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PubMed1993

Screening with conventional and digital bite-wing radiography compared to clinical examination alone for caries detection in low-risk children.

The study compared conventional and digital bite-wing screening, performed in combination with a clinical examination for caries detection, in 168 14-year-old children with little caries experience. Radiography revealed 2-3 times more carious lesions than did clinical examination. Conventional and digital radiography detected dentinal caries in only 1.6 and 1.1%, respectively, of the clinically sound surfaces. Conventional, as well as digital radiography revealed caries in 7% of occlusal surfaces suspected of caries after a clinical examination. Of the suspected approximal surfaces, conventional radiography found caries in 25%, and digital radiography in 19%. From these results, it may be appropriate to perform radiographic screening in combination with clinical examination when the purpose is to assess caries prevalence, and as a basis for individual treatment decisions, if treatment is offered to surfaces with enamel lesions. However, if treatment is offered only to surfaces with clinically detected lesions and to surfaces with radiographically perceived dentinal lesions, it may not be appropriate to perform radiographic bite-wing screening, as less than 2% of the treatment-demanding surfaces will be overlooked by clinical examination alone. Instead, selective radiography should be conducted of surfaces suspected clinically as being carious.

Adolescent↗

PubMed1994

A microbiological study of recurrent dentinal caries.

A cross-sectional microbiological study of recurrent (secondary) dentinal caries was conducted. Freshly extracted human teeth containing amalgam restorations judged to be clinically intact were scrubbed with chlorhexidine soap and soaked in povidone-iodine solution. The teeth were then split to remove the fillings and examined for dentinal caries. Of 54 teeth examined, 22 (40%) were free of dentinal caries in the restored site. The remainder were assigned to arbitrary groups of questionable (15), initial (8) and active caries (9), based on the amount of dentinal decay observed. Comparison of pre-extraction bite-wing radiographs with the in situ findings revealed the sensitivity for secondary caries detection to be only about 50%. In contrast, the specificity for absence of caries was 73%. There was considerable variation in the numbers and types of micro-organisms found in dentine samples from lesions of comparable severity. Facultatively, anaerobic streptococci were the most numerous and most prevalent micro-organisms in the affected dentine, but no single species was significantly associated with recurrent caries. Mutans streptococci were found in 40% of sites with any degree of caries and in only 3 of the 9 sites with the most caries. Homofermentative lactobacilli were present in 18 of the 54 dentine samples, including 4 from caries-free sites. While the prevalence and numbers of lactobacilli increased with the degree of caries, they occurred in less than half of the affected dentine samples. Actinomyces occurred in 15 of 32 affected sites but only in 2 of the 9 most active sites. Their numbers never exceeded 3 x 10(3) CFU/mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomyces↗

PubMed1995

In vivo diagnosis of fissure caries using a new electrical resistance monitor.

The aim of this investigation was to study the accuracy of a newly developed electrical resistance monitor in diagnosing occlusal fissure caries in vivo in teeth without cavitation. The electrical resistance was measured in vivo on human third molars without existing restorations and without any macroscopic carious cavitation. Data from 41 sites on 26 occlusal surfaces were obtained. After measurement, the teeth were extracted, histologically prepared, and serially sectioned perpendicular to the occlusal surface and examined for the presence of caries. Nineteen sites had no caries, 7 had enamel caries, and 15 sites showed dentinal caries, 4 of which deep dentinal caries. For the diagnosis of occlusal caries with the electrical resistance monitor, the specificity was 0.77, the sensitivity 0.93, and the accuracy 0.83. Likelihood ratios for four diagnostic levels (no caries, enamel caries, dentinal caries, and deep dentinal caries) were 0.09, 0, 3.47, and 4.16, respectively. Diagnosis of occlusal caries using conventional bite-wing radiographs showed a specificity of 0.77, a sensitivity of 0.62, and an accuracy of 0.71. The electrical resistance monitor was well suited to detect in vivo occlusal caries under clinically intact fissures. The rather high value (0.23) of false-positive ratings, however, might lead to a substantial number of sound teeth being restored unnecessarily. Substantial improvement of occlusal, caries diagnosis may be achieved by combining this method with others.

Adult↗

PubMed1996

Oral hygiene as a variable in dental caries experience in 14-year-olds exposed to fluoride.

