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PubMed2001

Clinical-radiographic correlation in occlusal surfaces.

The aim of the present study was to correlate clinical and radiographic diagnoses of the occlusal surfaces of the first permanent molars. A total of 56 first permanent molars with no macroscopic evidence of caries were selected from 40 children. A research worker performed the visual examination (VE) and an expert performed the radiographic analysis employing bitewing radiographs. Each professional performed diagnosis independently. The statistical analysis revealed: 1) Low correlation between both methods; Kappa: 0.03, p = 0.34; 2) Correlation between past history of caries and VE: taub Kendall 0.333, p = 0.003; no correlation between past history of caries and radiographic diagnosis: 0.002, p = 0.984; 3) No correlation between each of the methods of diagnosis and the age of the patients. The radiographic analysis showed a high revalence of radiolucid images, interpreted as caries, that failed to be detected by VE. To improve VE as a diagnostic method for pits and fissures we should combine various procedures and consider other clinical predictors.

Age Factors↗

PubMedDate not supplied

Radiographic dentinal caries and its progression in occlusal surfaces in Dutch 17-year-olds: a 6-year longitudinal study.

In this study, the status of 705 occlusal surfaces of first and second molars of 90 17-year-olds was analysed longitudinally in a 6-year follow-up, using a combination of clinical and radiographic information. Clinical data were derived from an epidemiological project. Each of two examiners judged all bitewing radiographs. The overall Cohen's kappa for interexaminer agreement of radiographic assessments was 0.77. Between the age of 17 and 23 years, about one third of sound occlusal surfaces developed a new dentinal radiolucency, and over 70% of existing radiolucencies showed progression, both irrespective of the presence of a sealant. In both examination years, almost 20% of the restored surfaces showed signs of a dentinal radiolucency. It was concluded that at the age of 17 occlusal surfaces are still highly susceptible to new dentine caries and further progression of dentinal radiolucencies already present.

Adolescent↗

PubMed1991

Extent and Severity Index based on assessments of radiographic bone loss.

The purpose of the present study was to develop a partial recording system based on the principles of the Extent and Severity Index, aiming at describing the degree of radiographic alveolar bone loss on a population level. The data analyzed were derived from a subject sample comprising 531 individuals aged 25-75 yr. In these subjects alveolar bone level (ABL) was radiographically assessed at all approximal tooth surfaces. An ABL value of greater than 2 mm was required for a tooth site to be included in the computation of a full mouth bivariate Extent and Severity Index (FESI). A partial recording index (PESI-2) based on 18 ad hoc selected tooth sites depicted in one periapical and one vertical bitewing radiograph was evaluated in comparison with the FESI as well as with partial recording indices based on the 9 and 18 tooth sites which displayed the highest correlation with full mouth scores (PESI-9 and PESI-18, respectively). It was shown that all three partial recording systems generated values reasonably close to the full-mouth scores. However, the fitness of all partial indices varied with age. The potential of the partial indices to predict full-mouth scores could be further enhanced via simple regression models. Such an evaluation should, ideally, be carried out in an independent subject sample.

Adult↗

PubMed1990

Radiographic versus clinical diagnosis of approximal carious lesions.

For school-age children, in whom caries activity has declined considerably, the efficiency of bitewing radiographs in diagnosing approximal lesions requires reevaluation. Therefore parallel clinical and radiographic examination of approximal surfaces were carried out in 317 14-year-old children. To assess the degree of agreement between both methods sensitivity and negative predictive value were determined. At the same time previously published data of children aged 8 through 12 years were reassessed. From the results it is concluded that omission of radiographic examination will not result in a substantial loss of information under the age of 12, but above this age it is advisable to include radiographic diagnosis for approximal surfaces.

Adolescent↗

PubMed1990

Progression of posterior approximal carious lesions in Norwegian teenagers from 1982 to 1986.

