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PubMed1997

Caries behaviour in Danish teenagers: a longitudinal radiographic study.

Coinciding with the decline in caries prevalence observed among children and adolescents, changes in the distribution and progression rates of the disease have been found. The aim of this study was to assess occlusal and approximal caries behaviour and disease distribution within a group of Danish teenagers, and to determine whether the presence of occlusal fillings at baseline could be used as predictor for caries behaviour. The material used was bitewing radiographs taken twice in 197 adolescents, at the age of 14.5 years (first examination) and approximately 3 years later (second examination). Of the occlusal surfaces assessed at both examinations, 93% remained unchanged, 1% developed new carious lesions, and 6% had been filled during the study period. All occlusal dentinal lesions found at the first examination and left unrestored during the study period did not appear to have progressed. Of the approximal surfaces, 86% remained unchanged, 9% developed caries, 2% showed caries progression, and 2.5% had been filled during the study period. 22% of the approximal enamel lesions found at the first examination progressed into the dentine during the study period. 18% of all the children were responsible for 50% of the total number of new lesions and fillings. The proportion of children exhibiting new lesions at the second examination was almost evenly distributed among children with and without occlusal fillings at the first examination. In the group of children with occlusal fillings at baseline, significantly more individuals than in the other group showed new fillings and lesions with and without progression. It is concluded that the progression percentage for approximal enamel lesions to penetrate into the dentine was low, that the distribution of new carious lesions and fillings among the children was polarized, and that the presence of occlusal fillings at baseline could not be used to identify children with a specific caries behaviour.

Adolescent↗
PubMed2004

Looking for caries...? Teachers evaluate a program to improve caries diagnosis from radiographs.

We developed a computer-assisted learning (CAL) program to improve student caries diagnosis from bitewing radiographs. In order to decide on its appropriateness, dental teachers independently evaluated the program before it was introduced. Our objective was to describe an evaluation by the teachers of the CAL diagnostic module and to compare the diagnostic performance with the evaluation score of the program. Key dental teachers involved in teaching clinical caries diagnosis and epidemiology (n = 22) viewed the CAL program. They evaluated aspects of the program by scoring 10 criteria on a visual analogue scale. Measures of the teachers' initial diagnostic accuracy assessed during use of the program were: sensitivity and specificity for the presence of dentine caries. Using Pearson's correlation coefficients, these measures of the teachers' diagnostic accuracy were compared separately with their evaluation score of one aspect of the program: the overall functionality of the program for a 2nd-year dental student. The teachers' mean sensitivity for dentine caries diagnosis was 76.5% (median 77.8%; SD 15.4%) and the mean specificity was 93.7% (median 94.2%; SD 3.9%). The teachers gave the program a mean overall functionality score of 68% (median 75.1%; SD 21%). Dentists with a lower sensitivity (P = 0.065) for dentine caries tended to give the CAL program a higher overall functionality score than the other teachers. The CAL program was valued as generally useful. It tended to be more highly valued by the dentists with initially lower scores for diagnostic accuracy.

Computer-Assisted Instruction↗
PubMed2004

Can nonstandardized bitewing radiographs be used to assess the presence of alveolar bone loss in epidemiologic studies?

OBJECTIVE: To compare periodontitis-associated alveolar bone loss assessment by standardized and nonstandardized radiographs in clinical and epidemiologic studies. METHODS: Participants included 37 patients aged 21-66 years with prior nonstandardized bitewing radiographs scheduled to receive bitewing radiographs as part of their next routine dental care visit. Standardized bitewing radiographs were taken with a Rinn film holder to position the film in the mouth and align the X-rays so that they were at 90 degrees to the film. Before taking the radiograph the bite was registered in centric relation using a polyether impression material. One registered dental hygienist took and processed all the standardized radiographs. One dentist read all radiographs using a viewing box, magnifying lens, and periodontal probe with William's markings. Radiographic bone loss was measured to the closest millimeter at mesial and distal sites of the posterior teeth excluding third molars. The examining dentist was blinded to the participant's name, age, gender, or if the radiograph was standardized or nonstandardized. RESULTS: Mean bone loss (+/- SD) was similar in the standardized and nonstandardized groups (1.60 +/- 0.72 mm versus 1.64 +/- 0.85 mm), and the correlation was high (r = 0.95). Periodontitis was defined as present if the participant had at least one site with 3, 4 and 5 mm bone loss. The Kappa statistics for concordance using these three cutoffs were good and ranged from 0.60 to 0.65. The sensitivity ranged from 72.7 to 80.8% and specificity from 88.5 to 90.9%. CONCLUSIONS: Periodontitis assessed as mean alveolar bone loss or the prevalence of disease based on alveolar bone loss can be accurately and reliably evaluated from nonstandardized radiographs.

