Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars

The aim of the study was to describe the 3-yr results of a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 children 6-8 yr old with their permanent right first molars in different stages of eruption. The results were compared with record data from 58 children of the same age who had received a traditional caries treatment program including fissure sealing (control group). After 1 yr a significant reduction of occlusal surfaces with visible plaque was noted in the study group as well as an increased proportion of arrested lesions. These results were maintained after 2 and 3 yr. Ten (9%) teeth were sealed and one filled during the study period. Examination of record data in the control group over a 3-yr period revealed that 76 (65%) first molars were sealed and 7 (6%) were filled. During the first year 1/3 of the children in the study group needed 5-6 recall visits, whereas in the following period all children were only seen 1-4 times. In contrast, 50% of the children in the control group needed 5-6 recalls in the 3rd yr. Our data indicate that professional care for erupting teeth on an individual basis has a long-term effect on occlusal surfaces as well. The alternative technique required less clinical time than the traditional application of sealants.     

Control of occlusal caries in the first permanent molars by oral hygiene

Abstract Caries of the pits and fissures of permanent teeth continues to be a problem for children, newly erupted permanent molars being particularly at risk. Oral hygiene measures have been shown to be able to reduce the incidence of caries. The aim of this study was to compare the caries-preventive effects on newly erupted first permanent molars of a professional tooth cleaning and oral health education program (test) with a standard preventive program (control), comprising selective fissure sealing and application of topical fluorides. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to four test or four control clinics. Schoolchildren, mean age 6.3±0.3 (s) years with sound, newly erupted first permanent molars were included in the study (207 test, 197 control). After 12 months, 186 test and 163 control children were examined by an examiner who was ‘blind’ to the test or control status of the children. Caries of the first permanent molars developed in 34 test and 35 control children; the estimated risk ratio was 0.86 (95% CI 0.56, 1.30). Children in the test group had an average DFT score of 0.26±0.62 compared with 0.29±0.64 DFT in the control group (t-test, P=0.67). The 12-month results suggest that there was no statistically significant difference between the caries-preventive effects of a professional tooth cleaning and oral health education program and a program based on selective fissure sealing and application of topical fluorides.     

Dental plaque and caries on permanent first molar occlusal surfaces in relation to sagittal occlusion

This study examines the influence of sagittal occlusion on occlusal plaque formation in permanent first molars (PFM) in 72 7–10-yr-olds before loss of primary second molars. Of a total of 288 PFM, 140 (49%) were sealed and 23 (8%) filled. Occlusal plaque was recorded at two levels of examination: 1) visible plaque on the entire surface and 2) detailed macromorphologic mapping. Enamel caries was recorded after professional tooth cleaning. After 48 h without tooth brushing, plaque examinations were repeated. Stone models were used for 1) identification of interocclusal contact areas and 2) classification of sagittal molar occlusion. The detailed mapping of plaque on unfilled surfaces showed a clear pattern of preferential locations related to the macromorphology of the occlusal surfaces. Active caries was restricted to those anatomic structures where plaque accumulated. 48-h median plaque values on mandibular molars in normal and with one cusp distal occlusion were significantly lower ( P < 0.01) compared to surfaces in 1/4, 1/2 and 3/4 distal molar occlusion. Maxillary molars with normal and with 1 cusp distal occlusion had lower median plaque values than other sagittal occlusion categories. In general, however, plaque scores were higher in maxillary teeth because more than 2/3 of these teeth were without occlusal contact in the distal part. Mandibular occlusal surfaces in normal and with one cusp distal occlusion had significantly fewer active lesions than teeth with 1/4, 1/2 and 3/4 cusp distal occlusion. The significant influence of variations in sagittal molar relation on occlusal plaque formation and caries initiation occurring in fully erupted PFM before loss of primary second molars thus supports the view that physical forces operating during mastication are an important factor for colonization and growth of bacteria with cariogenic potential.     