The purpose of the present study was to assess the progression rate of approximal carious lesions in Norwegians aged 14-18 years. Sixty-five subjects whose average age at base line was 14.9 years had one pair of posterior bitewing radiographs taken annually from 1982 to 1986. One examiner assessed all radiographs in chronologic order, recording degree of approximal caries. When a surface changed from one state to another, it was assumed to have changed at the midpoint between the two examinations. A total of 590 lesions were observed. Uncensored lesions took on average nearly 3 years to penetrate the enamel. Inclusion of right censored lesions by the Kaplan-Meier approach increased the uncensored estimate by approximately 20%. The average for doubly censored lesions was about 6.5 years. Low average rate of caries progression coupled with wide variations between lesions and among subjects suggests a need for individually prescribed recall routines.

Adolescent↗

PubMed1991

Marginal bone loss in 16-year-old Swedish adolescents in 1975 and 1988.

The study was designed to compare the prevalence of marginal bone loss in 2 cohorts of 16-year-old adolescents, born in 1959 and 1972, respectively. Bitewing radiographs from 400 adolescents in each group were evaluated and the presence of bone loss (distance between the cemento-enamel junction and the alveolar crest greater than 2 mm), calculus, restorations and proximal dental caries were recorded. The prevalence of bone loss was 3.5% in 1975 as well as in 1988. Bone loss was found most frequently at the mesial and distal surfaces of the first maxillary molar. The prevalence of calculus was 12% in 1975 and 7% in 1988. The mean DFS for proximal surfaces was 3.1 in 1975 and 0.8 in 1988. No statistically verified dependence was found between bone loss and calculus, or bone loss and proximal caries.

Adolescent↗

PubMed1992

A computer-assisted method for making linear radiographic measurements using stored regions of interest.

Accurate detection of changes in alveolar bone height requires radiographic measuring methods with a reliability of standard deviation (SD) of 0.15 mm or better. No periodontal digital imaging system has reached this reliability, although 3 analogue methods have achieved this goal. However, existing linear methods are time-consuming, difficult to use, unsuitable for measuring all possible (unsharp) anatomical sites and do not provide a confidence estimate for sites of change observed in serial standardized films. A rapid computer-assisted method using stored image regions of interest (ROI) has been developed which allows retest measurements for all possible sites and automatically calculates a 90%, 95%, 98%, or 99% confidence threshold value, derived from duplicate measurement variation, for sites of apparent crest height change. 28 examiners, with minimal training in operating the system, measured 14 different cement-enamel junction to crest height distances from a standard bitewing image, with and without the ROI method. The measurements were repeated 4 weeks later. 13/14 sites achieved an intra-examiner SD threshold of less than or equal to 0.15 mm with the ROI method but 0/14 without. A higher inter-examiner SD threshold of less than or equal to 0.22 mm was achieved for 13/14 sites using ROI and 0/14 without (p less than 0.001). The measurement of crest height changes in a region of previous severe vertical bone loss is demonstrated using serial films. The potential for using trabecular bone patterns as reference sites in regions where traditional measurement points are absent is demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗

PubMed1996

Ontario dentists' knowledge and beliefs about selected aspects of diagnosis, prevention and restorative dentistry.

Based on the responses of 1,276 general dental practitioners in Ontario to a mail questionnaire, variations in certain aspects of the dentists' diagnostic, preventive and restorative knowledge and beliefs are examined. Despite recent practice recommendations and guidelines indicating that patient need and service selectivity, rather than traditional, routine prescriptions, should be the guiding principle of practice, many dentists seem to follow tradition in defining optimal intervals for dental examinations and prophylaxes, bitewing radiographs and topical fluoride applications. Although the respondents' knowledge and beliefs were correct and consistent with current evidence in many areas, some large deficiencies were identified. These include: a lack of awareness that professional prophylaxis prior to topical fluoride application is usually unnecessary and that sealant applications to certain teeth are not cost-effective; an over-estimation of the speed at which dental caries progress through the enamel; and, despite good knowledge about the opportunities for the remineralization of enamel lesions with fluorides, a tendency to restore enamel caries. In some instances, practitioner beliefs were shown to influence practice. For example, dentists who knew about the slow progression of approximal surface caries also reported more often that bitewing intervals should be longer, and that the placement of a restoration should be delayed until the caries penetrates the dentin. Similarly, correct knowledge about sealant effectiveness was positively associated with high sealant use. If dentists are to be expected to understand and follow emerging diagnostic, preventive and restorative practice recommendations and guidelines, continuing education is required to correct and update some of their knowledge and beliefs, as displayed in the responses to this questionnaire.