Adult↗
PubMed1997

Effect of the NSAID flurbiprofen on remodelling after periodontal surgery.

The aim of the present experiment was to assess the effect of the administration of the NSAID flurbiprofen (Froben) on tissue healing after periodontal surgery. Sites from patients with the same treatment modality (modified Widman flap) but receiving a placebo drug and sites within each patient not exposed to surgery served as controls. Nineteen patients suffering from moderate to severe periodontal disease were recruited and they signed informed consent forms. These patients required periodontal surgery as assessed at the periodontal re-evaluation. The sites chosen for the study were all diagnosed with PPD > or = 5 mm and were bleeding on probing. During the healing phase 10 patients received 50 mg Froben 3 times per day for 30 d whereas 9 patients received a placebo drug. Two sites with PPD > or = 5 mm after initial therapy and bleeding on probing served as surgical sites, whereas 2 similar sites were not exposed to surgery. The study design was set up double-blind. The radiographic examination consisted of 2-4 standardized vertical bitewings obtained at the periodontal re-evaluation (BL) at 1, 3 and 6 months post-surgically for digital subtraction and computer assisted densitometric image analysis (CADIA). The regions of interest analysed were mesial or distal crestal sites. Minimal remodelling activity was observed radiographically after periodontal surgery in both patient groups. There were no statistically significant differences between the four groups of sites regarding the mean changes in density when analysing the pairs of radiographs 0-1, 0-3, 0-6 months. A frequency analysis was performed to list the number of sites with different ranges of density change. No differences in the distributions of the numbers of sites were observed when comparing the 4 site groups (Kolmogorov-Smirnov, p > 0.05). A significant reduction of the probing pocket depth and a significant amount of clinical attachment gain was noted at the surgically treated sites irrespective of whether the patients had used flurbiprofen or placebo. Whereas the pathways leading to bone resorption in periodontally diseased sites have been shown, in other studies, to be influenced by NSAID, the results of the present study could not justify general administration of Froben for the purpose of reduction of bone resorption after periodontal surgical procedures in patients with adult periodontitis.

Absorptiometry, Photon↗
PubMed2003

Coronal pulp size in molars: a study of bitewing radiographs.

AIM: To: (i) study coronal pulp dimensions in human first molar teeth; (ii) investigate the effects of restorations on pulp size; (iii) determine differences in dimensions between teeth of Mongoloid patients and teeth of other ethnic groups; and (iv) record the presence of pulp stones. METHODOLOGY: Bitewing radiographs of 121 subjects (mean age, 20.9 years) were taken under standardized conditions. The films were digitally scanned and nine measurements were made from the image of each first molar. The data were analysed in terms of presence or absence of restorations and in terms of racial group. Differences were examined using Student's t-test, Pearson correlations and Levene's test. RESULTS: A total of 445 teeth were analysed. Large crowns were correlated to large pulps. Teeth restored with occlusal and proximal restorations had significantly smaller pulps (P = 0.044 and 0.004, respectively), but no difference was found in pulp area in the clinical crown between the restoration types. Mongoloid crowns were shorter and more bulbous. Pulp areas of maxillary molars and pulp widths at the cervix of mandibular molars were significantly larger in Mongoloids. The pulp area in the clinical crown correlated to pulp horn height for Mongoloids and others and for maxillary and mandibular teeth. No differences were found between the heights of pulp horns in the Mongoloid and other teeth. Four of the pulp measurements demonstrated sexual dimorphism. Stones were present in almost 10% of the subjects, representing 4% of the tooth pulps examined. CONCLUSION: Even teeth with shallow occlusal restorations had reduced pulp spaces. There were significant differences in pulp and crown dimensions between the teeth of Mongoloid patients and those of other patients.

Adolescent↗
PubMed1997

Differences in caries recording with and without bitewing radiographs. A study on 5-year old children in the County of Bohuslän, Sweden.

