Progression of approximal caries in primary molars and the effect of Duraphat treatment

The progression of caries lesions over a 2-yr period was studied in 3–6-yr-olds. All 468 children included in the study lived in an area during 1977–85 (Malmö, Sweden) with a low fluoride concentration (0.2 ppm) in the drinking water. Radiographs were taken with a standardized periodic identical technique. Caries lesions were scored on the distal surface of the first and on the mesial surface of the second primary molars (maximum 8 per child) according to G röndahl et al . Half of the children were treated semiannually with a fluoride varnish (Duraphat). In all, 421 surfaces with caries at baseline were available at the 1-yr examination and 369 at the 2-yr examination. After 1 yr, 34.1% of the shallow enamel lesions remained unchanged, while a progression was seen in 60.9%. 5.1% had been restored. The corresponding figures after 2 yr were 20.6, 52.1 and 27.3%. Of the deeper enamel lesions at baseline, 28.8% remained unchanged after 1 yr and 13.7% after 2 yr. Of the lesions extending into the dentin, 81.5% had been restored after 1 yr and all after 2 yr. When evaluating the effect of Duraphat, only the percentage of individuals with one or more superficial enamel lesions showing progression was determined. After 1 yr, 51.2% in the Duraphat ( n = 41) and 82.8% in the control group ( n = 29) showed progression (restored surfaces included). The corresponding figures after 2 yr were 66.7 ( n = 42) and 91.2% ( n = 34). The differences after both 1 yr and 2 yr were statistically significant. The main conclusions from this study are that the progression rate of approximal caries lesions in primary molars is comparatively high and that semiannual application of a fluoride varnish has a certain cariostatic effect on the progression.     

Progression rate of approximal carious lesions in Swedish teenagers and the correlation between caries experience and radiographic behavior. An analysis of the survival rate of approximal caries lesions

The objectives were to study the progression rate of approximal caries in 14 to 19-year-old adolescents and to assess the influence of experience of previous caries as a predictor of caries progression during the following years. The study population comprised 100 adolescents, all 19 years old, randomly selected. In all, there were 93 adolescents included in the study, for whom all sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. It could be noted that 32% of the adolescents had had at least one bitewing examination every year from 14 to 19 years of age. At the age of 14, 38% of the males and 24% of the females were radiographically without any sign of caries lesions (caries-free). The median survival time of initial caries in the present study was >5 years, while for manifest caries it was 3.2 years. It was found that 37% of the surfaces with manifest caries in males and 18% of the corresponding surfaces in females were restored within a year. The results show that experience of previous caries does not seem to be a significant indicator and does not influence when the next radiographic examination should be performed. It is thus concluded that individualized bitewing examination is the exception rather than the rule.     

Progression rate of approximal carious lesions in Swedish teenagers and the correlation between caries experience and radiographic behavior. An analysis of the survival rate of approximal caries lesions

The objectives were to study the progression rate of approximal caries in 14 to 19-year-old adolescents and to assess the influence of experience of previous caries as a predictor of caries progression during the following years. The study population comprised 100 adolescents, all 19 years old, randomly selected. In all, there were 93 adolescents included in the study, for whom all sets of bitewing radiographs from 14 up to and including the age of 19 were assessed with respect to approximal caries. It could be noted that 32% of the adolescents had had at least one bitewing examination every year from 14 to 19 years of age. At the age of 14, 38% of the males and 24% of the females were radiographically without any sign of caries lesions (caries-free). The median survival time of initial caries in the present study was >5 years, while for manifest caries it was 3.2 years. It was found that 37% of the surfaces with manifest caries in males and 18% of the corresponding surfaces in females were restored within a year. The results show that experience of previous caries does not seem to be a significant indicator and does not influence when the next radiographic examination should be performed. It is thus concluded that individualized bitewing examination is the exception rather than the rule.     

Optical quantification of approximal caries in vitro.