Adolescent↗

PubMedDate not supplied

Taking bitewing radiographs in preschoolers using behavior management techniques.

Radiographs are essential diagnostic tools to enable dentists to make adequate decisions and treatment plans. Treatment plans for young children, however, are quite often based on no or less than ideal radiographs. Getting successful bitewing radiographs from young children demands both behavior management techniques and adequate equipment. This report reviews the literature, and presents a modified technique of taking radiographs in young children. The technique was successfully used with 156 three-to-five-year-old children from Yakima County, Washington. Behavioral management of the children employed several techniques: building rapport, tell-show-do, modeling, positive reinforcement and increasing the child's sense of control. The equipment and placement technique were designed to be as atraumatic as possible. Positive experiences in the dental office often enhance a child's future cooperation. The techniques presented are simple to learn and use in treating very young children.

Behavior Therapy↗

PubMed1998

Effect of semi-annual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence in schoolchildren. A three-year radiographic study.

Development and progression of approximal caries is still difficult to prevent and control even in societies with declining caries prevalence. In this study, a test group of 115 12-yr old children were treated semi-annually with a mixture (1:1) of a varnish containing 0.1% F (Fluor Protector) and 1.0% chlorhexidine (Cervitec). A reference group of 104 children received fluoride varnish treatment (Fluor Protector) semi-annually. Approximal caries was recorded from bitewing radiographs at baseline and after 3 yr. At baseline, total decayed and filled surfaces (DFS) including enamel caries were 1.79+/-2.36 in the reference group and 2.0+/-2.77 in the test group. After 3 yr, the mean approximal caries incidence including enamel caries was 3.01+/-3.74 and 3.78+/-4.32, respectively. The differences at baseline as well as after 3 yr were not statistically significant. The results showed that both groups had a comparatively low incidence of approximal caries during the experimental period, and suggest that a mixture of fluoride and antibacterial varnish had no additional preventive effect on approximal caries incidence compared with fluoride varnish treatments alone.

Anti-Infective Agents, Local↗

PubMed1998

Three year in vivo investigation to determine the progression of approximal primary carious lesions extending into dentine.

OBJECTIVE: To investigate the proportion of a sample of approximal carious lesions extending up to 1 mm into dentine which progressed over a 3-year period and to examine factors which influenced that progression. DESIGN: Prospective, single centre, clinical study. SETTING: Restorative Clinic at Bristol Dental School, UK. SUBJECTS AND METHODS: Sixty-five adult patients were identified who each had an approximal carious lesion which extended up to 1 mm into the dentine and which were assessed at intervals of up to 36 months. All patients were given appropriate preventive advice. MAIN OUTCOME MEASURES: Progression of the lesions was determined by assessment of sequential bitewing radiographs. RESULTS: 29% of the lesions progressed within 8 months, 56% by 20 months and 69% by 36 months. After 36 months, lesions which extended over 0.5 mm and up to 1 mm into the dentine were significantly more likely to have progressed (92%) compared with shallower lesions which extended up to only 0.5 mm into dentine (50%). CONCLUSIONS: The depth of an approximal dentine lesion was the main clinical marker which related to its progression. It is recommended that operative intervention is considered for approximal lesions which extend deeper than 0.5 mm into the dentine, while preventive treatment and re-assessment may be considered for shallower lesions.

