An in vitro study of the correlation between clinical and radiographic examinations of proximal carious lesions in primary molars

The present in vitro study assessed the correlation between clinical and interproximal radiographic examinations in diagnosing proximal caries of primary molars. A total of 223 mesial and distal surfaces, from 125 primary teeth, were evaluated clinically and radiographically. The results demonstrated a strong correlation between the increase of depth of radiolucency in radiographic examination and the clinical stage of lesions The interproximal radiographic examination presented an excellent capability for discriminating surfaces with and without cavities in primary molars.     

Secondary caries in crowned teeth: correlation of clinical and radiographic findings

STATEMENT OF PROBLEM: The diagnostic value of radiographs for interproximal caries detection on nonrestored teeth is well investigated. However, little is known about the use of radiographs in the diagnosis of secondary caries localized at crown margins. PURPOSE: The aim of this study was to correlate clinical findings with regard to secondary caries with the findings of a radiographic evaluation. MATERIALS AND METHODS: One hundred randomly selected patients who underwent restorations with fixed prostheses and were exhibiting at least one secondary carious lesion were included in the study. A total of 820 restorations (test group, 730 interproximal surfaces of 365 single crowns and 910 interproximal surfaces of 455 fixed partial denture retainer crowns) and 1024 interproximal surfaces of 512 nonrestored teeth (control group) were investigated clinically, with the use of modified California Dental Association criteria, and radiographically for interproximal carious lesions. The extension of the lesions was rated to be initial (with no cavitation), early (with cavitation limited to orthodentin), or deep (with cavitation). The data were statistically analyzed for normal distribution, and the frequency of the findings was calculated in absolute numbers and as a percentage. Statistically significant differences were determined by use of the chi(2) test (P<.05). A linear regression model was applied for the correlation between the percentage of secondary caries and the duration of the crowns in situ. RESULTS: Secondary caries was diagnosed clinically in 11.2% of 1640 interproximal surfaces but only in 8.3% radiographically. In contrast, the frequency of interproximal carious lesions diagnosed clinically in nonrestored teeth increased with the use of radiographs from 3.3% to 4.1%. CONCLUSION: Within the limits of this study, the results confirm that radiographs improve the diagnostic sensitivity for interproximal caries in nonrestored teeth. However, for the diagnosis of secondary caries in crowned teeth, the clinical examination is more reliable than the radiographic evaluation.     

Radiographic diagnosis of incipient proximal caries: an ex-vivo study

The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-microm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6% and 83.3% for clinical examination and 29.7% and 95.8% for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.     

Comparison of diagnostic yields of clinical and radiographic caries examinations in children of different age.

AIM: This was to investigate if the pattern of distribution of caries lesions detected by clinical and radiographic examinations at different diagnostic thresholds changed over a 3-year period during the course of eruption of the permanent dentition. It has been hypothesized that the contribution of bitewing radiography to caries detection in posterior teeth may increase when approximal contacts are established during maturation of the dentition. METHODS: Clinical and radiographic caries recordings were made using the non- cavitated/enamel and cavity/dentine thresholds for caries detection among a group of 12-year-old Lithuanian children with a high caries experience. Examinations were repeated in the same children after 3 years. The bitewing radiographs from both examination sessions were coded to ensure unbiased recordings and were read by a single examiner. RESULTS: The diagnostic yields of the clinical and radiographic examination methods did not change after the permanent teeth had fully erupted. At both examination sessions the clinical examination resulted in the detection of significantly more lesions than did the radiographic method at the non-cavitated level (43- 47% lesions detected by clinical means only and 2-26% by radiographic means only). Only for approximal surfaces at the cavity/dentine diagnostic threshold did radiographs contribute to more lesions (15-16% lesions detected by clinical means only and 38-41% by radiographic means only). Establishment of approximal contacts in the permanent dentition did not increase the relative diagnostic yields of bite-wing radiography in this study group. CONCLUSION: The contribution of the two methods to caries diagnosis depends more on the diagnostic threshold selected than on the stage of maturation of the dentition.     

