the lesions to be active more frequently than the qualitative criterion. CLINICAL RELEVANCE: The determination of caries lesion activity is a key decision point in the treatment of caries disease. This study discusses the best option to assess the activity of non-cavitated occlusal caries lesions.

Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil.

This population-based cross-sectional study aimed to assess the prevalence and risk indicators for tooth loss due to dental caries among 12-year-old schoolchildren from South Brazil. 1,528 out of 1,837 (participation rate = 83.17%) schoolchildren were included. Tooth loss prevalence was 5.81% (95% CI = 3.71-8.98) and 0.08 (95% CI = 0.04-0.12) teeth were missing. Schoolchildren with low socioeconomic status (OR = 2.28, 95% CI = 1.23-4.21), who repeated years in school (OR = 1.56, 95% CI = 1.01-2.42), and with gingivitis (OR = 1.81, 95% CI = 1.33-2.45) were more likely to have missing teeth. Schoolchildren brushing 2 times/day (OR = 0.78, 95% CI = 0.64-0.96) or more (OR = 0.49, 95% CI = 0.33-0.74), and those with dental insurance or private dentists (OR = 0.60, 95% CI = 0.39-0.93) were less likely to present missing teeth. © 2014 S. Karger AG, Basel.

Clinical and ultrastructural effects of different liners/restorative materials on deep carious dentin: a randomized clinical trial.

We evaluated the effect of calcium hydroxide cement (CHC) and glass ionomer cement (GIC) on carious dentin and bacterial infections after partial caries removal and sealing. Sixty permanent teeth with deep lesions underwent partial caries removal, the application of CHC, GIC or wax, i.e. negative control (NC), and were then sealed for 3-4 months. After the partial caries removal and the sealing period, the dentin was clinically assessed (colour and consistency) and analysed by scanning electron microscopy to assess dentin organization and bacterial infections. The effect of the treatment in each group was assessed by the Wilcoxon and χ2 tests, differences among groups by the Kruskal-Wallis test and the correlations between variables by Spearman correlation. No clinical symptoms or radiographic signals of pulpits or pulp necrosis were observed during the study. Dentin darkening was observed after the sealing period in the CHC and NC groups (p < 0.05). However, there was no difference in the colour after treatment among the 3 groups (p > 0.05). Dentin hardening occurred in all groups after treatment (p < 0.05), also with no differences (p > 0.05). Dentin samples showed better organization after the sealing period than after partial caries removal, with total or partial obliteration of dentinal tubules (CHC p < 0.03, GIC p < 0.05, NC p < 0.01) and a reduction of bacterial infections (CHC p < 0.03, GIC p < 0.05, NC p < 0.03). No differences were observed. Correlations between the different criteria, except for colour and bacterial infection, were detected in all cases. Partial caries removal and sealing resulted in dentin hardening, decreased bacterial numbers and dentin reorganization, irrespective of the dentin protection used.

Clinical and radiographic diagnosis of underlying dark shadow from dentin (ICDAS 4) in permanent molars.

This study investigated the radiographic pattern of underlying dark shadow from dentin (ICDAS 4) in permanent molars and assessed the association between enamel breakdown and radiographic features. Ninety-five teeth (54 patients) were clinically and radiographically assessed. The majority of ICDAS 4 caries lesions presented enamel breakdown (n = 78, 82.1%) and no radiographic image (n = 64, 67.4%) or a radiolucent zone restricted to the enamel-dentin junction (n = 17, 17.9%). No association was found between enamel breakdown and radiographic features. This study suggests that a radiographic examination is needed prior to the decision making process for underlying dark shadows from dentin.

Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results.

AIM: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. INCLUSION CRITERIA: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. OUTCOMES: success was defined as pulp sensitivity to cold test and absence of periapical alterations. RESULTS: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. CONCLUSION: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Influence of eruption stage and biofilm accumulation on occlusal caries in permanent molars: a generalized estimating equations logistic approach.

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6-15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0-183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5-32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

Multidisciplinary research agenda for novel antimicrobial agents for caries prevention and treatment.