The aim of the study was to examine the relationship between oral hygiene level and caries experience in 14-year-olds using fluoride dentifrices on a regular basis. Oral hygiene expressed as Gingival Bleeding Points (GBP) was recorded in 267 individuals in the county of Lillehammer in Norway. Total caries experience as DMFS and approximal carious lesions in the outer half of the enamel (D1), in the inner half of the enamel (D2), in dentin (D3), and filled approximal surfaces were registered clinically and on standardized bite-wing radiographs. Using multiple regression analysis, oral hygiene level expressed as GBI was the only factor that could account for variation in caries experience (DMFS). Any significant effect of consumption of sweets on caries experience could not be demonstrated with the multivariate analysis. The average percentage of GBP (+/- SD) was 35.7 +/- 10.0%. The individuals were divided into one group with good oral hygiene (GBP < 35.7%) and one group with poor oral hygiene (GBP > or = 35.7%). Significantly fewer carious lesions and filled approximal surfaces were demonstrated in the group with good oral hygiene compared with the group with poor oral hygiene. About 16% of the study population used fluoride tablets or fluoride mouthrinses in addition to a fluoride toothpaste. Only in the good oral hygiene group, additional fluoride resulted in a lower caries experience compared with those using only a fluoride toothpaste. In the group with poor oral hygiene, additional fluoride did not result in lower caries experience. The study thus supported the view that during regular fluoride exposure oral hygiene level is an important variable to explain caries risk.

Adolescent↗

PubMed1996

Approximal cavitation related to bite-wing image and caries activity in adolescents.

Cavitation of enamel lesions probably represents a significant step regarding further progression of the caries process. The primary objective of this study was to examine in adolescents the macroscopical appearance of approximal surfaces with radiographic lesions and relate this to the caries activity of the individual. A second objective was to establish the clinical feasibility of a modified technique for inspection of approximal contact surfaces. The material consisted of 46 enamel lesions selected on the basis of routine bite-wing radiographs of 140 patients aged 17-18 years, available from the Public Dental Service of Lillehammer, a non-fluoridated town. Lesions close to or approaching the AD junction were classified as D2 lesions, whereas those demonstrating a shadow not more than 1 mm into the dentine were designated D3 lesions. Based on recorded treatment during the last 3 years, patients were dichotomised as caries-active (CA) if they had more than 6 new lesions involving the dentine. The remainder with little or no activity were designated modestly active (MA). A small orthodontic rubber ring was placed around the contact point of the approximal surface of interest 1 day before an impression was taken. A separation of 0.5 mm facilitated cleansing and injection of low viscosity impression material (Xantopren(R) L, Blue, Bayer Dental). Discontinuity in the approximal enamel surface, determined by visual inspection of stone dyes, prepared from the impressions, was classified as cavitation. The results demonstrated that in MA patients D2 lesions seldom had cavities while in CA patients cavitation was usually found both in D2 and D3 lesions. The feasibility of the impression/inspection method seems established. It is easily performed and should be considered as a diagnostic tool in borderline cases.

Adolescent↗

PubMed1996

Mechanical defects in dental enamel vs. natural dental caries: observer differentiation using Ektaspeed Plus film.

The value of imaging modalities in enabling the observer to detect proximal dental caries has been tested previously using both natural carious cavitations and mechanical defects. This study compared the ability of dentists to detect mechanically created defects and natural dental carious cavitations on the proximal surfaces of extracted teeth, and to differentiate between the two. Detection rates according to lesion depth were also investigated. There was a difference in the ability of readers to detect natural proximal dental carious cavities and mechanical defects in the proximal enamel. The odds of detecting artificial cavities was 2.92 times the odds of diagnosing natural caries cavitations. There was great variation in the ability of the dentists to identify natural and artificial lesions. According to logistic regression, when the cavity depths are equal, the mechanical defects in the proximal dental enamel are easier to identify than are natural enamel dental caries cavitations. The odds ratio charts provided from this study show the depths of mechanical and natural lesions that are comparable in diagnostic challenge. These charts might permit rough approximations to be made when comparing previously published papers that variously use both mechanical defects and natural caries. Use of poorly designed in vitro models for testing can produce a false guide to the clinical performance of diagnostic systems.

Dental Caries↗

PubMed1996

Cavitation at radiolucent areas on proximal surfaces of posterior teeth.

To investigate the factors that influence the probability of clinical cavitation at radiolucent areas of proximal surfaces of posterior teeth, 108 molars and premolars with varying depths of proximal radiolucency were examined clinically, after cavity preparation on the carious contiguous tooth surfaces. The data obtained were subjected to logistic regression analysis with cavitation as the dependent variable, while age, tooth type and past caries experience (DMFT and DFS) were independent variables. When proximal radiolucency was confined to the outer half of enamel, there was no cavitation, but when it extended to the amelodentinal junction and the outer and inner half of dentine, there was cavitation in 19.3, 79.1 and 100% of cases, respectively. Moreover, there was a statistically significant relationship between the probability of cavitation, depth of radiolucency and age, suggesting that these should be among the main factors considered when restorative management of a radiolucent proximal surface of a posterior tooth is contemplated.