A fluorescent dye was applied to extracted premolars with either early artificial lesions or natural white-spot lesions. The teeth were placed in an approximal geometry, and with a specially designed fibre-optic probe the fluorescence of the dye was measured in the lesions. The same fibre-optic probe was used to measure the transmission of light at a wavelength where the dye does not absorb. This transmission of light was used to correct the fluorescence for attenuation by the intermediate layer of sound enamel situated between the probe and the lesion. Both signals varied with time because of the necessary addition of ethanol during the measurement. The mineral loss from the lesions was measured with wavelength independent microradiography (WIM) for the artificial lesions, and the optical caries monitor (OCM) for the natural white-spot lesions. The correlation coefficient between corrected fluorescence and mineral loss was r = 0.86. The results indicate that measurement of dye uptake may be a very sensitive method to diagnose early approximal caries lesions and may enable quantification of these lesions.     

Effect of intensified caries prevention on approximal caries in adolescents with high caries risk.

The aim of this study was to evaluate the effect of two preventive programs carried out in Public Dental Clinics for children with high caries risk. From all the 13-year-olds living in Kuopio (n = 871), 323 (37%) were selected as a high-risk group on the basis of the level of salivary mutans streptococci or DS score. They were randomly divided into two groups. The first group continued with the preventive care they had received before the study. The dentists treating the children in the second group were specifically informed about their high caries risk, and instructions concerning intensified prevention were given. For comparison, half of the 13-year-olds with low caries risk were included in the study (group 3, n = 248). No special instructions concerning these children were given. After 2 years, approximal caries increment in the two risk groups was three times that of the low-risk group (2.6, 2.3 and 0.7 in groups 1-3, respectively). There was no significant difference between the two risk groups in spite of the fact that significantly more preventive procedures were provided for group 2 than for group 1. The results indicate that assessment of the subjects as high and low-risk groups was successful, but caries prevention targeted for the risk groups failed to lower the rate of caries to the same level as that of the children with an anticipated low risk. For children at high risk, the intensified prevention program monitored by dental authorities was no more successful than prevention planned by individual dentists.     

Progression of proximal caries in primary teeth in relation to radiographic scoring codes

The posterior bitewing radiographs of 50 children from a Duraphat clinical trial were re-examined to compare the information provided on progression of caries of two scoring systems, that of Murray & Majid (1) and that of Pitts (2). Pitts' scoring system (Method 1), by recording the disease process at an earlier stage, and by avoiding the unnecessary loss of data, provided a more complete overall picture of the carious process than the scoring system used by Murray & Majid (Method 2). The progression rates were found to be significantly faster with Method 2 (P less than 0.05). With Method 1, a mean of 60% of enamel lesions per subject had remained confined to enamel 12 months later, the corresponding figure for Method 2 was 37%. Method 2, by excluding outer enamel lesions and overlapped surfaces, introduces biases which favour overestimating the proportion of lesions deemed to have progressed. The diagnostic criteria used by Murray & Majid lead to an overestimation of the rate of progression of caries in primary teeth.     

Prevalence of approximal caries in posterior teeth in 15-year-old Swedish teenagers in relation to their caries experience at 3 years of age

The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospectively followed Swedish population (n = 568), with special reference to their caries experience at the age of 3 years. Only approximal surfaces were recorded, since all children in the Community of J?nk?ping have had fissure sealing performed on all caries-free permanent molars. At 15 years of age, the mean number of approximal tooth surfaces with initial caries lesions (D(i)a), manifest caries lesions and fillings (D(m)Fa) and total caries experience and fillings (D(i + m)Fa)--recorded on bitewing radiographs--was 2.78 , 0.45 and 3.23, respectively. One third of the adolescents had no approximal caries or fillings; the D(i)a constituted 86% of the D(i + m)Fa. Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age (41 vs. 17%). Furthermore, children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries (37 vs. 17%). All these differences were statistically significant (p < 0.001). Additionally, early childhood caries experience (developed before 3 years of age) had a greater predictive value than late childhood caries experience (developed between 3 and 6 years of age) concerning approximal caries at 15 years of age.     

Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age

The aim was to investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience (including initial caries lesions) at the age of 15 years (n = 568). Data were selected from examinations, interviews and questionnaires at 1 and 3 years and bitewing radiographs at 15 years. Four levels of cut-off points for the statistical analysis were used: DFa = 0, > 0, > or = 4 and > or = 8. In the final logistic regression analyses, mother's self-estimation of her oral health care being less good remained statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa > or = 4: (1) female gender, (2) plaque on maxillary incisors at 1 year, (3) mother's self-estimation of her oral health care being less good and (4) father being less satisfied with his social situation. Two variables predicted DFa > or = 8: (1) toothbrushing with fluoride toothpaste just once a day, and (2) father being less satisfied with his social situation. Furthermore, children who failed to attend the examination at 1 year of age had 6.95 +/- 5.36 (mean +/- SD) DFa at 15 years compared with 3.10 +/- 3.85 for children who were examined at 1 year of age (p < 0.01). To conclude, factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents.     

Statistical relationship of morsal to bucco-lingual, approximal and sulcal caries in rats.

The correlation of morsal with sulcal, bucco-lingual and approximal caries scores of rats was compared. The morsal with bucco-lingual plus approximal correlation was significantly better than the morsal with sulcal correlation. When reporting rat caries, sulcal scores should be reported alone; morsal scores should be grouped with bucco-lingual and approximal to demonstrate total smooth surface lesions.     

Errors in diagnosis of approximal caries on bitewing radiographs

ABSTRACT The number of overlapped and unreadable surfaces occurring on bitewing radiographs of 1,417 children participating in a clinical trial was recorded. Of erupted surfaces, only 73.3 % were completely visible to both participating examiners. Interexaminer and intraexaminer reproducibility ratios were calculated according to the F.D.I, recommendations. The ratios obtained in the present study ranged from 0.06 to 0.36. Almost 57 % of approximal cavities were diagnosed on radiographic examination only: 21 % were diagnosed clinically, but were not apparent on the radiographs.     

Restorative treatment decisions on approximal caries in Norway

A random sample of dentists in Norway were asked which radiographic criterion for assessing the initiation of restorative treatment of approximal caries they would use, and which type of cavity preparation and filling material they would prefer for a distal lesion on an upper second premolar. Only 19 per cent stated that they would treat approximal lesions confined to enamel, with 81 per cent opting to wait until lesions had reached dentine, compared with 66 per cent in a similar study performed in 1983. The tunnel preparation was cited most often as the preparation of choice (47.3 per cent), while 28.2 per cent preferred traditional class II preparations and 24.3 per cent a saucer shaped preparation. Only 15.5 per cent of the dentists chose amalgam as the restorative, 15.8 per cent composite, 22.3 per cent a conventional glass ionomer cement, 7.2 per cent a resin modified glass ionomer cement and 22.4 per cent a combination of glass ionomer and composite. There has been a shift in operative treatment criteria among the majority of dentists in Norway from 1983 to 1995, with most now waiting until the lesion is diagnosed in dentine radiographically before restoring. Most dentists prefer new preparation techniques for approximal caries using tooth coloured materials. Only every fifth dentist has amalgam as a first choice for approximal restorations in the posterior region.     

Optical quantitation and radiographic diagnosis of incipient approximal caries lesions.

The objectives of this study were to test the applicability of photocell measurements in approximal caries diagnosis and to evaluate the use of radiographs as validating criterion. Forty extracted premolars were selected, and the progression of the approximal lesions was graded clinically and radiographically by three examiners. Each tooth was transilluminated from the occlusal surface, and the throughput of light at the approximal surface was measured by a photocell. Together with clinical examination, the results of microradiographic analysis served as validating criterion in this study. The results indicate that photocell measurements can be useful in the diagnosis of incipient approximal caries lesions. Radiographs have a restricted value as validating criterion in diagnostic studies pertaining to incipient caries.     

Detection of approximal caries in 5-year-old Swedish children

The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. Two hundred and sixty-seven consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs (decayed, missing and filled surfaces) value (canines and molars), the number of occlusal dmfs, the frequency of intake of between-meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs value without bitewing examination was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33% at least one enamel lesion that were detected from bitewing examination only. The gain from adding bitewing examination to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist's overall judgement with an average precision of 73%; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33% of the 5-year-olds, representing a low caries prevalence population, benefited from bitewing examination. The ability to identify these children from the predictors was, however, limited.     

