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Distribution of caries in 12-year-old children in Sweden. Social and oral health-related behavioural patterns.

OBJECTIVE: To describe the distribution of caries in 12-year-old children in Sweden according to socio-demographic and oral health related behaviour. PARTICIPANTS: The study group consisted of 3,373 12-year-old children residing in catchments of 26 different public dental health clinics in Sweden, geographically well represented. METHOD: The clinical examination for dental caries was performed by 28 calibrated dentists. A questionnaire on lifestyle was distributed to the children with questions on ethnicity, socio-economic level and oral health as well as overall health attitudes. RESULTS: The proportion of 12-year-old children with no experience of dentine caries was 47% and 35% were completely free from all caries. Intraoral distribution of caries showed most lesions on the first molar mesial surface, with 80% enamel and 20% dentine caries. Almost all children brushed their teeth twice a day and a third of the children had an extra intake of fluoride. Decayed surfaces including enamel caries (DeS) was chosen as a measure of ongoing caries and used when dividing children into three caries groups; caries free (50%), 1-3 lesions (40%) and the high caries group (10%) with more than 3 lesions. These groups showed distribution differences. More non-Swedish children, children from workers' homes, and children who brushed their teeth less than twice a day were found in the high caries group. More children from workers' homes living in big cities and snacking more than once a week were also found in the high caries group. This could not be shown for other social groups. Also children who had an extra intake of fluoride were classified in the high caries group.

Child↗

Diagnosis of dental caries: a comparison of three radiograph viewing techniques.

Interproximal caries scores for identical surfaces were compared across the three visualization techniques. First, the scores obtained by the naked eye method were compared to the scores obtained using the magnified view box. The second comparison looked at difference in scores between the magnified view box technique and the D.E.T.E.C.T. machine. A third comparison between the naked eye technique scores and the D.E.T.E.C.T machine scores was also made for each of the two operators. The comparison of caries score between the magnified view box and the digital image enhancement D.E.T.E.C.T. machine showed a more homogenous result. More caries was scored by both operators using the digital image enhancement system than with the view box technique. The difference in caries scores between the two techniques assigned for every surface by the two operators were statistically significant (p < 0.05). It is clear from this study that image enhanced interpretations of conventional radiographs is a necessary step to fine-tune the caries diagnosis process.

Child↗

Atypical migration of an impacted lower third molar.

This report describes the atypical migration of an impacted lower third molar tooth in a 42-year-old woman. Serial radiographs showed that, over a period of 13 years, the tooth migrated from its original disto-angular position posterior to and beneath the roots of the adjacent second molar to a more horizontal position beneath the roots of the first permanent molar. The tooth was surgically removed under general anaesthesia, with biopsy and curettage of soft tissue found in the bone posterior to the tooth along the path of migration. This pattern of tooth movement is highly unusual in an adult patient.

Adult↗

Apical root resorption of upper first molars as related to anchorage system.

Night-time use of extra-oral traction for anchorage may cause jiggling, rotational and extrusional forces. The purpose of the study was to test the hypothesis that headgear forces in an anchorage system may increase the risk of radiographically detectable root resorptions on molar teeth. Twenty-one patients were selected among patients planned for orthodontic treatment, in which there was a need of anchorage in a full-bond appliance during a period of at least 6 months. An experimental group of 11 patients was given reinforcement anchorage in the maxilla with an extra-oral traction (cervical-pull) during night. Ten patients in a control group was given anchorage by a Goshgarian palatal bar, or by Class II-elastics. Periapical radiographs were taken of the upper first molars according to a standardised technique at the start of treatment, and at 3 and 6 months. Recordings included also patient compliance, force evaluation and the measurement of tooth movement. Significant reduction of root length was shown for some roots already after 3 months. However, mean root resorption after 6 months did not exceed 0.6 millimeter in any upper first molar root of the present sample. The degree of root resorption was similar in the experimental and the control groups. The hypothesis of a significant effect on root resorption of upper first molars by night-time use of extra-oral traction for a 6 month period was rejected. It is concluded that patients given anchorage by night-time use of extra-oral traction will show similar degrees of root resorption of the upper molars as those in which anchorage is given by a Goshgarian bar or Class II elastics.

Extraoral Traction Appliances↗

Crestal bone changes around titanium implants: a methodologic study comparing linear radiographic with histometric measurements.

Generally, endosseous implants can be placed according to a nonsubmerged or a submerged technique and in 1-piece or 2-piece configurations. Recently, it has been shown that peri-implant crestal bone reactions differ significantly radiographically as well as histometrically under such conditions and are dependent on a rough/smooth implant border in 1-piece implants and on the location of a microgap (interface) between the implant and the abutment/restoration in 2-piece configurations. The purpose of this study was to evaluate whether standardized radiography as a noninvasive clinical diagnostic method correlates with peri-implant crestal bone levels as determined by histometric analysis. Fifty-nine implants were placed in edentulous mandibular areas of 5 foxhounds in a side-by-side comparison in both submerged and nonsubmerged techniques. Three months after implant placement, abutment connection was performed in the submerged implant sites. At 6 months, all animals were sacrificed, and evaluations of the first bone-to-implant contact (fBIC), determined on standardized periapical radiographs, were compared to similar analyses made from nondecalcified histology. It was shown that both techniques provide the same information (Pearson correlation coefficient = 0.993; P < .001). The precision of the radiographs was within 0.1 mm of the histometry in 73.4% of the evaluations, while the level of agreement fell to between 0.1 and 0.2 mm in 15.9% of the cases. These data demonstrate in an experimental study that standardized periapical radiography can evaluate crestal bone levels around implants clinically accurately (within 0.2 mm) in a high percentage (89%) of cases. These findings are significant because crestal bone levels can be determined using a noninvasive technique, and block sectioning or sacrifice of the animal subject is not required. In addition, longitudinal evaluations can be made accurately such that bone changes over various time periods can be assessed. Such analyses may prove beneficial when trying to distinguish physiologic changes from pathologic changes or when trying to determine causes and effects of bone changes around dental implants.