In Sweden, when caries prevalence was much higher, bitewing radiographs (bwg's) were taken on all school children at their annual examination. It has been argued that bwg's should also be taken on 4- to 6-year-olds, with approximal surfaces in the molar area in contact (Stecksén-Blicks & Wahlin 1983). However, discussion about radiation-risk in combination with low caries prevalence seem to have made Swedish dentists reluctant to take radiographs on pre-school children. The aim of this study was to find out if there was a difference in caries recording when information from bwg's was added to that from clinical examination. Therefore 180 5-year-old children were randomly selected to constitute a test group examined both by the dentists who see the patients at the annual examination and do not use bwg's and by two of the authors, who had access to bwg's. No statistically significant difference in carries prevalence was noted from the registrations made by the clinicians and the authors when bwg's were not used (x = 1.8 versus 2.0). When the authors had access to bwg's they considered 1.8 more surfaces to be carious compared to when bwg's were not used (x = 3.8 versus 2.0). Of these, 1.0 surfaces were open lesions and 0.8 were incipient lesions. The difference was statistically significant (p < 0.001) as tested by paired t-test. Extreme differences were noted in single cases. It was concluded that clinical examination only, underestimates the correct caries status.

Child, Preschool↗
PubMed1998

Plaque and gingival status as indicators for caries progression on approximal surfaces.

This study aimed to (1) record the plaque and gingival status on sound and carious approximal surfaces and (2) investigate whether the two parameters could predict approximal lesion progression. For this purpose two samples were selected among 18- to 25-year-old patients at the Dental Faculty in Copenhagen. Sample 1 consisted of 45 patients, each having an approximal posterior surface requiring operative treatment and a contralateral approximal space, where both surfaces were radiographically sound. Sample 2 consisted of 25 patients, each having a posterior approximal tooth surface with an enamel/initial dentinal lesion recorded on a bitewing. Plaque and gingival status were classified using 4-point ranked scales. The recordings were performed once on each participant in sample 1. The recordings in sample 2 were repeated 5 times during a 15-month period. In order to assess lesion progression in sample 2, two serial intraoral examinations were performed, i.e. at the beginning and end of the study. Less than 10% of the sound and carious surfaces were recorded as plaque-free, while about 40% had a thick or heavy plaque accumulation. No significant difference was observed between plaque scores on sound and carious surfaces (p = 0.5), in contrast to findings representing the gingival status (p < 0.001). Tooth surfaces requiring operative treatment were associated with bleeding of the gingiva after probing. In sample 2, 3 of the 25 participants did not finish the study. On the remaining participants caries progression was observed in 9 cases (41%), while no progression was observed in 13 cases. Analyses showed that there were no significant differences between plaque scores in cases with caries progression, as compared with no caries progression (p > 0.05). Similar analyses concerning gingival status showed that bleeding of the gingiva was related to cases with progressing caries. Analyses also disclosed no direct association between plaque and gingival status (Spearman correlation coefficient 0.39). Thus, the occurrence of plaque does not have the same predictive power as bleeding after probing in decision-making as to whether or not a lesion progresses.

Adolescent↗
PubMedDate not supplied

Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden.

The objectives were (1) to assess caries development, including the incidence and rate of lesion progression, in a Swedish cohort from adolescence to young adulthood and (2) to compare the caries incidence rates in adolescents with those of young adults. The original material consisted of 536 children aged 11-13 years at baseline. This cohort had been followed through annual bitewing radiographs to 21-22 years of age. In 1998-1999, 250 of these individuals were re-examined at the age of 26-27, and the new caries data were added to the original data. The results showed that fewer new enamel lesions developed on approximal surfaces during young adulthood than during adolescence; the caries incidence rates for enamel lesions decreased from 4.3 in the age group 12-15 years to 2.7 new caries lesions/100 surface-years in the age group 20-27 years. The same applied to the rate of lesion progression, where the corresponding values from the enamel-dentin border to the outer dentin were 32.5 for the youngest and 10.9 new lesions/100 surface-years for the oldest age group. The caries incidence of outer dentin lesions on approximal surfaces was low but increased from 0.2 in the age group 12-15 years to 0.9 new outer dentin lesions/100 surface-years in the age group 20-27 years. The incidence rates varied considerably between different tooth surfaces. Also for occlusal surfaces, fewer new dentin lesions developed during young adulthood than during adolescence; the incidence was 2.0 new dentin lesions/100 surface-years in the youngest age group and 0.7 during young adulthood. At the age of 13, the proportion of DFS of occlusal surfaces predominated over DFS of approximal surfaces but at the age of 26-27 the proportions of occlusal and approximal DFS were almost equal.