Prevalence and severity of dental fluorosis in primary schoolchildren in Nairobi, Kenya

Abstract – The purpose of this study was to assess the prevalence and severity of dental fluorosis in 513 primary school children in Nairobi. The clinical examination was performed in a room with natural daylight using T hylstrup & F ejerskov 's index (TFI). Overall, 18% of 6–8-yr-olds had dental fluorosis in the primary dentition and 76% of 13–15-yr-olds in the permanent dentition. There was no significant sex difference ( P >0.05) in either the prevalence or the severity of fluorosis. In children with mixed dentition, the prevalence and severity of fluorosis was higher in the permanent teeth. In the permanent dentition, no clear difference was demonstrable in the severity between the anterior and the posterior teeth. The degree of fluorosis in most of the children in the area served with river water (0.2–0.4 ppm F⁻) was of a very mild form. However, in the area served with borehole waters, 48% of the children and 40% of the teeth were found to have TFI scores 5. Measures to reduce dental fluorosis are necessary in the latter area.     

Radiographic alveolar bone morphology and progressive periodontitis

1 Background

This study evaluated the relationship between radiographic crestal alveolar bone morphology and progressive periodontitis.

2 Methods

A total of 1,356 posterior interproximal sites in 56 adults treated for chronic periodontitis and receiving systematic 3‐month maintenance care were scored for angular or horizontal marginal bone morphology, as well as for alveolar crestal lamina dura, on radiographs obtained at baseline of a 30‐month post‐treatment period. Semi‐annually, the study patients were clinically evaluated for progressive periodontitis. Logistic regression analysis assessed baseline parameters to progressive periodontitis over the 30‐month post‐treatment period.

3 Results

Progressive periodontitis was detected at 33 (2.4%) posterior interproximal sites in 20 (35.7%) patients. Sites with post‐treatment angular bony defects developed progressive periodontitis more frequently (14.7%) than sites with a horizontal bone topography (1.8%). Angular bony defects (odds ratio = 10.6) and periodontal probing depths ≥5 mm (odds ratio = 4.2) were identified as statistically significant independent predictors of progressive periodontitis at posterior interproximal sites. Angular bony and horizontal lesions with intact radiographic lamina dura revealed an absence of progressive periodontitis through 24 months.

4 Conclusions

Post‐treatment presence of angular bone morphology and periodontal probing depths ≥5 mm significantly increased risk of progressive periodontitis at posterior interproximal sites. Sites of all morphology and probing depth that displayed radiographic crestal lamina dura at post‐treatment baseline exhibited clinical stability for ≥24 months.     

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.     

The use of fibre-optic transillumination in general dental practice

OBJECTIVE: To assess the use of fibre-optic transillumination (FOTI) as a diagnostic tool in general dental practice. DESIGN: A cross-over quantitative study for the diagnosis of approximal carious lesions by two clinical methods with a qualitative component. SUBJECTS AND METHODS: Seven GDPs were trained to use FOTI as an adjunct to their usual clinical examination to diagnose approximal caries. After 12 weeks of use in their practices four of the GDPs took part in two assessment sessions, set a week apart, using 29 volunteer patients. Each patient was examined on two separate occasions by each GDP using either their standard clinical examination technique alone or supplemented by FOTI examination. The order of the techniques was randomised. Radiographs of each patient were also examined separately. An experienced FOTI user also examined the patients to provide a benchmark. From standard charts the number of enamel and dentinal lesions on approximal surfaces was summed and comparisons made between the techniques. Six GDPs took part in one-to-one interviews. MAIN OUTCOME MEASURES: Mean numbers ofcarious lesions recorded by each clinician using each technique. RESULTS: There was a trend for all GDPs to find more enamel and dentinal lesions using FOTI, than with their standard clinical examination with or without radiographs. All GDPs found the FOTI technique a useful adjunct. They used FOTI in different ways and found a variety of uses for it other than caries diagnosis. CONCLUSIONS: The     

Approximal caries diagnosis using fiber-optic transillumination: a mathematical adjustment to improve validity

Several studies were conducted recently to evaluate the use of Fiber-Optic Trans-Illumination (FOTI) in the diagnosis of approximal carious lesions. All these studies utilized radiographic readings to validate the FOTI diagnoses. Other investigations studied the value of radiographic readings using more solid validating techniques, which made it possible to judge the true state of decay, such as histology, cavity preparation and microradiography. In this study, data from both types of studies were used to estimate the validity of FOTI diagnosis of approximal caries relative to the true status of decay through correction for radiographic misclassification. The results indicate that particularly the sensitivity of FOTI diagnosis has yet to be determined.     

