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PubMed1997

Localized juvenile periodontitis and Actinobacillus actinomycetemcomitans in a Brazilian population.

Localized juvenile periodontitis (LJP) has been used as a model for studying periodontal disease, and its prevalence is considered to be higher in third-world countries (0.3-8%) than in industrialized countries (0.1%). Mostly, the disease has been associated with Actinobacillus actinomycetemcomitans (A.a.) but lack of association has also been reported. The aim of this study was to identify LJP patients in geographically different Brazilian populations and assess the presence of A.a. in their periodontal lesions. 7843 children, 12-19-years of age, from the cities of Rio de Janeiro, Votorantim and Belo Horizonte were screened, and LJP patients were identified by strict clinical and radiographical criteria. A final LJP prevalence of 0.3%, with a 99% confidence interval between 0.16% to 0.47%, was found. The prevalence in the subpopulations varied between 0.1-1.1% in the different areas. Subgingival bacterial samples were obtained from the oral cavity of 25 patients and their family members. 80% of these patients, 39.5% of their family members, 35.3% of their parents, and 43.9% of all siblings were culture positive for A.a. All but one of the families had at least one member in addition to the patient who was culture positive for A.a. In 3 families, > 1 member showed radiographic and clinical signs of LJP. 30% of non-LJP subjects coming from one of the areas with higher LJP prevalence harbored A.a. We conclude that LJP is highly associated with A.a. in this Brazilian population.

Actinobacillus Infections↗

PubMed1996

Efficacy of quantitative digital subtraction radiography using radiographs exposed in a multicenter trial.

Digital subtraction radiography (DSR) has been shown to be a sensitive and specific method for the detection of small bony changes in periodontitis. The purpose of this study was to perform a multicenter validation of the DSR in human subjects. Seventeen subjects were enrolled at 3 centers. Feather-edged hydroxyapatite chips (approximately 1, 7 and 10 mg) were used to simulate osseous lesions. Bilateral radiographs were taken with and without chips. Geometry was standardized using a cephalostat and the order of radiographs was determined using a randomization plan. Radiographs were subtracted, lesions isolated, and quantified at a single center without knowledge of the randomization code or location of the chips used in each subject. The overall sensitivity and specificity in detecting 1 mg changes was 87.8% and 100%, respectively. Sensitivity and specificity in detecting 7 mg and 10 mg chips was 100%. A strong linear relationship between actual lesion mass and calculated mass was observed (R2 = 0.94, slope = 0.98, p < 0.0001). No significant differences were observed by center. These data indicate that the DSR is a valid technique for the assessment of alveolar bone changes in multicenter trials.

Adult↗

PubMed2000

Identification of adult populations at high risk for dental caries using a computerized database and patient records: a pilot project.

OBJECTIVES: The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries-active and caries-inactive working adults, as determined by bacterial levels. Computerized identification of at-risk groups may facilitate subject selection for clinical trials designed to test caries-preventive strategies. METHODS: Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one-year period: a "low restorative" group of individuals defined as persons who had received no restorative treatment, and a "high restorative" group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n = 48). RESULTS: The high and low restorative groups differed in mutans streptococci levels, but not on other measures. CONCLUSIONS: A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free.

Adult↗

PubMed1999

Radiographic appearance of alveolar osseous defects in relation to their anatomic location.

Radiographs are of limited value in the diagnosis of osseous defects. Anatomic and technical factors affect the radiographic appearance of bone lesions. This study was undertaken in order to determine whether the radiographic appearance of alveolar osseous defects depends on their location, and particularly whether there are any differences in radiographic detection between bone defects located in the maxilla or the mandible, and on the buccal or lingual aspects of the alveolar crest. Experimental bone lesions were created in the alveolar crest of a skull. Standardized periapical radiographs were obtained before and after the defects were made. After processing, pairs of radiographs were randomly mounted. Five dentists acted as observers in order to determine whether or not a change in alveolar bone was detectable at each of the five possible locations. The unpaired t test was applied for the assessment of statistically significant differences with respect to sensitivity, specificity, and positive diagnostic value in the diagnosis of bone lesions depending on their location. The results showed that the anatomic location of a lesion in the alveolar bone affected its radiographic appearance. Moreover, experimental defects were detected more often in the mandible and on the lingual surfaces of the alveolar crest.