Adolescent↗
PubMed1996

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

PURPOSE: To compare the accuracy of clinical examination performed with bitewing radiographs or clinical examination using tooth separation to identify carious lesion activity. MATERIALS AND METHODS: 320 surfaces from 40 bitewing radiographs were examined for approximal caries on the maxillary and mandibular primary molars of 20 patients 3-10 years old. The patients were divided into three groups: (1) Absence of the permanent first molar; (2) Partial eruption of the permanent first molar; and (3) Full eruption of the permanent first molar. Two examiners evaluated the radiographs using a megascope, a magnifying glass (x2), and an amplifying image screen. Approximal radiolucencies were identified on 72 surfaces. Following the radiographic examinations, the two examiners performed conventional clinical inspection using a No. 4 dental mirror, a No. 5 dental explorer, and an air-water syringe, with artificial light and relative isolation. The separation method was performed with elastic bands, which were removed after 24 hours, and the clinical examination conducted as in the non-separation group. RESULTS: The correlation between the extension of interproximal radiolucent lesions in primary dentition and their clinical diagnoses following separation of the teeth, was similar to findings on literature evaluating the permanent dentition. On radiographic findings for enamel lesions, white spots predominated both in the inner (100%) and in the outer (94%) half of enamel upon clinical examination with separation of teeth. For radiolucent lesions in dentin, on the other hand, cavities predominated over white spot lesions (84%). In Groups 1 and 2 (young primary), white spots occurred in cases where the radiolucent lesions reached the dentin (15% and 25%), similar to findings for young permanent teeth. Clinical diagnosis performed with the mechanical separation of teeth cannot be considered conclusive for the primary dentition.

Child↗
PubMed1999

Tunnel restorations in general practice. Influence of some clinical variables on the success rate.

Using bitewing radiographs and clinical inspection, the success rate for tunnel restorations was assessed in a population with low caries activity. The material consisted of 242 tunnel restorations in permanent premolars and molars in 142 individuals (mean age = 18.8 years). The median DFSappr value (decayed and filled approximal surfaces) at the time of restoration was 4.0. The mean follow-up time was 25 months. Bivariate associations between the outcome variable (success/failure of the tunnel restoration) and conceivable explanatory variables were investigated. In a multivariate logistic regression analysis, the independent variables tooth type (premolars vs molars), surface site (mesial vs distal), radiographic stage of approximal carious progression and age of patient at the time of restoration (9-15 years vs > 15 years) were used to estimate the effect on the dependent variable success/failure. Using the life table method, the estimated cumulative proportion of successful restorations was 81% after 2 years and 64% after 3.5 years. The success rate was not related to caries activity and did not differ between the two types of tunnel preparation techniques nor between different follow-up periods. In the multivariate regression analysis, tooth type (molars vs premolars) was the only factor significantly associated with failure. Thus, a failure occurred about 5 times as often in molars as in premolars. Of the failures, half were due to caries; either radiographically observed adjacent to the restoration or progressing enamel caries on the outer proximal surface. Marginal ridge fractures constituted 26% of the failures. From the present results it can be concluded that in a population with low caries activity, the tunnel restoration technique can be recommended for premolars.

Adolescent↗
PubMed2003

Randomized controlled trial of a computer-assisted learning program to improve caries detection from bitewing radiographs.

OBJECTIVES: To investigate whether using a computer-assisted learning (CAL) calibration program improves the accuracy of dental students in caries detection from bitewing radiographs. METHODS: Dental students were assigned to an experimental (n=33) and control (n=34) group using a randomized block design. The experimental group used the CAL program with feedback to calibrate themselves against experts in radiographic caries detection and a histological gold standard of the actual clinical condition. Feedback was provided visually of the actual tooth surface condition and in the form of graphics showing diagnostic accuracy performance measures. Performance was tested before the program (for the control group) and after the program (for the experimental group) by assessing surfaces (n=56) from a new independent digital test set of evaluation radiographs for the presence, histologically, of dentine caries (n=23). The summary receiver operating characteristic (SROC) method for summarizing true positive ratio (TPR) (sensitivity) and false positive ratio (FPR) (1-specificity) was used to analyse the dichotomous data. Differences between the control and experimental groups were tested for (a) the area under the SROC curve (A(z)) and (b) the TPR, FPR and diagnostic odds ratio (DOR) using the Mann-Whitney test (P<0.05). RESULTS: The mean TPR for dentine caries detection was 76.3% (SD 13.0%) for the experimental group and 66.9% (SD 14.8%) for the control group (P=0.005). Mean FPRs were similar (experimental 28.1% and control 28.7%; P>0.5). The area under the SROC curve A(z) was 0.832 for the experimental group and 0.773 for the control group (P=0.002). The mean DOR for dentine caries in the experimental group (12.4) was better than that in the control group (8.8) (P=0.003). CONCLUSIONS: The CAL program does improve diagnostic performance. Improving the cognitive feedback provided by the program should be considered before implementation.