Adolescent↗

PubMed1996

Impact of including or excluding cavitated lesions when evaluating methods for the diagnosis of occlusal caries.

The aim of this study was to assess different methods for the diagnosis of fissure caries when employed on 37 extracted teeth with cavitated occlusal surfaces. A further aim was to compare these results with a previous assessment of the same diagnostic methods on 63 non-cavitated teeth [Lussi, 1993]. The examinations were performed under standard conditions in a professional dental unit. The methods employed were: visual inspection (VI, 26 dentists), VI with magnification (VIM, x2, 26 dentists), bite-wing radiography (BW, 24 dentists), VI combined with BW (VI + BW, 10 dentists) and VI combined with light-pressure probing (VI + P, 23 dentists). For information about the reproducibility, the VI and the VI + BW were repeated. After the last inspection, the teeth were histologically prepared, serially sectioned perpendicular to the occlusal surface and diagnosed for the presence of caries. The agreement between histological and clinical diagnosis was assessed. Sensitivities were VI = 62%, VIM = 75%, BW = 79%, VI + BW = 90%, and VI + P = 82%. The sensitivities found by the same dentists diagnosing non-cavitated teeth were VI = 12%, VIM = 20%, BW = 45%, VI + BW = 49%, VI + P = 14%. The differences between these sensitivities have a direct impact on the DMFS reported for fissure caries. It was concluded that the significant influence of the surface status (cavitated/non-cavitated) should be taken into account when comparing different methods for the diagnosis of occlusal caries.

Analysis of Variance↗

PubMed1997

Progression of radiopacities and radiolucencies under amalgam restorations on bite-wing radiographs.

Radiolucent and radiopaque areas in the dentine under amalgam fillings represent demineralized tissue. The aim of this study was to investigate whether caries progresses in radiolucent and radiopaque areas under amalgam fillings, by assessing their enlargement longitudinally on bite-wing radiographs. Bite-wings from dentitions of persons aged 17, 20 and 23 years were compared. For a 3-year evaluation, 365 teeth with class I and class II amalgam restorations were available on bite-wings; 16 radiopacities, 46 radiolucencies and 28 combinations could be followed longitudinally. All radiopacities remained the same size, 14 radiolucencies enlarged and 8 combinations enlarged. For a 6-year evaluation, 236 filled teeth were available; 10 radiopacities, 30 radiolucencies and 11 combinations could be compared longitudinally. All radiopacities remained the same size, 12 radiolucencies enlarged and 6 combinations enlarged. Because the radiopaque areas had not enlarged visibly on bite-wing radiographs over 3 or even 6 years, it was concluded that radiopacities may be non-progressing caries. A substantial number of radiolucent areas, with or without concomitant radiopacities, did not enlarge while radiolucent areas are considered as progressing caries.

Adolescent↗

PubMed1997

Validity of radiographs for diagnosis of secondary caries in teeth with class II amalgam restorations in vitro.

In the present in vitro study, the validity was determined of bite-wing radiographs for the diagnosis of secondary caries in approximal parts of teeth with class II amalgam restorations in vitro. The study was performed on 47 molars and 49 premolars providing 68 and 69 filled approximal surfaces, respectively. The teeth were radiographed in a buccolingual direction to obtain images comparable to bite-wings. Radiolucencies and radio-opacities were scored as caries. Subsequently the teeth were sectioned (700 microns) in transverse or sagittal direction and then the sections were radiographed. Validation was performed against these radiographs of sections, on which also radiolucencies and radio-opacities were scored. Statistical analysis of the results revealed significant differences between the validity parameters for molars and premolars, being for sensitivity 73 and 80%, respectively, for specificity 90 and 95%, for positive predictive value 95 and 92%, and for negative predictive value 58 and 86%. For molars, the results did not differ significantly from the results of our previous study on caries diagnosis in teeth with occlusal fillings. The present experiment showed that bite-wing radiographs are useful for the diagnosis of secondary caries under approximal parts of class II amalgam restorations, just as for secondary caries diagnosis adjacent to class I restorations.

Bicuspid↗

PubMed1997

The effect of fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces.

