Comparison of tooth surface-specific dental caries attack patterns in US schoolchildren from two national surveys

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia

AIM

To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia.

MATERIALS AND METHODS

A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23.

RESULTS

All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child.

CONCLUSION

Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene.

CLINICAL SIGNIFICANCE

Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

Efficacy of tooth brushing via a three-dimensional motion tracking system for dental plaque control in school children: a randomized controlled clinical trial

BACKGROUND

School children are in a developmental period in which permanent teeth replace primary dentition. It is also a period with a high incidence of gingivitis and caries, which can be improved with adequate tooth brushing. Advances in information technology have led to the development of smart health devices that assist in tooth brushing. We compared the effectiveness of computer-assisted toothbrushing using a toothbrushing instruction (TBI) method called the smart toothbrush and smart mirror (STM) system with that of conventional TBI (verbal instructions) for plaque control in school children.

METHODS

This randomized controlled clinical trial analyzed and compared the reduction of the modified Quigley-Hein plaque index between the two methods in 42 school children. The participants were randomly assigned to the STM system group (n = 21) or conventional-TBI group (n = 21). The plaque indices were evaluated at baseline, immediately after TBI (day 0), and 1 week and 1 month after TBI.

RESULTS

The STM system and conventional TBI led to an average reduction of 40.50% and 40.57%, respectively, in whole mouth plaque. Reductions in the plaque indices within each tested time period were observed in both groups (P < 0.001), and the mean plaque reduction did not differ between the two groups (P = 0.44).

CONCLUSIONS

The present study tested a computer assisted system for TBI, more studies are needed to confirm its usefulness in different objectives. Clinical relevance The computer-assisted STM system may be an alternative of TBI for children. Trial registration ClinicalTrials.gov (NCT04627324) Registered 13/11/2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04627324 .

Biochemical and Mechanical Analysis of Occlusal and Proximal Carious Lesions

A precise evaluation of caries excavation endpoint is essential in clinical and laboratory investigations. Caries invasion differentiates dentin into structurally altered layers. This study assessed these changes using Raman spectroscopy and Vickers microhardness. Ten permanent molars with occlusal and proximal carious lesions were assessed and compared at 130 points utilizing four Raman spectroscopic peaks: phosphate v1 at 960 cm^-1, amide I (1650 cm^-1), amide III (1235 cm^-1) and the C-H bond of the pyrrolidine ring (1450 cm^-1). The phosphate-to-amide I peak ratio and collagen integrity peak ratio (amide III: C-H bond) of carious zones were calculated and compared in both lesions. The former ratio was correlated to 130 Vickers microhardness indentations through lesions. The caries-infected dentin (CID) exhibited low phosphate peak, but higher amide I, III and C-H bond peaks than other zones in both lesions. The peaks in amide regions (I and III) varied in occlusal versus proximal lesions. A high correlation was found between mineral: matrix peak ratio and equivalent microhardness number within carious lesions, while the collagen integrity peak ratio was applied in proximal lesions only. Raman spectroscopy detected changes in the mineral and matrix contents within different carious zones and regions.

Posterior tooth autotransplantation: a case series

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. Autotransplantation can provide a long-term, cost-effective and biological solution for adolescent patients with congenitally missing teeth or significantly compromised teeth when a suitable donor tooth is available. Successful autotransplantation of immature teeth can offer many advantages for a growing patient, including a normally functioning periodontium, proprioception and preservation of alveolar bone volume. Even in the event that an autotransplanted tooth does eventually fail, the bone and soft tissue conditions are likely to be conducive for subsequent implant treatment. Despite the significant physiological and cost-benefit advantages, tooth autotransplantation remains relatively underutilized, as the procedure is considered to be technique-sensitive. Although carefully considered individual case selection and surgical skill are the critical determinants for success, advances in three-dimensional computed tomography and rapid prototyping have the potential to simultaneously reduce the technique sensitivity and increase the predictability of the autotransplantation procedure. It is hoped that this case series will provide greater awareness and an appreciation of the tremendous value of autotransplantation for the management of patients with congenitally missing or significantly compromised posterior teeth.

The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex

The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.

Chemical and biological properties of new sealant-use cement materials

OBJECTIVES

The aim of this study was to investigate the chemical and biological properties of newly developed bioactive cements, modified such that they are largely composed of calcium, phosphate and fluoride. We investigated whether newly developed bioactive cements have the potential to further protect surrounding hard tissue and enhance remineralization of demineralized tissue by additional ion release.

METHODS

We developed four types of novel GIC based on Fuji VII, modified with phosphate and fluoride and calcium. Compressive strength tests were performed following JIS T6607 methods. Ion release of calcium, phosphate and fluoride after 24 h storage were determined using atomic absorption spectroscopy, colorimetry and an ion-specific electrode. Fluoride releases and recharge were measured at 1, 3, 6, 12, 24 and 168 h. Viability was determined by colony-forming units. Inhibitions of biofilm formation and cell proliferation activity were measured.

RESULTS

The GIC groups showed no significant differences in compressive strength after 1 and 7 days. The rates of fluoride ion release from newly developed GICs were significantly greater than those of Fuji VII, Fuji III and BS. All materials except TM can be recharged with fluoride ions. Compared with the control group, which did not release fluoride ions, all materials showed significantly stronger antibacterial effects. The newly developed GICs and BS showed less biofilm formation than Fuji VII and Fuji III.