Alveolar Process↗

PubMed2002

Caries inhibitory effect of fluoridated sugar in a trial in Indonesia.

BACKGROUND: In some regional areas of Indonesia, caries prevalence is increasing rapidly. As water, salt or milk fluoridation were not considered suitable for use throughout Indonesia, and fluoridated tooth paste is mostly too expensive, a fluoride co-crystallised sugar containing 10 ppm fluoride was prepared. Its efficacy in inhibiting caries development was tested in a field trial. METHODS: The field trial was established in Medan, Sumatera. All dietary background data necessary to ensure the safety of a trial were collected. Subjects chosen were 176 children who were residents of two orphanages and a boarding school for children of poor rural families. The trial used a double-blind format. Close monitoring of fluoride consumption was maintained, and fluoride excretion rates were assessed six monthly by urinary fluoride analysis. RESULTS: Records of total tooth surface caries present initially and after 18 months of sugar supply showed that the children using fluoridated sugar had significantly fewer carious lesions than those who used normal sugar. CONCLUSION: This result indicates that sugar might be considered as a further vehicle for supplementary dietary fluoride in communities where there is a high caries prevalence or high caries risk and little exposure to fluoride.

Adolescent↗

PubMed1998

Caries development from 11 to 22 years of age: a prospective radiographic study. Prevalence and distribution.

The aim was to assess the distribution and pattern of caries development longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A baseline cohort of 536 children was studied, using bite-wing radiographs, from 11 to 22 years of age. The results showed a slow but continuous increase in both enamel and dentin caries of approximal surfaces. At 21, 29% of all posterior approximal surfaces had enamel caries according to the radiographic diagnoses, 14% had dentin caries and another 5% were restored. At the age of 20 21, the skewed distribution of DMFS(appr) apparent at 12 and 15 had given way to a more uniform picture and the percentage of individuals with no decayed approximal surfaces (DMFS(appr) = 0) decreased from 71 at 12-13 to 28 at 20-21 years of age. The proportion of DFS(occl) in relation to all DFS decreased from 83% at 12 to 52% at 21. The occlusal, mesial and distal surfaces of the first molar accounted for 60% of all restored surfaces at 21.

Adolescent↗

PubMed1998

Reliability of visual examination, fibre-optic transillumination, and bite-wing radiography, and reproducibility of direct visual examination following tooth separation for the identification of cavitated carious lesions in contacting approximal surfaces.

The aim of this study was to evaluate the diagnostic accuracy of visual, fibreoptic transillumination (FOTI), and bite-wing radiographic examination performed by 4 observers for the identification of cavitated carious lesions in contacting approximal surfaces, and to assess the inter-observer agreement with these methods and with direct visual examination conducted after tooth separation, the method used as validation for definitive determination of cavitation. A total of 338 unrestored approximal surfaces in 53 students were examined independently by 4 dentists using the diagnostic methods under study. The results from the diagnostic methods were compared with the results from the validation method for each observer. The sensitivities for identification of cavitated lesions using visual examination ranged from 0.12 to 0.50. For FOTI and radiography, the sensitivities ranged from 0.00 to 0.08 and from 0.56 to 0.69, respectively. The specificities exceeded 0.90 for all observers with all methods. Kappa values expressing inter-observer reproducibility were lowest for FOTI, followed by visual and radiographic examination. On the basis of these results, it was concluded that FOTI was the least reliable of the diagnostic methods tested. For the validation method, the inter-observer agreement was only 'substantial'. This implies that the method cannot be used as a validation for other diagnostic methods applied for the identification of cavitated carious lesions in contacting approximal surfaces. However, visual inspection after tooth separation may serve as a supplementary diagnostic tool to conventional visual and radiographic examination for clinical management of aproximal carious lesions.

Adult↗

PubMed1998

Electrical methods in occlusal caries diagnosis: An in vitro comparison with visual inspection and bite-wing radiography.

The aim of this study was to compare in vitro diagnostic performance of three electrical methods for occlusal caries diagnosis with that of visual inspection and bite-wing radiography. One hundred and seven extracted molar and premolar teeth were subjected to the diagnostic methods by 2 operators and subsequently sectioned for histological validation. Electrical measurements were made at site level and at surface level using two different instruments. The diagnostic parameters calculated from the results were: sensitivity, specificity, diagnostic accuracy at a theoretical caries prevalence of 10% and area under the ROC curve. The electrical methods and bite-wing radiography showed higher sensitivity and lower specificity than visual inspection. Diagnostic accuracy was significantly lower for bite-wing radiography and one electrical method than for visual inspection. Overall diagnostic performance of two electrical methods was superior.