Caries in fissures of permanent first molars as a predictor for caries increment

A group of 268 children were checked for caries experience at the age of 7.2 yr later at the age of 9 and 4 yr later at the age of 11 yr. Caries experience of fissures in permanent first molars at the age of 7 yr served as a screening criterion for caries increment between the ages of 7 and 11 yr. This screening resulted in a sensitivity of 0.62, a specificity of 0.82, and a diagnostic power of 0.83 for total caries increment in the permanent dentition and in a sensitivity of 0.68, a specificity of 0.80, and a diagnostic power of 0.78 for caries increment in fissures of permanent first molars. It was concluded that this screening offered the best method available for identifying children at risk from fissure caries in their permanent first molars. Cost effectiveness of preventive treatment directed towards individuals, for instance the application of fissure sealants, can be improved by using this screening method.     

A longitudinal study of caries experience and extraction of permanent first molars in English children

One hundred and twenty eight children in Leeds, England, initially aged 11 years, were examined annually for 6 years. The site of dental caries on 441 permanent first molars was recorded at the first examination. Twelve per cent of the teeth were caries free, 83 % had between one and three DF sites each, and 6 % had four or more DF sites. After 6 years 8 % of the originally caries free teeth had been extracted, compared with 19 % of those that initially had had up to three DF sites and 58 % of those with four or more DF sites at the first examination. With the exception of the distal surface site a consistent pattern of the prevalence of caries was seen in each of the sites in the permanent first molar teeth that were not extracted during the study. In the distal site dental caries became relatively more prevalent as the children grew older. The accumulation of similar information from other populations should provide a useful guide for the prognosis of dental caries in the permanent first molar teeth.     

Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements

This epidemiological study aimed to compare the diagnostic outcome of the WHO criteria, ICDAS II criteria, laser fluorescence measurements, presence of plaque and roughness as activity scores on occlusal fissures and buccal/palatal pits of the first permanent molars. The study involved 311 children between 8 and 12 years of age from the Ennepe-Ruhr District in North Rhine-Westphalia, Germany. The surface-related caries status was registered according to the WHO basic method criteria (1997). Additionally, pit and fissure sealants, the ICDAS II visual criteria, the DIAGNOdent reading, plaque retention and surface roughness were documented. Caries experience was 1.0 (+/-2.5) DMFS. About 70% of the examined students had no obvious dentin caries in the permanent dentition (DMFS = 0). Sealants were registered on 1.4 (+/-1.7) occlusal fissures and 0.4 (+/-0.9) palatal/buccal pits. Noncavitated caries lesions were recorded as ICDAS II score 1-4 on 1.8 (+/-1.6) fissures and 1.5 (+/-1.4) pits. The comparison of the diagnostic methods suggests a relationship between higher ICDAS II scores/DIAGNOdent values and a proportional increase in the occurrence of plaque as well as in the number of rough surfaces. In conclusion, this study showed the diagnostic potential of the ICDAS II criteria in comparison to the traditional WHO criteria by means of the noncavitated caries lesions additionally detected. The DIAGNOdent use in field studies that already apply detailed visual criteria seems to bring limited additional information. While the presence of plaque provides information for the caries activity assessment more work is required to provide information about the contribution of surface roughness.     

Evaluation of a routine for prevention and treatment of fissure caries in permanent first molars

Fissure sealing as well as fluoride varnish have shown good preventive effect against fissure caries in newly erupted teeth. The purpose of this study was to evaluate a clinical routine in which these two methods were combined. The evaluation was done in a public dental clinic in Norway, and three dentists performed and evaluated the treatment. The population belonged to two different year classes (born 1978 and 1979), 196 in all, and they were followed semiannually from age 6 until 8 and 9 yr, respectively. The routine was as follows: all erupted permanent first molars without fissure caries were cleaned and painted with a fluoride varnish (Duraphat) every 6 months. Fissures showing incipient caries were opened with a rotating instrument and sealed if caries was restricted to the enamel. Amalgam fillings were placed if caries had progressed to the dentin. The operator time required for the fissure treatment was recorded. After 2 yr observation of children born in 1978 and 1979, 72% of the fissures were intact, 13% had been sealed, and 15% filled, and the corresponding figures after 3 yr (1978-children) were 65%, 15%, and 20%. In approximately 45% of the children all four permanent molars were intact, while about 12% had all molars sealed or filled. The average time spent for application of sealants was 4.1 min and for application of amalgam fillings 5.9 min.     