Antimicrobial methods to augment fluoride-mediated caries inhibition are necessary. Several methods are described here, but none was considered likely to be as effective as fluoride usage. None had been tested in effective models to demonstrate their ability to act either additively or synergistically with fluoride-containing toothpastes. Dental caries is a biofilm-mediated disease: The composition of the biofilm associated with caries initiation and progression is diverse. Caries-associated taxa - including mutans streptococci, lactobacilli, bifidobacteria, and yeasts - may be useful surrogate markers for in vivo investigations. In vitro testing should progress from single-species planktonic cells to multi-species biofilms prior to essential testing in randomized control trials (RCTs). Modern high-throughput sequencing techniques need to be applied to the study of bacterial acquisition from birth and of the composition of the biofilm associated with the formation of white-spot lesions. The determination of the functions of the biofilm and the phenotype of the bacterial components may be determined by RNA-seq techniques, since they must be conserved between caries lesions and will include the ability to produce acids and survive and proliferate in acidic conditions. The application of such methods will significantly improve our understanding of the etiology and progression of dental caries.

Genetic diversity of Lactobacillus paracasei isolated from in situ human oral biofilms.

AIM: To determine the genetic diversity and possible origin of Lactobacillus paracasei found in the oral biofilm. METHODS AND RESULTS: Lactobacilli were isolated from a biofilm model, formed in situ prior to and during a period of exposure to 20% sucrose solution (28 days), using Rogosa Agar. The lactobacillus colonies were randomly selected (n = 222) and subcultured. The isolates were identified using pheS or rpoA gene sequence analysis. Lactobacilli identified as Lact. paracasei (n = 75) were subjected to multilocus sequencing typing (MLST) analysis by determining partial sequences of seven housekeeping genes fusA, ileS, lepA, leuS, pyrG, recA and recG. An increase recovery of lactobacilli after sucrose phase compared with nonsucrose period was observed (31 prior to and 191 following a sucrose exposure period). Seven subjects harboured Lact. paracasei and these represented 14 sequence types (ST). Comparison of the STs showed that unrelated subjects may harbour the same ST and that individuals harbour multiple STs. Three subjects harboured STs previously isolated from dairy products. CONCLUSION: The present data supports the hypothesis that oral lactobacilli may be of exogenous origin. SIGNIFICANCE AND IMPACT OF THE STUDY: The study allow us to gain insight into the genetic diversity of Lact. paracasei in oral biofilm.

Anti-caries effect of fluoridated milk-based drink consumed by older adults on an in vitro root caries experimental model.

OBJECTIVE: This study aimed to evaluate the anti-caries effect of a fluoridated milk-based drink on a root caries model by assessing mineral loss and both biofilm microbial viability and acidogenicity under increasing concentrations of fluoride supplementation. DESIGN: Streptococcus mutans UA159 biofilms were grown on root dentin slabs for five days. The slabs were randomly assigned to following groups: milk-based drink (G1) and milk-based drink supplemented with 5-ppm NaF (G2), 10 ppm NaF (G3), and 20 ppm NaF (G4). A 10% sucrose and 0.9% NaCl solution were used as positive and negative-caries controls, respectively. Slabs/biofilms were exposed to the different treatments 3 times/day for 5 min. To estimate biofilm acidogenicity, the pH of the spent media was serially measured to calculate the area above the curve. Viable bacteria and dentin demineralization were assessed after the experimental phase. Results were compared using ANOVA followed by the Tukey test. RESULTS: G1 exhibited slightly lower acidogenicity than the positive caries control group (p < 0.05). G2, G3, and G4 induced lower acidogenicity than 10% sucrose and the non-supplemented milk-based drink. The lowest acidogenicity was found in G4 (p < 0.05). Fluoride-supplemented milk-based drinks (G2, G3, and G4) resulted in lower bacterial counts (p < 0.05) and induced lower demineralization (p < 0.05) than the positive caries control and non-supplemented milk-beverage (G1). There was a dose-dependent inhibition of demineralization with fluoride-supplemented milk-based drinks. CONCLUSIONS: Fluoride supplementation of a milk-based drink for older adults may reduce its cariogenicity in root dentin.

Artificial enamel dental caries treated with different topical fluoride regimes: an in situ study.