Area Under Curve↗

PubMed1999

A comparison of increment and incidence density analyses in evaluating the anticaries effects of two dentifrices.

This study aimed to determine whether incidence density (ID) calculations of caries incidence rates would provide a more sensitive means of detecting caries-preventive effects than would traditional techniques. A secondary analysis was conducted using data from a 1981 study in which three dentifrices were compared in a double-blind randomized clinical trial. Subjects were examined at baseline and 1, 2 and 3 years after baseline. Three-year DMFS increments were calculated for 1,754 subjects attending the baseline and 3-year examinations. Caries ID rates then were calculated for 2, 661 subjects who had at least two examinations, using each surface's net increment (-1, 0 or +1) as the numerator and the surface's time at risk as the denominator. Despite theoretical advantages, the ID method did not alter the conclusions drawn using DMFS increments, apparently because (a) subjects lost to follow-up were similar to those completing the study, and (b) loss to follow-up was similar among treatment groups.

Adolescent↗

PubMed1999

Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: A prospective radiographic study.

Using annual bite-wing radiographs, the incidence and progression of approximal caries (4d-7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1-2 = radiolucency in the enamel up to the enamel-dentin border; 3 = radiolucency with a broken enamel-dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface-years, and the Kaplan-Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface-years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11-12 years had a risk of new approximal enamel lesions (state 0-2) that was 2.5 times greater than that of the group with DMFSappr = 0-1.

Adolescent↗

PubMedDate not supplied

A comparison of clinical and radiographic caries diagnoses in posterior teeth of 12-year-old Lithuanian children.

Bite-wing radiography has been recommended for use in adolescents as clinical examinations alone may lead to underestimation of carious lesions in approximal and occlusal surfaces. The aim of this study was to describe the relationship between clinical and radiographic caries diagnoses among 12-year-old Lithuanians using a new clinical scoring system which differentiates between cavitated and non-cavitated caries lesions. Eight hundred and seventy-two children were examined clinically and two standardized posterior bite-wing radiographs were taken of each participant. Bite-wing radiography contributed significantly to the total number of lesions diagnosed only at the dentin level in approximal surfaces. Clinical examination performed better than radiographic examination at the non-cavitated/enamel level, particularly on occlusal surfaces. Less than 2% of the clinically sound surfaces were diagnosed with dentin lesions/fillings radiographically. When using the cavitated level of clinical diagnosis, the frequency of 'hidden' caries lesions increased from 1.9 to 2.9% in approximal surfaces, and from 1.7 to 5. 2% in occlusal surfaces. The intra-examiner reliability data for the clinical and radiographic recordings supported the conclusion of an additional diagnostic value of bite-wings only for approximal surfaces. The findings demonstrate that the diagnostic yield of bite-wing radiography is higher for approximal than for occlusal surfaces. The efficacy of bite-wings depends on the refinement of the clinical caries diagnostic criteria. 'Hidden' caries does not seem to be a major problem when the clinical caries diagnostic criteria include non-cavitated diagnoses.

Bicuspid↗

PubMedDate not supplied

A two-film versus a four-film bite-wing examination for caries diagnosis in adults.

The aim of this study was to compare the caries diagnostic outcome of a two-film and a four-film routine bite-wing examination undertaken in an adult population. A digital bite-wing examination using two and four films, respectively, was performed in 174 patients. The radiographs from the two examinations were assessed jointly by 2 observers for the number of imaged surfaces in the area from the distal surface of the canine to the distal surface of the third molar and for the detection of carious lesions. Significantly more surfaces were available for examination by the four-film than by the two-film examination. Overlapping surfaces were recorded in 14 and 10%, respectively, of the surfaces imaged by the two-film and four-film set. The prevalence of primary enamel and dentinal caries was 6.8% with the two-film and 5.6% with the four-film method. In 1, 684 surfaces only imaged by the four-film method caries was detected in 20 surfaces. If these extra lesions were added to the number of lesions found by the two-film method the total disease prevalence using the last-mentioned method would increase by 2 per thousand. The majority (92-99%) of all recorded lesions were detected in surfaces located between the occlusal surface of the first premolar and the mesial surface of the third molar. The little additional diagnostic outcome obtained by the use of four instead of two films did not seem to match the extra resources (double patient charge and radiation dose, and extended scan/developing and recording time for the dentist) connected to the four-film method. Thus, it may be recommended that a routine bite-wing examination undertaken in young adults should be performed with only two films: one in each side of the mouth, placed behind the premolars and the first and second molars.