Oral hygiene in the control of occlusal caries

Occlusal pit and fissure caries accounts for a high proportion of the total caries burden among children. Studies from Denmark suggested that oral hygiene measures may be effective in the control of occlusal caries in permanent teeth. This study reports on the findings after 24 months of a controlled field trial comparing the caries-preventive effects of a professional tooth-cleaning and dental health education programme (test) with a standard preventive programme (control), comprising selective fissure sealing and application of topical fluorides. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to four test or four control clinics. Schoolchildren, mean age 6 years, with sound newly erupted first permanent molars were included in the study (207 test, 197 control). After 24 months, 179 test and 156 control children were examined by a calibrated examiner who was 'blind' to the test or control status of the child. Thirty-two test and 31 control children developed occlusal caries on the first permanent molars; the estimated risk ratio was 0.90 (95% CI 0.58–1.41). Children in both groups had an average DMFT score of 0.30. The 24-month results suggest that the two preventive programmes did not differ with respect to the control of occlusal caries in newly erupted molars.     

第一恒磨牙患龋与乳磨牙患龋相关性的研究

目的 探讨6～10岁儿童第一恒磨牙患龋与乳磨牙患龋的相关性,以期为临床提供参考.方法 采用整群、分层、随机抽样的方法,抽取济南市10个区(县)40所小学,对6 ～ 10岁符合纳入标准的3680名儿童进行患龋情况调查,并分析第一恒磨牙患龋率与年龄、性别及乳磨牙患龋之间的相关性,对第一恒磨牙龋失补牙数(decayed-missed-filled teeth,DMFT)、龋失补牙面数(decayed-missed-filled surfaces,DMFS)及乳磨牙龋失补牙数(decayed-missed-filled teeth,dmft)、龋失补牙面数(decayed-missed-filled surfaces,dmfs)进行相关分析.结果 6～10岁第一恒磨牙DMFT为1440,龋均0.39(1440/3680);患龋率20.7％ (763/3680),女性患龋率[28.9％ (509/1762)]显著高于男性[13.2％ (254/1918)] (P ＜0.01);第一恒磨牙患龋率随年龄增长呈上升趋势.第一恒磨牙DMFT与乳牙dmft呈显著正相关关系(r=0.31,P＜0.01),DMFS与dmfs呈显著正相关(r=0.35,P＜0.01).当dmft＞3、dmfs＞ 19时第一恒磨牙患龋率成倍增长.结论 第一恒磨牙患龋率与性别、年龄及乳磨牙患龋指数有关,对乳磨牙高龋患者应早期对第一恒磨牙采取必要的防龋措施.     

Caries susceptibility of permanent first and second molars in children aged 5–15 years

Clinical examinations of 276 5-year-old children were carried out twice yearly for 2 1/2 years, and a further 1104 11-12-year-old children were examined annually for 3 years. Fifty per cent of permanent first molar teeth had erupted by 6.4 years; the mean age of eruption for permanent second molar teeth was 12.2 years. One year after these mean eruption dates over 10% of first molars and 45% of second permanent molars were already carious. Although development of caries was initially slower in permanent first molars, between the ages of 7.5 and 8.5 years the caries increment rose to 18.8%. By the age of 15 years the DMF Was 92% for first and 68% for second molar teeth. The missing and filled proportion of the total DMF rose consistently. This represents the amount of treated caries and exceeded the amount of untreated caries in permanent first molars at all age levels. The rate of caries initiation in the present investigation emphasizes that restorative programmes and preventive regimens for children must be based on frequent recall examinations of not more than 6-monthly intervals.     

Comparison of the severity of caries attack in permanent first molars in Iraqi and Sudanese schoolchildren

Severity of caries attack of the permanent first molars was investigated on two population groups of Arabian origin, namely 1617 Iraqi and 725 Sudanese primary schoolchildren ranging in age from 6 to 12 years. The results showed a higher DMF rate in the Iraqis in all the age groups studied, reaching a maximum of 83% at age 11, whereas the maximum level was 60% in Sudanese children at age 10.     