It has been suggested that the diagnosis of occlusal dentine carious lesions has become more difficult due to the influence of fluoride on the character of pit and fissure surfaces. The issue pertains to the occurrence of hidden caries exemplified by occlusal surfaces judged as clinically sound but showing a radiolucency on the bite-wing radiograph. The aim of this study was to investigate the influence of water fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces in young people. The data of 515 persons (15 years of age) collected in 1968/1969 as part of the Dutch longitudinal epidemiological Tiel/Culemborg study were used. The participants in Tiel (F) were exposed to artificially fluoridated drinking water (F-concentration 1.1 ppm F) from birth until the end of the data collection. The participants in Culemborg (NF) were not exposed to extra fluoride (F-concentration 0.1 ppm F). In 1994 the status of occlusal surfaces of the first and second molars, as read from bite-wings made in 1968/1969, were judged by 2 investigators. (Cohen's Kappa intra- and inter-examiner agreement 0.90, 0.83 and 0.85, respectively). The original clinical data of 270 inhabitants of Tiel (F) and 245 of Culemborg (NF) were compared with the radiographic judgements. The children examined in Tiel (F) had a mean of 2.54 clinically sound occlusal surfaces in first and second molars (including surfaces with an enamel demineralization only) of which bite-wing radiographs detected 0.43 surfaces (16.9%) with a radiolucency into dentine. In Culemborg (NF) the children had a mean 0.65 clinically sound judged surfaces of which 0.16 (24.6%) showed a radiolucency on the bite-wing films. The results of the investigation show a proportional reduction of surfaces with hidden caries among clinically sound surfaces in the fluoridated area compared to the control.

Adolescent↗

PubMed1997

Prediction of the extent of caries in pit and fissure lesions in a field trial in the west of Scotland.

A field trial is in progress in which 14 community clinical dental officers and 19 general dental practitioners were asked to record the actual extent of fissure lesions and how this compared with the cavity size they expected. Participating operators worked under their normal conditions of daily practice. Forty-eight to fifty-seven percent of 644 prepared cavities were of the expected size upon investigation, depending on the diagnostic technique used. Greater accuracy was achieved among the smaller cavities (58-75% as expected) than with the larger (52-69% larger than expected). More difficulty with cavity size prediction occurred with the lower right first molar than with the other first molar teeth and with both mandibular second molars compared to the maxillary molars. Comparisons between the accuracy of cavity size prediction achieved using a visual inspection in combination with the probe and a visual inspection alone showed no significant difference. Under the conditions of this field trial, considerable difficulties were experienced in predicting cavity size accurately.

Adolescent↗

PubMed1992

Dental predictors of high caries increment in children.

A comprehensive set of dental variables was investigated to find the "best" combination of predictors for high caries increment in 7/8-year-old and 10/11-year-old children. Four populations with widely different caries prevalence were studied. Logistic regression analysis supplied multiple-input models by stepwise selection of predictors. A "low number of sound primary molars" was the best and most consistent predictor of high caries increment. The second best predictors were "high numbers of pre-cavity lesions on permanent first molars" (discolored pits and fissures in the younger age group and white spots on the smooth parts of buccolingual surfaces in the older age group). Inclusion of radiological variables did not substantially increase the quality of prediction. For practical application, models with various multiple inputs selected by stepwise procedures were compared with "fixed" three-input models. These three-input models resulted in predictive quality nearly equal to those of the multiple models. Traditional one-input models, containing DMFT or dmft, were inferior to the three-input models, particularly in the older age class. The lower the caries prevalence of the source data, the better was the prediction. As a summary measure characterizing the predictive performance of a model, we used the index "area under the receiver operating characteristic curve" A. For the 1984 data and the three-input models, the area was approximately 80%, and for the 1972 data, the area was 65-70%.

Age Factors↗

PubMed1995

Urinary catecholamine levels in children with and without dental caries.

Urinary catecholamines have been used to measure emotionally stressful states which may affect the development of dental caries. This study investigates the hypothesis that children with and without dental caries do not differ significantly in the mean values of urinary catecholamines such as epinephrine, norepinephrine, and dopamine. As a test of this hypothesis, 314 children, males and females, aged from 6 to 8 years, were included in the study. Dental caries were recorded clinically and radiographically, and oral hygiene was evaluated by the recording of dental plaque. A 24-hour urine sample was collected for each subject, and a representative sample (25 mL) was analyzed by the HPLC technique to assay the catecholamine content. Socioeconomic factors such as parental age, education, and profession were recorded by a questionnaire distributed to the parents. Of the examined children, 38 (14 males and 24 females) were free of dental caries and constituted the case group. Two control groups, A and B, of 38 children each (14 males and 24 females) with dental caries were matched by age and gender. Differences in the quantitative and qualitative data were tested by the paired t test and the X2-test, respectively, while a regression analysis was applied to measure the effects of norepinephrine and dopamine on epinephrine. The logistic multiple-regression analysis was used to test, in the entire population, the impact of catecholamines and other related factors on the probability of subjects' developing dental caries. The 95% probability was used. The results showed statistically significant differences in epinephrine values between the case group and control groups A and B. The data suggest, therefore, that children with emotionally stressful states have higher probability of developing dental caries.