Adult↗

PubMedDate not supplied

Behaviour of approximal carious lesions assessed by clinical examination after tooth separation and radiography: a 2.5-year longitudinal study in young adults.

This study aimed to record and monitor over a 2.5-year period the occurrence of cavitation and lesion depth progression in approximal surfaces with radiographic caries at baseline. In total, 66 approximal sites (in 29 students), where at least one of the contacting surfaces had radiographic caries, were selected to take part in the study. A clinical examination undertaken before and after tooth separation in order to assess the presence/absence of cavitation was repeated every sixth month. To monitor lesion progression bite-wing radiographs were taken every sixth month, too. After each series of examinations, surfaces judged to be prone for disease progression were referred to operative caries treatment. In surfaces with radiographic dentinal caries at baseline the cavitation prevalence following tooth separation found at the various recall examinations ranged from 20 to 44%. In surfaces with radiographic enamel caries at baseline this prevalence ranged from 4 to 8% at the various recall examinations. In dentinal lesions found with an intact surface at baseline, the risk of cavitation development during the first 1.5-year period was assessed to be up to 22%. After this period no new cavitations were found in previously intact dentinal lesions. In intact enamel lesions the risk of cavitation formation was found to be 3% during the first 1-year period. After this period no new cavitations developed in previously intact enamel lesions. Three of 7 lesions, which showed radiographic caries progression from the outer one third to the inner two thirds of the dentine during the observation period, had intact surfaces at baseline. On the basis of these results it is recommended to re-examine carefully intact, dentinal lesions by repeated clinical examination after tooth separation and by radiography about 1-1.5 years after baseline.

Adult↗

PubMedDate not supplied

Value of bite-wing radiographs in a clinical epidemiological study and their effect on the DMFS index.

The aim of this study was to determine, for different age groups, the additional value of bite-wing radiographs compared to the clinical information, and to calculate the subsequent effect on the DMFS index. Subjects were 14, 17, 20, 23 years old, or in the age groups 25-34 and 35-54, who participated in a clinical epidemiological survey. After obtaining consent, bite-wings were taken of approximately 25% of the participants (n = 663). The extra diagnostic yield of the bite-wings varied between 163 and 700% for approximal dentine caries diagnosis of untreated surfaces, and between 233 and 593% for inadequate restoration judgement for filled surfaces. The DS score went up by about 20-98%, whereas the DMFS index increased between 1 and 12%, resulting in a radiographic correction factor of 1.01-1.12. In conclusion, the considerable increase in the prevalence of approximal dentinal lesions and inadequate restorations for all age groups results in higher numbers of surfaces in need of treatment, but is not accompanied by a significant increase in DMFS scores.

Adolescent↗

PubMedDate not supplied

Reproducibility in the assessment of caries lesion behaviour: a comparison between conventional film and subtraction radiography.

The purpose of this study was to compare reproducibility in the assessment of caries lesion behaviour in digital subtraction images and conventional radiographs. Ninety-seven pairs of conventional film bite-wings were included. The radiographs had been taken with a Kwik-Bite filmholder without further standardisation. The selection criterion was that at least one surface imaged in a bite-wing pair should show progresssion of a caries lesion from the first exposure to the second. The time interval between the bite-wings was 1-2 years. The radiographs were scanned into a personal computer and the two images from the same patient subtracted. Seven observers scored the subtraction images and the conventional films. The scale was based on no change/ change in surface appearance scored in the following categories: 0 = no change; 1 = development of a new caries lesion in enamel; 2 = development of caries lesion in enamel and dentine/progression of an existing enamel lesion into dentine/progression of a dentinal lesion further into dentine; 3 = development of secondary caries; 4 = new filling/change of filling/extension of filling. Cohen's kappa coefficients were calculated for intra- and inter-observer agreement for the two radiographic methods separately. The kappa value served as the statistical sampling unit for testing differences between the two methods (Wilcoxon's test for ranked pairs). The average intra-observer kappa value was 0.875 (range 0.775-0.958) for the subtraction images and 0.758 (range 0.560-0.890) for the conventional radiographs. The difference was statistically significant (p<0.05). For inter-observer agreement, the kappa values were lower than for intra-observer agreement. The average value was 0.678 (range 0.485-0.754) for the subtraction images and 0.701 (range 0.497-0.817) for the conventional radiographs (p>0.1). This study suggests a new way of comparing reproducibility in terms of kappa values between diagnostic methods in clinical studies where accuracy cannot be evaluated. The subtraction method may be useful in the assessment of caries lesion behaviour in the clinic.