Performance of some diagnostic systems in examinations for small occlusal carious lesions.

The objective of this study was to compare the performance in occlusal caries diagnosis of various available diagnostic systems when applied to the same teeth. The sample investigated consisted of 13 children for whom 4 premolar and 19 molar teeth were judged to require a sealant. The indication was based on the criteria 'fissure discoloration', 'enamel decalcification' and 'absence of dentinal decay'. For predefined locations within these occlusal fissures a diagnosis was obtained by the following diagnostic systems: clinical examination, examination on fiber-optic transillumination (FOTI), fissure discoloration, electrical resistance measurement, radiographic examination and ratings of fissure morphology. Tooth material was removed until no (more) carious enamel or dentin was left. Two dentists then jointly decided on the status of decay for each of the defined locations within the fissure. These ratings served as the 'gold standard' diagnoses. The electrical resistance measurement with a sensitivity of 0.96 and a specificity of 0.71 was the only diagnostic tool with acceptable performance. Radiographic diagnosis was characterized by a moderate sensitivity and specificity. All other diagnostic systems had either very low sensitivities or very low specificities, or both. The positive predictive value of FOTI examination and the negative predictive value of the electrical resistance measurements were very high, irrespective of the prevalence of occlusal dentinal decay.     

Examiner performance with visual, probing and FOTI caries diagnosis in the primary dentition.

To compare clinical reproducibility of dental caries diagnosis in the primary dentition under field conditions, a convenience sample of 5-year-old children in a nursery school in Germiston, was examined for dental caries by four dentists using visual (mirror), visual plus tactile (mirror plus probe) and fibre-optic transillumination (FOTI) methods. Seventeen children were examined on day one and 11 re-examined on day two. Inter-examiner agreement was high, above 90%. Visual examination on its own is comparable with the traditional visual plus tactile method and to FOTI under field conditions. New caries data collected by visual diagnosis alone may, reasonably, be compared with historical data diagnosed with visual + tactile examination.     

A comparison of combinations of clinical and radiographic examinations in evaluation of a dental clinic population

Panoramic periapical anterior and posterior bitewing radiographic, mirror-explorer, and transillumination clinical examinations were performed on 300 patients. Various combinations of the radiographic and clinical examination techniques were compared in terms of their ability to diagnose caries, alveolar bone loss, calculus, periapical bone lesions, impacted teeth, root tips, and miscellaneous conditions. A mirror-explorer clinical examination with panoramic and posterior bitewing radiographs and either anterior bitewing radiographs or transillumination proved to be as efficient in the initial examination of patients as the mirror-explorer clinical examination with periapical and posterior bitewing radiographs.     

Diagnosis of dentin involvement in occlusal caries based on visual and radiographic examination of the teeth

The purpose of the present study was to examine the validity of visual, radio-graphic and combined visual-radiographic examination of occlusal caries, with special reference to the diagnosis of dentin lesions, using the microscopic diagnosis after sectioning the teeth as validating criterion. Thirty extracted permanent molar teeth with signs of occlusal caries were selected and radiographed using a standard method similar to bitewing. Ten dentists, five from the Department of Cariology and Endodontics and five from the Department of Pedodontics, were asked to make a visual, radiographic and combined visual-radiographic caries examination with an interval of at least 1 month between different examinations. The teeth were sectioned bucco-lingually and the caries assessed as enamel or dentin lesion in a stereomicroscope. The sensitivity/specificity of the diagnoses of dentin lesions was 0.72/0.41 for the visual, 0.66/0.50 for the radiographic, and 0.86/0.64 for the combined visual-radiographic examinations. The Receiver Operating Characteristic (ROC) method revealed a statistically significant difference between combined visual-radiographic examination and the two other, but not between the isolated visual or radiographic examination. It is concluded that the combined use of visual and radiographic examination is belter than either visual or radiographic examination alone.     