Adolescent↗

PubMed1994

Dental injuries, temporomandibular disorders, and caries in wrestlers.

The aim of this study was to examine the prevalence of dental injuries, temporomandibular disorders (TMD), and dental caries in a group of champion wrestlers. Twenty-six male wrestlers, with a mean age of 23 yr, and an age-matched control group participated in the study. A questionnaire was used with questions on trauma, frequency of headache, intensity of practicing sports, use of sugar-containing "sports drinks", use of mouth guards, and previous TMD problems. Four bitewing radiographs were taken in all subjects. In addition, three intraoral apical radiographs of maxillary and mandibular frontal regions were taken in the wrestlers. The number of existing teeth, dental caries, amount and type of restorations, and dental injuries were recorded. Examination of the stomatognathic system comprised bilateral palpation of the masseter and temporal muscles and temporomandibular joints, and evaluation of the mandibular movements. None of the subjects had drunk sports drinks or worn mouth protectors regularly. The wrestlers had more frequent and severe dental injuries localized to the frontal region of the maxilla than the controls. No statistical differences were found in the prevalence of caries or TMD between the groups.

Adolescent↗

PubMed1999

Adjusting estimates of alveolar bone loss for missing observations: developing and testing a general model.

The occurrence of missing teeth is a vexing and growing problem in epidemiological studies of dental disease. The number of units of measurement (i.e., teeth/tooth sites) varies between persons and may affect summary statistics in descriptive studies as well as in analytical studies. The purpose of the present study was to develop a general model to adjust summary statistics for missing teeth. The proposed method was applied to alveolar bone loss in current smokers, former smokers, and non-smokers, from 45 to 64 years of age (n = 812). Alveolar bone loss was measured on bitewing radiographs. The adjustment method was based on the assumption that the probability of losing a tooth was an increasing function of alveolar bone loss. The main finding of the present study was that mean alveolar bone loss increased after adjustment for the number of missing teeth. This increase was larger for current smokers than for non-smokers, indicating that the effects of smoking were slightly underestimated when missing sites were ignored. Further research is required for the model to be applied to other data, estimating different types of dental disease with various degrees of disease prevalence and various numbers of missing teeth, and for validating the adjustment method by means of longitudinal data.

Age Factors↗

PubMed2004

Alveolar bone height in infraoccluded primary teeth.

The purpose of this research is to describe the distance from the cemento enamel junction (CEJ) to the alveolar bone crest (ABC) of infra occluded primary molars and the adjacent and opposing teeth. Bitewing radiographs from 29 children (mean age 98.8 months; SD 21.2), who had infra occluded molars, were scanned and measured. The results of these measurements found that the means of the CEJ-ABC distances of the mesial and distal aspects of the infra occluded teeth were 0.78 mm (SD 0.3) and 0.94 mm (SD 0.32) respectively. Pearson correlation coefficient analysis revealed no significant correlation between the different measurements, except when comparing the measurements in the infra occluded tooth and those of the opposing tooth. It was concluded that the CEJ-ABC values for infra occluded primary molars are shorter than normal values. The CEJ-ABC distances of the opposing and adjacent teeth to the infra occluded tooth are within normal limits.

Adolescent↗

PubMed1992

Diagnosis of approximal caries: radiographic versus clinical examination using tooth separation.

This study compared the accuracy of clinical examination with bitewing radiographs and clinical examination using tooth separation to recognize the carious lesions activity. 336 bitewings were reviewed for approximal caries on the maxillary and mandibular second premolars and first molars of 168 high school students. Three examiners evaluated the radiographs using a megascope, a magnifying glass (x2) and an amplifying image screen. 77 surfaces were identified with approximal radiolucencies. After the radiographic examinations, the three examiners performed a conventional clinical inspection using a No. 4 odontoscope, a No.5 explorer probe and an air-water syringe with artificial light and relative isolation. The variables recorded were: (1) healthy surface; (2) white spot; or (3) carious cavitation. The separation method was performed with elastics. After 24 hours, the elastics were removed and the clinical examination conducted as in the non-separation group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Lack of effect of fluoride releasing resin modified glass ionomer restorations on the contacting surface of adjacent primary molars. a clinical prospective study.