Area Under Curve↗
PubMed2006

Caries increment and prediction from 12 to 18 years of age: a follow-up study.

AIM: This was to determine the increment of caries from 12 to 18 years of age and to explore the possibility of predicting caries increment in this period based on the caries experience at age 12 years. STUDY DESIGN: Prospective longitudinal survey. METHODS: A sample of 12-year-old children (n =159) were examined in 1993 and 70% of them re-examined at 18 years of age. Bitewing radiographs were taken and a diagnostic system using five caries grades (D(1) to D D(5)) was used at both ages. Children at risk were defined as those who developed manifest caries lesions (D(3-5)FS) on approximal surfaces during the follow-up period. Possible predictors were analysed by calculation of sensitivity, specificity, efficiency of the test, proportion that tested positive and actual proportion of the population at risk. RESULTS: The mean caries increment (D(1-5)MFS) from 12 to 18 years of age was 4.2 (SD +/- 9.1). The percentage of caries-free adolescents at 12 and 18 years of age was 10% and 1% respectively; 25% had either a reversal or no increment in caries experience while the D(1-5)MFS increased in 65% of the adolescents. Of the increment of manifest lesions (D(3-5)FS), 18% were located in incisors/canines, 40% in premolars, 26% in first molars and 16% in second molars. Premolars had the largest proportion of the approximal surfaces with manifest caries increment. The best predictors of children at risk of approximal caries increment (D(3-5)FS) were caries experience (D(1-5)FS) on the approximal surfaces of premolars and second molars at the age of 12 years. The individuals that developed four or more manifest lesions on approximal surfaces between 12 and 18 years were the easiest to predict (sensitivity + specificity = 175%). CONCLUSIONS: There was a considerable increment of manifest caries lesions from 12 to 18 years of age in all tooth groups. The best predictors for increment of manifest caries on approximal surfaces during the age period were approximal caries in premolars and second molars at the age of 12 years.

Adolescent↗
PubMed2000

Acid formation in sucrose-exposed dental plaque in relation to caries incidence in schoolchildren.

The aim was to investigate the composition and concentration of organic acids produced by plaque bacteria in vivo and its possible relation to caries development in schoolchildren. Sucrose-exposed pooled plaque from 25 healthy teenagers was collected and the levels of Streptococcus mutans and lactobacilli were estimated. The acid anions were analysed with isotachophoresis. The prevalence and incidence of dental caries during a 2-year period was recorded. Depending on the amount of plaque collected, the subjects were divided into a low (n = 12) and a high (n = 13) plaque weight group. The dominating anions in sucrose exposed plaque were lactate, acetate and propionate. For the entire study group, no association was found between the total acid concentration and caries development but for the participants with low plaque weight a positive relationship (P < 0.01) was disclosed. No correlation was found between the concentrations of acids and the number of lactobacilli or Streptococcus mutans. The present results did not suggest that the acidogenicity of sugar-exposed pooled plaque samples was a suitable indicator of caries activity in teenagers.

Acetates↗
PubMed1993

Resin-bonded fixed partial denture technique: results of a medium-term clinical follow-up investigation.

Results of a clinical investigation with cast metal, electrolytically etched, resin-bonded fixed partial dentures (FPDs) are reported. These FPDs were inserted under standardized conditions. The FPDs had been in place and functioning for an average time of 21.4 months. Sixty-five patients with a total of 82 resin-bonded FPDs were followed up. There was a retentive failure in only one FPD. All patients were satisfied from both functional and esthetic points of view. The results of this study indicate that the concept of treatment with resin-bonded FPDs should be considered as an alternative to conventional treatment.

Acid Etching, Dental↗
PubMed1991

Diagnostic methods for caries: what is appropriate when?

A Workshop was held which invited a range of speakers to consider separately the different diagnostic tools presently available for the detection of caries and then the various applications to which these tools can be put. Each presentation was followed by a vigorous discussion period. It was concluded that there is no one single method suitable for all anatomical sites and degrees of caries and that the requirements for epidemiological surveys, clinical trials and individual patient care are different. The choice of appropriate diagnostic technique(s) should be made, in each situation, on the basis of published performance data which has to be regularly re-evaluated due to the pace of change.

DMF Index↗
PubMed1992

GDPs' and specialists' decisions in the management of fissure caries.

As part of a continuing education programme in dentistry, four specialists and 27 selected general dental practitioners were asked to rate 58 clinical management options relating to fissure caries in six simulated patient management problems called challenges. Their ratings are presented and the advantages and disadvantages of the approach are discussed. Areas of agreement and disagreement are highlighted and possible reasons for these explored.

Composite Resins↗