Efficacy of FDA guidelines for ordering radiographs for caries detection

This study evaluated the effect on caries diagnosis of using the Food and Drug Administration (FDA) guidelines for ordering radiographs on a sample of new adult patients seeking general dental care at a dental school clinic. These guidelines recommend posterior bitewing views accompanied by supplemental periapical views as indicated by the patient's clinical signs or symptoms. We compared the findings from the use of this protocol to those from a full-mouth set of radiographs made on the same new patient. We examined 490 patients and ordered periapical radiographs in accordance with the FDA guidelines, namely, when there was some clinical sign or symptom suggesting the need for radiographs. A full-mouth set of radiographs was obtained, and both the full and selected sets were evaluated separately. We found that 95% of our patients had one or more carious lesions, with an average of 5.7 carious teeth per patient. Of the 2808 carious teeth detected in the study, 1949 (69%) were found radiographically and 1564 (56%) were found clinically. Indeed, 1244 (44%) of the carious teeth were detected only by radiographic examination. Use of the FDA guidelines resulted in a 43% reduction in the number of radiographs ordered. Reduction in the number of images made on patients resulted in failure to detect 93 lesions (3.3%) located on 88 teeth in 11.4% of the study patients. Most of the missed lesions (2.9%) were radiographically confined to the enamel of anterior maxillary teeth. Only 36 of the missed lesions (1.6% of all radiographic lesions) extended into the dentin. We believe that this number is very small and most likely inconsequential compared with the considerable diversity among dentists regarding radiographic detection of caries, as well as the diversity of opinion regarding the indications for restorative treatment.     

Comparison of three methods for detection of carious lesions in proximal surfaces versus direct visual examination after tooth separation

The present study aimed to compare clinical, fiber-optic transillumination and bite-wing radiographic assessment of carious lesion depth in contacting proximal surfaces with the results obtained by direct visual inspection after tooth separation of the respective surfaces. It is suggested that when a carious lesion is diagnosed as non-cavitated by clinical examination or restricted to enamel by FOTI or radiographic examinations in a population of children with low caries prevalence, dentists should adopt a preventive approach.     

Forecasts of preserved teeth and denture wearers among Danish adults early in the next century

To assist in the planning of oral health services, forecasts were made and goals specified with regard to the numbers of preserved teeth and subjects wearing full or partial dentures among Danish adults in 1992 and 2002. Forecasting was based on existing data, viz. a survey in 1982, including clinical examination, of a representative sample of 20-80-yr-olds (n = 2548), on register data from the National Health Insurance, and survival rates. By combining information from these sources, an increase was estimated in number of preserved teeth among 20-99-yr-olds from 68 million in 1982 to 82 and 92 million in 1992 and 2002, respectively. Correspondingly, a 28% increase in the mean number of remaining teeth was proposed as a goal for the year 2002. A decrease was estimated in the number of denture wearers, from 1.4 million in 1982 to 1.07 and 0.74 million in 1992 and 2002, respectively. The corresponding goal was specified as a 50% reduction in the proportion of denture wearers in 2002. In the middle aged and older part of the population the increasing number of remaining teeth may be expected to imply considerable needs for professional care even in the beginning of the next century.     