OBJECTIVES: To evaluate whether the topical fluoride application (acidulated phosphate fluoride, APF) at high concentration has an additional effect on the control of enamel lesions compared to fluoride dentifrice (FD; low concentration). The frequency of APF treatment on the arrestment of caries lesions and the amount of fluoride deposited on enamel after application of high and low fluoride concentrations were also evaluated. METHODS: Five subjects wore partial dentures with in vitro demineralized blocks during 35 days. All specimens (5p/subject) were brushed three times daily for 1 min with FD (1100 ppmF). Besides the FD treatment, four specimens were submitted to APF gel topical applications (12,300 ppmF) on weekly intervals (one to four applications). The enamel blocks were analyzed at baseline, after demineralization and after intraoral procedures regarding: surface roughness (SR), clinical aspects (brightness and texture), surface microhardness (SMH) and enamel fluoride content. Friedman's test was used to compare SMH and SR among the treatments. Analysis of variance, followed by Tukey's studentized range test, was used to evaluate fluoride content and SR among the groups. The significance level used was 5%. RESULTS: Changes in surface brightness, texture and SR were not detected. FD+3 APF and FD+4 APF were the only treatments capable of increasing SMH values and fluoride content compared to demineralized blocks (p < 0.001), although no differences could be observed within the treatments. CONCLUSIONS: This study showed that > or = 3 APF in addition to FD enhance enamel rehardening and produce a larger reservoir of fluoride.

Dental erosion among South Brazilian adolescents: A 2.5-year longitudinal study.

OBJECTIVES: This population-based longitudinal study investigated the incidence, progression and risk factors for dental erosion among South Brazilian adolescents. METHODS: Eight hundred and one schoolchildren attending 42 public and private schools were clinically examined at 12 years of age; clinical examinations were repeated after 2.5 years (SD=0.3). After tooth cleaning and drying, permanent incisors and first molars were classified using the Basic Erosive Wear Examination (BEWE) scoring criteria. Questionnaires were used to collect data on socio-demographic characteristics, dietary habits, toothbrushing frequency and general health. Poisson regression analysis was used to assess the association between dental erosion incidence and explanatory variables, with adjusted incidence risk ratios (IRR) and 95% CI estimated. RESULTS: Among those who did not have dental erosion at baseline, 49 of 680 schoolchildren (7.1%; 95% CI=5.2-9.1) developed erosive lesions over the follow-up period. Among schoolchildren who had dental erosion at baseline, 31 of 121 (25.4%; 95% CI=17.6-33.3) had new or more severe lesions. Boys were more likely to develop dental erosion than girls (IRR=1.88; 95% CI=1.06-3.32). CONCLUSIONS: A moderate incidence of dental erosion was observed among South Brazilian adolescents, with boys being at higher risk. The high progression rate of 25% observed here is very concerning, and it should be taken in consideration when designing preventive strategies for dental erosion.

Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study.

Radiographic changes after indirect pulp capping (32 teeth in 27 patients) were studied for up to 36-45 months. Radiolucent zone (RZ) depth and tertiary dentine formation were assessed qualitatively and changes in radiographic density (by image subtraction) in RZ and control areas (CA) were estimated. During follow-up there were 1 pulp necrosis, 1 pulp exposure, 3 fractures and 3 withdrawals. Twelve cases showed decreased RZ depth and 4 displayed tertiary dentine. No changes with time in density of CA or RZ, or in the difference between them, were observed. It is concluded that indirect pulp capping arrests lesion progression, suggesting that complete dentine caries removal is not essential for caries control.

Validity of diode laser to monitor carious lesions in pits and fissures.

OBJECTIVE: To analyse the DIAGNOdent's performance to longitudinally monitor the arrestment of non-cavitated carious lesions in occlusal surfaces. METHODS: The sample consisted of 15 children (12-13 years old) with 40 active non-cavitated lesions. The protocol for the examinations was: prophylaxis, drying teeth for 30s; clinical examination, examination with DIAGNOdent. Lesions were classified as active or arrested according to this criteria--active lesion: opaque and whitened enamel, and arrested lesion: enamel with shiny, white or dark spot. The cut offs used for DIAGNOdent measurements were: between 0 and 14--sound tissue (stage 1), between 15 and 20--enamel lesion (stage 2) and above 20--dentine lesion (stage 3). The patients were treated with professional plaque removal, topical application of 1.23% of fluoride in gel and oral hygiene instructions. Thirty days after the first session, the lesions were examined (clinical and DIAGNOdent examinations). The lesions that were not arrested after this period were resubmitted to the previous treatment measurements at 14-day intervals until total clinical arrestment. RESULTS: The Kappa index was 0.75 for the clinical examination and 0.71 for the DIAGNOdent examination. After 60 days, all the 40 initial lesions were arrested. The mean, +/-standard deviation, median and range of values with DIAGNOdent of active lesions were respectively 22.34, +/-21.41, 15.00 and 0-81.00; after clinical arrestment these values were 20.25, +/-18.01, 15.00 and 0-71.00. No significant difference was observed between the two periods. CONCLUSION: DIAGNOdent was not capable to monitor changes occurring during the clinical arrestment of lesions.