Case-Control Studies↗

PubMed2006

Technical factors in fractal analysis of periapical radiographs.

OBJECTIVES: Fractal analysis quantifies complex geometric structures by generating a fractal dimension, which can measure trabecular bone density. The use of non-standardized radiographic techniques potentially limits the reliability of fractal analysis. The objective of this study was to determine how variations in radiographic technique affect fractal dimension. METHODS: Periapical radiographs of maxillary incisors taken on eight dry human skulls at varying angulation, tube potential and impulse settings were subjected to Fourier transform fractal analysis. RESULTS: A significant (p < 0.05) difference in fractal dimension, ranging from 2.5 to 2.9, was found between the skulls, potentially reflecting variations in bone trabeculation. However, variations in angulation, tube potential or impulse did not have a statistically significant effect (p > 0.05) on fractal dimension, with the standard deviation of the fractal dimension ranging from +/- 0.005 to +/- 0.062 at various radiographic machine settings. CONCLUSIONS: This study indicates that non-standardized periapical radiographs may provide a reliable method for determining fractal dimensions, which could be useful in analysing changes in alveolar bone density in various bone disorders.

Alveolar Process↗

PubMed2000

Oral midazolam for adults with learning disabilities.

This paper demonstrates how oral midazolam can be employed as an alternative method of behaviour management to general anaesthesia for the dental treatment of people with learning disabilities. A range of treatments, from scaling to root canal therapy, can be carried out successfully using the sedation technique outlined. The advantages of sedation include reduced morbidity and mortality. Treatment outcomes are also likely to be improved as root canal therapy and periodontal care can be carried out over a number of visits rather than a single treatment session under general anaesthesia. Oral sedation with midazolam should improve the scope of dental treatment available to patients with disabilities.

Administration, Oral↗

PubMed2001

Occlusal caries: pathology, diagnosis and logical management.

Occlusal caries now accounts for most of the lesions in children aged 8-15 years. This paper presents a ranked visual scoring system for occlusal caries diagnosis. It relates the clinical appearance of the lesion to its activity, the level of infection of the dentine and the histopathology. The appropriate management for each score is suggested.

Adolescent↗

PubMed2005

Description of a system designed to assist primary dental care clinicians in decision-making with regard to specialist periodontal referrals and report of two clinical audits using the system.

INTRODUCTION: Identifying which patients are at risk of significant periodontal breakdown and may need specialist care is a process fraught with problems. This paper summarises factors that should be considered by referring clinicians, describes a system to assist them, and presents the results of two sequential audits carried out in general dental practice using the system. AIMS, MATERIALS AND METHODS: The author aims to present the system and the results of two sequential audits, carried out in the same eight general dental practices by 23 general dental practitioners (GDPs) after training from a specialist in periodontics. The system is based on the use of the Basic Periodontal Examination (BPE), a constant pressure periodontal probe, and a computer screen that prompts the clinician who is performing periodontal screening. A series of risk factors, including smoking, presence of relevant systemic disease and age, is used to modulate the score. Patients are then classified into one of three complexity groups. Those in the Complexity 3 group are deemed to be potentially at risk of significant periodontal breakdown and in need of referral for specialist advice and/or care, in accordance with the published British Society of Periodontology guidelines. In each audit a random sample of the records of ten dentate patients over the age of 20 years, who attended for recall or new examinations by each of the 23 GDPs over a calendar month, were assessed to see whether or not BPE scores had been recorded and whether or not those classified as Complexity 3 (and in need of referral) had been correctly identified and referred. RESULTS: In both audits the total random sample of patient records was 225 (ten for 22 dentists and five for the remaining dentist who only worked for a short time during the months of the audit). In the first audit cycle 139 (62%) of the random sample of records included a BPE score and 11 (8%) of the patients concerned were identified as Complexity 3 and referred for specialist advice and/or treatment. All 11 accepted the referral and when examined by the specialist in periodontics were confirmed as Complexity 3. In the second audit cycle, which took place seven months later, 179 (80%) of the random sample of patient records included a BPE score and 14 patients were assessed by their GDPs as being Complexity 3. All 14 accepted a referral and were deemed to be Complexity 3 when they were subsequently examined by the specialist in periodontics. CONCLUSION: Although the full potential of the system was not investigated during the two audits, these preliminary results suggest that it may assist referring clinicians in identifying which patients to refer and encourage clinicians to perform periodontal screening.

Adult↗