The prevalence of clinically undetected occlusal dentine caries in Scottish adolescents

During the third examination of a 3-year anti-caries dentifrice study, bitewing radiographs were read to detect occlusal, as well as approximal caries lesions in 2623 subjects aged 14-15 years. These analyses showed that 1.4% of 2107 upper molars and 7.2% of 2288 lower molars (P less than 0.001), previously scored as clinically 'sound', were carious at a radiographic Grade '3' score (dentinal involvement), and 0.2% had radiographic pulpal lesions. However, for teeth which had been deemed as having a 'suspicion' of caries clinically, but which a 0.6 mm blunted probe would not enter, 29.1% of lower molars had definite radiographic evidence of dentinal caries as compared to only 7.6% of upper molars (P less than 0.001), and a further 0.5% exhibited pulpal extension. In addition, 23.9% of lower premolars also showed dentinal involvement in this group. Overall, 12.1% of lower molars and 3.1% of upper molars showed definite radiographic evidence of occlusal caries in the absence of a firm clinical indication. Thus, the use of bitewing radiographs would appear to be a most helpful adjunct to clinical caries diagnosis, not only of approximal lesions, but also for the detection of early occlusal caries, in these days of generally available topical fluoride.     

Periodontal bone loss in English secondary school children

The prevalence and incidence of periodontal bone loss during a 3-year period was investigated in 373 English secondary school children aged initially 11--12 years. Bone loss was diagnosed from standard radiographs obtained at the baseline and third year examinations of a caries prophylactic clinical trial in which the children were participating. The interproximal spaces mesial and distal to the first permanent molar teeth were examined: 18.5% of subjects had evidence of bone loss at these sites at baseline and 44.0% at third year. In 60 subjects who had all second premolars and first and second permanent molars fully erupted and present at both examinations, the prevalence of bone loss was 36.7% at baseline and 68.3% at third year. Those children who had bone loss recorded at both the initial and final examinations had evidence of significantly more bone destruction at the conclusion of the study than those in whom bone loss was recorded only at the final examination (P less than 0.001).     

Prevalence of dental caries in Latvian 11- to 15-year-Old children and the enhanced diagnostic yield of temporary tooth separation, FOTI and electronic caries measurement

The aim of this study was to test the feasibility of employing clinical visual examination at the D(1) (enamel and dentine caries) diagnostic threshold, fibre-optic transillumination (FOTI), elective temporary tooth separation (ETTS) and electronic caries measurement (ECM) in the environment of an epidemiological study or clinical trial. It also aimed to compare the diagnostic yield of these diagnostic aides and methods. The sample consisted of 182 Latvian children, mean age 13.3 years (range = 10.6-15.7). For 12-year-old subjects the mean D(3)MFS was 10.58 (SD 6.05) and the mean D(1)MFS was 19.97 (SD 10.47). The additional diagnostic yield from FOTI examination of approximal sites was 40.0% at the D(1) threshold. The additional apparent yield for ETTS was 52.8% at the D(1) threshold. ETTS detected 38.3% more carious surfaces than FOTI at the D(1) threshold. Conversely 57 surfaces thought to be carious on FOTI examination were judged sound following ETTS. Although the ECM appeared practical to use, it broke early in the trial and the results obtained prior to breakdown appeared inaccurate. In conclusion, all diagnostic methods were feasible under the conditions of an epidemiological study or clinical trial.     

Hypodontia in 9-year-old Norwegians related to need of orthodontic treatment

The present study reports on the prevalence of hypodontia in a Norwegian population and classifies children with hypodontia according to need of orthodontic treatment. Orthopantomograms of 1953 children (960 girls and 993 boys) at the age of 9 were available for examination. Of the boys registered with hypodontia of second premolars at the age of 9, 11.3% showed late mineralization between the ages of 9 and 12. Only 2.9% of the girls showed late mineralization. The corrected prevalence of hypodontia, excluding third molars, in the girls was 7.2%, in the boys 5.8%, and in both sexes combined 6.5%, the difference between sexes not being statistically significant. Of the children with hypodontia, 86.6% lacked only one or two permanent teeth. The most frequently missing teeth were the mandibular second premolars, the maxillary second premolars, and the maxillary lateral incisors, in that order. Classification of children with hypodontia according to need of orthodontic treatment showed that about two-thirds had hypodontia only of single posterior teeth with a moderate need of treatment. About one-third had hypodontia involving anterior teeth, and only 3.1% had hypodontia of two or more teeth in the same quadrant with a great need of treatment.