AIM: This prospective, split mouth control study was planned to clinically evaluate shown short-term caries protection of glass ionomer cement on tooth enamel placed in contact to it, as a result of fluoride release. STUDY DESIGN: The sample consisted of 83 children, aged 4-7 years, visiting a private practice during the years 1999 and 2000. All subjects met the following criteria: a Class II restoration was needed to a maxillary or mandibular primary molar on both sides of the mouth, the adjacent molars being radiographically diagnosed as sound or with caries in the relative proximal enamel only. METHODS: A resin modified glass ionomer restoration (Vitremer, 3M) was placed at the test side chosen by chance, while an amalgam or composite restoration was placed at the control side. Lesion initiation or progression adjacent to each restoration was categorized in 5 stages radiographically. STATISTICS: The non-parametric Marginal Homogeneity test for paired observations was used. RESULTS: Differences between test and control were not statistically significant (p>0.1). Two years after restorations were placed bitewings were taken from 36 children (41 pairs of restorations). Uncontrolled brushing with fluoride dentifrice was reported. Mean fluoride treatments performed were 2.2, initial visit included. Lesion progression was: 14 pairs--no progression in either side; 9 pairs--equal progression by 1 stage in both sides; 9 pairs--progression by 1 stage at test side, no progression at control side; 6 pairs--progression by 1 stage at control side, no progression at test side; 3 pairs--various other combinations of scores. CONCLUSIONS: Under these clinical conditions, fluoride release from Class II Vitremer restorations did not affect the rate of caries progression at the adjacent enamel of proximal primary teeth.

Cariostatic Agents↗

PubMed1997

Influence of the addition of restorations on the diagnosis of caries from digitized bitewing radiographs.

OBJECTIVES: The purpose of this study was to assess the influence of additional caries and restorations on the detection of caries on the same radiograph. STUDY DESIGN: Six participants examined five series of four radiographs in which natural carious lesions were present. Each series consisted of the same image with progressively more restorative treatment digitally painted on. The films were randomly presented to the observers who examined the films for the presence and depth of carious lesions. The observers were not informed that the 20 films were disguised versions of the same original five radiographs. RESULTS: The number of carious lesions reported by the six observers did not increase despite the apparent increased restorative intervention viewed on the radiographs. CONCLUSIONS: The complexity of restorative care does not affect observers' ability to correctly detect approximal carious lesions.

Adult↗

PubMed1994

Bitewing-based alveolar bone densitometry: digital imaging resolution requirements.

The resolution requirements were determined for detection of incremental alveolar bone loss from digitized Ektaspeed radiographs. Ten clinical radiographs were examined with a calibrated optical microscope to measure the smallest feature of interest discernible for alveolar bone. Images of trabeculae > 100 microns in diameter could be identified, but smaller ones could not be resolved. The Nyquist Criterion requires sampling with 50 microns (or smaller) pixels to measure such features. Numerous 25 microns Ag aggregates were present. Fifty microns resolution is a practical compromise between noise level and feature resolution. In another example of 10 bitewings digitized at 8 bit grey scale, about half the available range was used for alveolar bone, resulting in uncertainty, over a range of 2 optical density (OD) units, of about 1.42% at the average OD for alveolar bone (1.1). With the same radiographs digitized at 12 bit resolution, over 2000 of 4096 grey scales were used with a corresponding uncertainty of about 0.09%. Twelve-bit precision was also able to resolve smaller increments in an aluminium stepwedge than was 8 bit precision. Twelve-bit grey scale and 50 microns spatial resolution are recommended for alveolar bone densitometry performed with Ektaspeed radiographs.

Absorptiometry, Photon↗