Caries prevalence in primary teeth as a predictor of early fissure caries in permanent first molars

The study aimed to examine the validity of employing the caries experience of the primary dentition for predicting early caries in the permanent first molar fissures. Subjects consisted of 192 children who were followed for 2 yr, 91 of whom were pursued for a further year, all receiving semiannual check-ups. The caries prevalence in the primary dentition (dmft), excluding incisors, was recorded at baseline, which was the year the children became 6. Fissure caries in the permanent first molars was recorded as being confined to enamel or dentin, based on findings during cavity preparation. The correlation between dmft and the number of intact permanent first molars was -0.368 and -0.337 after 2 and 3 yr observation respectively. When the children were grouped according to their dmft, a statistically significant relationship was found between the dmft and the number of intact molars in each individual. The positive and negative predictive values as well as the sensitivity and specificity of different dmft values were calculated, and the relationship between them illustrated by the use of ROC curves. Even if there are no specific dmft values which seem obviously favorable for the purpose, these data give information relevant in planning for large scale use of fissure sealing in preventing early fissure caries in permanent first molars.     

Relative effects of pre- and posteruption water fluoride on caries experience of permanent first molars

OBJECTIVES: Previous studies have attributed the caries-preventive effects of preeruption (PRE) and posteruption (POST) exposure to fluoridated water based on data collected before and after the commencement or discontinuation of water fluoridation. This study aims to determine the relative pre- and posteruption exposure effects of fluoridated water on caries experience of 6-15-year-old Australian children based on individual residential histories. METHODS: Parental questionnaires covering residential history of participants were linked to their oral examinations conducted between June 1991 and May 1992 by the School Dental Services of South Australia and Queensland. Percentage of lifetime exposed to optimally fluoridated water PRE and POST was calculated with respect to the eruption age for first permanent molars. Combined pre- and posteruption categories were created to test PRE against POST exposure: PRE & POST = 0, PRE < POST, PRE = POST in the range 0-90 percent of lifetime exposure, PRE > POST, and PRE & POST > or = 90 percent lifetime exposure. These categories were used as indicator variables with PRE and POST = 0 as reference in an analysis of first permanent molar DMFS scores. The linear regression model controlled for important potential confounders. RESULTS: Participation rates were 69.7 percent in South Australia and 55.6 percent in Queensland with 9,690 and 10,195 participants, respectively. Pre- and posteruption exposures were strongly correlated (r =. 74; P < .01). Compared to the reference, the categories PRE > POST, PRE = POSTin the range 0-90 percent, and PRE and POST > or = 90 percent showed significantly lower caries levels. CONCLUSIONS: The findings indicated that preeruption exposure was required for a caries-preventive effect and that exposure after eruption alone did not lower caries levels significantly. However, the maximum caries-preventive effects of fluoridated water were achieved by high pre- and posteruption exposure.     

部分去龋法治疗恒磨牙深龋的疗效观察

目的:探讨部分去龋治疗恒磨牙深龋的临床疗效.方法:对102颗恒牙深龋进行部分去龋法结合树脂严密充填,随访6个月以上,评价其牙髓存留率及治疗主观感受.结果:随访到的97颗患牙中,90颗充填物完好,牙髓活力正常,治疗成功率为92.8％;79.9％的患者治疗感受为轻度不适或无反应.结论:部分去龋法治疗恒牙深龋,可以减少牙髓暴露的风险,减轻患者治疗时的不适,获得较好的充填治疗效果,值得临床推广.     

Sealant retention and effects on occlusal caries after 2 years in a public program

A clinical trial of one application of Nuva-Seal fissure sealant was conducted under School Dental Service conditions in a low-income area of London. The sealant was applied to one of a cariesfree pair of permanent teeth by schools' dentists, the other tooth being left as a control. One examiner, who did not apply the sealant, conducted examinations at baseline, after 6 months, and after 2 years. There were 118 children, initially aged 5-12, who remained in the trial after 2 years. The sealant was fully retained on 27.4 % of the teeth, partially retained on 40.6 %, and missing on 17.9 %. The remaining 14.1 % of teeth had been restored. There was no statistically significant difference between subjects who had less decay in sealed teeth and those who had less decay in control teeth. The sealant was 13.6 % effective (not significant, P less than 0.4) in preventing caries in sealed teeth. These results are less favorable than those in other trials reported. The potential role of fissure sealants in a School Dental Service is discussed.     