Body adiposity status in teenagers and snacking habits in early childhood in relation to approximal caries at 15 years of age

Background.  The prevalence of overweight and obesity in children is steadily increasing in many countries. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits.
Objective.  The purpose of this study was to investigate the relationship between body weight status in adolescents and snacking habits in early childhood to approximal caries prevalence at 15 years of age.
Methods.  This study is part of a series of surveys of oral health in children followed from the ages of 1 year to 15 years. Body adiposity status was estimated at 13.5–16.4 years using the International Obesity Task Force cut-off values [age-specific body mass index (isoBMI)]. Information about snacking habits in early childhood was collected from interviews conducted at 1 year and 3 years. Approximal caries information was obtained from bitewing radiographs at 15 years. Data related to isoBMI and approximal caries were available in 402 teenagers.
Result.  Adolescents with isoBMI ≥ 25 ( n  = 64) had an approximal caries prevalence that was a mean of 1.6 times higher than those with isoBMI < 25 ( n  = 338) (4.64 vs. 2.94; P  = 0.014). Furthermore, children's snacking habits at an early age were associated with approximal caries at 15 years.
Conclusion.  Overweight and obese adolescents had more approximal caries than normal-weight individuals. Moreover, the frequent consumption of snacking products during early childhood appears to be a risk indicator for caries at 15 years. Future preventive programmes should therefore include, on a multidisciplinary level, strategies to prevent and reduce both obesity and dental caries at an early age.     

Progression of posterior approximal carious lesions in Norwegian teenagers from 1982 to 1986

The purpose of the present study was to assess the progression rate of approximal carious lesions in Norwegians aged 14-18 years. Sixty-five subjects whose average age at base line was 14.9 years had one pair of posterior bitewing radiographs taken annually from 1982 to 1986. One examiner assessed all radiographs in chronologic order, recording degree of approximal caries. When a surface changed from one state to another, it was assumed to have changed at the midpoint between the two examinations. A total of 590 lesions were observed. Uncensored lesions took on average nearly 3 years to penetrate the enamel. Inclusion of right censored lesions by the Kaplan-Meier approach increased the uncensored estimate by approximately 20%. The average for doubly censored lesions was about 6.5 years. Low average rate of caries progression coupled with wide variations between lesions and among subjects suggests a need for individually prescribed recall routines.     

Statistical relationship of morsal to bucco-lingual, approximal and sulcal caries in rats

The correlation of morsal with sulcal, bucco-lingual and approximal caries scores of rats was compared. The morsal and bucco-lingual plus approximal correlation was significantly better than the morsal with sulcal correlation. When reporting rat caries, sulcal scores should be reported alone; morsal scores should be grouped with bucco-lingual and approximal to demonstrate total smooth surface lesions.     

Grey-scale reversed radiographic display in the detection of approximal caries

OBJECTIVES: Purpose of this study was to determine the influence of grey-scale reversal of digital radiographic images on the detection of proximal caries. METHODS: Five observers assessed digital bitewing radiographs (Sidexis((R)), Sirona) of 320 unrestored surfaces of extracted posterior teeth embedded in 20 models, simulating pairing of maxillary and mandibular arches, using a six-category caries rating scale. Images were displayed in normal [N] and inverse [IN] mode at different image sizes (display ratio: 1:1, 1:2, 1:7) on a cathode-ray tube monitor (Nokia 446 XS) and a TFT display (Panasonic LC 50 S). Validation standard was defined as histological lesion depth. Validity was expressed as areas under receiver operating characteristic curves (AUC) calculated for two levels of histological caries penetration: presence of caries and presence of a dentine lesion. The factors 'inverse display', 'image size on-screen' 'display type' and 'disease cut-off' were analysed by repeated measures ANOVA. RESULTS: Inverse image display significantly influenced the diagnostic validity (P=0.014), but a reduced accuracy was only seen at the lowest image size (AUC (SE): [N] 0.64 (0.02); [IN] 0.62 (0.02)). At the validation threshold 'dentine caries' approximal caries detection deteriorated when using grey-scale reversal (AUC (SE): [N] 0.71 (0.02); [IN] 0.69 (0.02)). CONCLUSIONS: In conclusion, grey-scale reversal of digital radiographs did not optimise approximal caries detection and aggravated the detectability of dentinal lesions.