Dental Caries↗

PubMedDate not supplied

Detection of natural white spot caries lesions by an ultrasonic system.

Ultrasound has been used in industrial business as one of the nondestructive measurement methods. It was hypothesized that nondestructiveness of the ultrasonics could be useful in determination of demineralization of noncavitated carious lesions on human enamel. This investigation was designed to determine the presence of natural carious lesions on proximal surfaces of human molar teeth using an ultrasonic system compared to radiography and histology as the gold standards. Measurements were made directly from proximal surfaces of 20 mandible molar teeth with white spot carious lesion by 2 examiners independently with the ultrasonic system. Ultrasonic evaluation of each natural white spot lesion had a sensitivity of 88%, specificity of 86%, positive predictive value of 88% and a negative predictive value of 86%, and the chance-corrected agreement was also satisfactory (kappa=0.74) compared to histology. The radiograph demonstrated chance-corrected agreement of 0.41:0.38 for the first and second examiners, respectively. Duncan test analysis of the numerical values was significantly different for the intact and the noncavitated carious surfaces (p<0.05). The results indicated that the ultrasonic evaluation is a sensitive method for the detection of the natural white spot carious lesions and can differentiate the changes in elastic properties of enamel numerically.

Analysis of Variance↗

PubMedDate not supplied

An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth.

The aim of this study was to compare the performance of fibre-optic transillumination (FOTI), visual inspection and bite-wing radiographs to detect occlusal caries and estimate the lesion depth. Fifty-nine extracted molars were assessed using FOTI and visual examination by 4 trained examiners and 1 examiner evaluated the bite-wing radiographs. Histological validation was performed using 250-microm sections examined with a stereomicroscope. For the three methods, the correlation between the lesion depth and the histological scores varied from 0.65 to 0.73. For dentinal caries detection, the areas under ROC curves ranged from 0.83 to 0.87. The radiographic method was poor at detecting lesions confined to enamel. FOTI, visual inspection and radiographs showed a good correlation with the histology but had difficulty in distinguishing lesions located deep in enamel or in the outer third of dentine. FOTI was shown to be as accurate as a detailed visual inspection in detecting occlusal caries.

Dental Caries↗

PubMedDate not supplied

Caries rates for the mesial surface of the first permanent molar and the distal surface of the second primary molar from 6 to 12 years of age in Sweden.

The aim was to analyse the pattern of caries rates in enamel and dentin of the mesial surface of the first permanent molar (mesial 16, 26,36,46; here called 6m) and the distal surface of the second primary molar (distal 55,65,75,85; here called 05d) from 6 to 12 years of age. The material consisted of retrospectively collected bite-wing radiographs of a cohort of 374 children aged 5-7 years at baseline and followed to 11-12 years of age. The following scoring system was used: score 0 = no visible radiolucency, 1-2 = radiolucency in the outer (1) or inner (2) half of the enamel up to the enamel-dentin border, 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Two transitions were used: state 0-2 = the time lapse from state 0 until the lesion had reached state 2, and state 2-4 = the time lapse from state 2 until the lesion had reached state 4 or 5. At the age of 9, the mean defs (decayed, extracted and filled surfaces) of 05d was 0.70 and the mean DFS of 6m was 0.19. The enamel caries rates (state 0-2) were 4.6 new lesions/100 tooth surface-years for 6m and 11.3 for 05d. The dentin caries rates (state 2-4) were 20.5 new lesions/100 tooth surface-years for 6m and 32.6 for 05d. In conclusion, the enamel caries rate for 05d was more than twice that for 6m. Both surfaces had relatively high dentin caries rates, indicating that for these surfaces between 6 and 12 years of age, the rate of progression into the dentin is generally relatively high once the lesion has reached the inner half of the enamel as judged radiographically.

Age Factors↗