乌鲁木齐市7～9岁儿童第一恒磨牙龋病及萌出情况调查

目的:调查新疆乌鲁木齐市7～9岁儿童第一恒磨牙龋和萌出状况,为龋病的防治工作提供参考。方法:采用全国第二次口腔健康流行病学调查方法,统计第一恒磨牙患龋率、龋均,龋面均、未萌出率。分析年龄、性别与患龋率的关系,以及龋病的好发牙位、牙面。结果:2 422名儿童恒磨牙总患龋率为18.04%,龋均0.32,龋面均0.52,未萌出率11.23%;女生患龋率略高于男生,且随年龄升高而上升;7岁组患龋率和龋均最低;上颌好发于牙合面、舌腭面,下颌好发于牙合面、颊面。结论:乌鲁木齐7～9岁儿童第一恒磨牙龋损呈上升趋势。应加强口腔卫生指导,积极预防并早期治疗恒磨牙龋病。     

Effect of a field program based on systematic plaque control on caries and gingivitis in schoolchildren after 3 years

The effect of a field program, based on systematic plaque control, on caries and gingivitis was tested during a 3-year period on 1,100 schoolchildren. Once every 3rd week the children were given oral hygiene instructions, professional toothcleaning and fluorides topically delivered by specially trained dental nurses. The children of a control group of approximately the same number of pupils, participated in a preventive program consisting of mouthrinsings once every 2nd week with a 0.2% sodium fluoride solution. The children of the third and fourth grades were, at the start of the experiment, selected as reference groups and then continuously examined once every year. At the end of the trial the mean reduction of surfaces haboring plaque and units with gingival inflammation was 59% and 73%, respectively. The reduction in caries increment was 51%.     

Caries incidence in permanent first molars after discontinuation of a school-based chlorhexidine-thymol varnish program

OBJECTIVES: To determine whether the cessation for 3 years of a 24-month program of chlorhexidine-thymol varnish applications would affect caries incidence in the first permanent molars of a population of schoolchildren of middle and lower-middle socioeconomic level. METHODS: Two groups of 6-7-year-old schoolchildren, randomized by school-class, were followed up in a clinical trial. One group received applications of chlorhexidine-thymol varnish every 3 months and the other group acted as controls. The program ended after 24 months and its effects were evaluated. Three years later, 55.5% of the schoolchildren were re-examined and the caries increments were documented. RESULTS: At the end of the 24-month program, the treated children had significantly fewer decayed and filled surfaces in permanent molars (lower DFS index) versus the controls. At 3 years after the discontinuation of the program, this difference had disappeared; there were no differences in the incidence of decayed, missing and filled surfaces (DMFS) index in permanent molars between the treated children and the controls. CONCLUSION: The cessation for 3 years of a 3-month program of chlorhexidine-thymol varnish applications resulted in a nonsignificant increase in the prevalence of dental caries in the permanent first molar.     

Dental caries status and treatment needs of the permanent dentition of 6–12-year-olds in Hong Kong

An oral health survey was conducted in 1986 on a representative sample of primary school children in Hong Kong. 1483 Chinese children of both sexes, aged 6-12 yr, attending 56 primary schools were surveyed. The DMFT index for the 6-yr-olds was 0.1, and for the 12-yr-olds it was 1.5. Forty percent of the 12-yr-olds were clinically caries-free. The permanent molars constituted 90% of the total caries experience of the 12-yr-olds. Over 90% of the caries lesions were found in pits and fissures. The dental caries treatment need in the permanent dentition was low and of the simple type. A great reduction in the dental caries experience of the permanent dentition of children has occurred since the introduction of water fluoridation 25 yr ago. In addition to treatment care, preventive measures should be provided by the School Dental Care Service for children with a high caries risk.