Alveolar Process↗

The use of a bovine bone mineral in periodontal osseous defects: case reports.

This article reviews the clinical and radiographical results of 12 periodontal patients treated with a bovine bone graft, Bio-Oss. Thirty-two periodontal intrabony osseous defects of various sizes and morphology were surgically treated and evaluated at 6 months. The patients responded well to the use of the bovine bone mineral with good tissue response and an improvement of the intrabony defects. There was an overall mean probing pocket reduction in the deepest sites of 2.34 mm (S.D. +/- 1.59) and a mean gain in probing attachment levels of 1.84 mm (S.D. +/- 1.09). There was a difference in the sites treated with the bovine bone alone compared to sites treated with the bone mineral and barrier membranes, but these differences were not significant. These preliminary findings seem favorable for bovine bone mineral as an alternative graft material to allogenic bone grafts from human tissue banks in treating intrabony defects.

Adolescent↗

Dental misidentification on the basis of presumed unique features.

Positive identification of skeletal remains by dental comparison depends on the demonstrable concordance between postmortem and antemortem records. However, there is no accepted norm for the number of points of concordance and there are circumstances when a single (or a few) unique features may allow positive identification. We present a recent case in which superficial similarity may have led to misidentification. We argue that misidentification is particularly likely with over-reliance on apparently unique features. The fact that a single inexplicable inconsistency will rule out a positive dental identification is highlighted.

Adult↗

[Variations among dentists in the diagnosis of caries and assessment of dental restorations].

It is well-known that dentists differ in judgement when confronted with the same clinical situation. To study this phenomenon, 2 groups of 5 general dental practitioners have assessed the material of 20 patients, each consisting of a set of 2 bite wing radiographs and 2 photographs of the (pre)molar region. The teeth were examined for caries and the quality of the restorations, supported by a protocol which was mailed in advance. The examiner variability was expressed as Cohen's kappa, calculated per pair of GDPs and subsequently averaged per group. The interexaminer agreement was fair for the diagnosis of caries and was highest for the assessment of approximal caries on the bite wing radiograph. The agreement with respect to the quality assessment of dental restorations proved to be poor on average. The intra-examiner agreement varied widely between examiners. No difference could be established between the groups. It can be concluded that, without training and calibration, a sufficient inter- and intra-examiner agreement among GDPs is difficult to reach. Consequently, a substantial variation is found in the individual GDP's restorative treatment planning.

Clinical Competence↗

['Hidden caries' and radiographic studies in children's teeth].

Proximal cavities in deciduous molars are often clinically detected at the time the pulp is involved in the caries process. Besides the early detection of lesions in deciduous teeth in children with a high caries-risk the bite-wing also plays a role in the detection of occlusal 'hidden caries' in non-risk children. In case of 'hidden caries' curative intervention is indicated. Guidelines for the use of bite-wing radiograph's in children are discussed.

Child↗

Relating visual and radiographic ranked scoring systems for occlusal caries detection to histological and microbiological evidence.

This study compared a visual ranked scoring system and a radiographic ranked scoring system for occlusal caries detection with the level of infection of dentin. Seventy-five third-molars, designated for extraction, were professionally cleaned. Caries was scored according to a visual ranked scoring system at a selected site in the groove-fossa system. Radiographs of the teeth were available and caries was recorded along a five-point ranked scoring system. Each tooth was extracted and hemi-sectioned through the investigation site under aseptic conditions. A burful of dentin was removed from the EDJ of one of the section faces and these samples were processed to establish the level of dentin infection. The depth of the lesion was assessed on the other section face using a five-point ranked histological scoring system. A strong relationship was observed between the histological lesion depth and visual score (r(s)=0.93) while a moderate relationship was seen between lesion depth and radiographic scores (r(s)=0.77). The dentin from teeth with cavities exposing dentin was heavily infected. The dentin from teeth with microcavities or grey discoloration of the dentin was less infected than the lesions with frank cavitation (score 4) (p<0.05, t-test), but more infected than the initial lesions (p<0.05, t-test). The latter lesions showed minimal infection. A similar tendency was seen with respect to increasing radiographic scores and the level of infection of the dentin.

Colony Count, Microbial↗

Radiographic techniques for the pediatric patient.

Obtaining quality radiographs on pediatric patients can be a challenge. Suggestions for communicating with patients about radiation safety and the need for radiographs can facilitate the process. Guidelines for radiographic exposure intervals for young patients are key elements in the reduction of exposure to ionizing radiation and are presented in this paper. The child patient presents unique challenges for the dental professional and special techniques are presented in this article that may be helpful in the conducting radiographic examinations for this patient population.

Child↗

New caries detection technologies and modern caries management: merging the strategies.

Literature over the past decade has suggested that dental caries be treated as a curable and preventable infectious disease. The emphasis is placed on early detection and intervention, including chemical therapies and minimally invasive strategies. There are now new detection technologies commercially available to help detect carious lesions early; however, what seems to be lacking is a clear strategy on how to merge these new technologies in a way consistent with today's changing paradigm of caries management. There is a real danger that these early detection technologies may be used to unnecessarily and overaggressively "drill and fill" using Black's "extension for prevention" preparations. This paper will review the literature and key strategies for caries management and early detection and suggest one way (not necessarily the only way) in which they may be used in harmony. Two relatively new detection technologies (DIAGNOdent and DIFOTI) will be reviewed.

Anti-Infective Agents, Local↗