SIGNIFICANCE

Three of four newly developed GICs modified with calcium, phosphate and fluoride ions were found to be superior to other sealant materials.

Prevalence of dental caries among male students aged 15-17 years in southern Asir, Saudi Arabia

Background

Dental caries had been studied by several studies in Saudi Arabia among different age groups and at various places. According to World Health Organization (WHO), assessment of caries at 15 years of age is more meaningful. The objective of this survey was to assess the prevalence of dental caries among 15–17-year teenage students in Abha, Saudi Arabia. Results of the present study can be used as baseline data for future oral health interventions for the population.

Methods

A stratified cluster random sampling was followed in selecting the students. The clinical data was collected using dentition status component of WHO oral health assessment form 2013. Five investigators were trained and calibrated with 20 subjects for two successive days (Cronbach's Alpha = 0.91). Data was analyzed for descriptive statistics and Mann-Whitney U test was applied to compare the DMFT scores.

Results

Prevalence of dental caries among the study population was found to be 72.9%. The DMFT scores were found to be highest in the posteriors (90.7%). First permanent molar was the most common tooth affected by dental caries in all quadrants.

Conclusion

The present study revealed that there is a high prevalence of dental caries among students aged 15–17 years in Abha, Saudi Arabia. Caries prevalence was highest in mandibular posterior segments, however, it was lowest in mandibular anterior segments. There is an urgent need for both preventive and curative dental health services in the region. It is recommended that a coordinated school dental program may be initiated in the area.

Quantitative characterization and micro-CT mineral mapping of natural fissural enamel lesions

OBJECTIVES

The aim of this study was to characterize the mineral distribution pattern of natural fissural enamel lesions and to quantify structural parameters and mineral density of these lesions in comparison to proximal white spot enamel lesions.

METHODS

Imaging was undertaken using a high-resolution desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of images into true mineral density values. The value of lesion parameters including the mineral density and the thickness of the surface layer of the enamel lesion were extracted from mineral density profiles.

RESULTS

The thickness of the surface layer showed variation among different lesions and it ranged from 0-90 μm in proximal lesions and 0-137 μm in fissural lesions. The average thickness of surface layer in fissural lesions was significantly higher than smooth surface proximal lesions. Sound fissural enamel showed lower mineral density compared to proximal enamel.

CONCLUSION

Micro-CT and the suggested de-noising and visualization method provide an efficient high-resolution approach for non-destructive evaluation of fissural lesions. Using these methods, the current study revealed the exclusive pattern and structure of fissural enamel lesions which may provide a basis for future studies on prevention and remineralization of these lesions.

CLINICAL SIGNIFICANCE

The common demineralization pattern of fissural lesions, which indicates the extension of the lesion in two directions towards the pulp horns, may explain the early inflammation and symptoms of the pulp in fissural lesions even when the lesion base appears far from the pulp roof in normal radiographs. In addition, the presence of the surface layer, indicates that vigorous probing of the occlusal fissures may lead to breakage and cavitation of the enamel lesions.

Caries pattern in primary molars in Dutch 5-year-old children

AIM

The aim of this study was to investigate the difference in caries prevalence based on quadrant dmfs data between first and second primary molars in 5-year-old Dutch children.

STUDY DESIGN

Cross-sectional observational study. METHODS AND STATISTICS: For this study 692 children, all insured by a "Health Insurance Fund", living in one of four selected cities in The Netherlands were asked to participate in the study. From the original cohort 435 children (49% girls) participated. Clinical examinations were performed and only carious lesions with involvement of the dentine were reported. Lesions on the occlusal, buccal, palatinal/lingual, mesial and distal surfaces as well as lesions in buccal and palatinal pits and fissures were reported separately. No radiographs were taken. Systematic differences in dmfs between first and second molars in the same quadrant of each primary dentition were tested with the Wilcoxon signed rank test.

RESULTS

Second primary molars, even after correction for caries in pits and buccal/palatinal fissures, had a statistically significant higher total dmfs than the first primary molars. The differences were mainly found on the occlusal surfaces. On proximal surfaces, the first primary molars had significant more caries than the second primary molars. The d-component constituted the major part of the caries index.

CONCLUSIONS

Second primary molars, corrected for decay in the pits and buccal/palatinal fissures of this molar, are more affected by caries than first primary molars and that the differences in caries prevalence are the largest on the occlusal surface. The specific site of the caries found suggests that developmental disturbances in second primary molars may attribute to their prevalence.

Microleakage resistance of minimally invasive Class I flowable composite restorations

Minimally invasive flowable composite Class I restorations are widely used. However, flowable composites are characterized by low filler contents, modified resin formulations, low moduli of elasticity, low viscosity, generally poor mechanical properties, and decreased long-term stability. The purpose of this study was to compare the microleakage resistance of a wide variety of flowable composites used with their manufacturers' recommended bonding systems to that of a long-used and widely studied microhybrid composite when placed as minimally invasive occlusal restorations. Molar teeth were prepared in a standardized manner, restored, artificially aged, stained, sectioned, evaluated, and analyzed. Microleakage varied substantially, by a whole order of magnitude, among the material groups tested. The control group, a conventional microhybrid composite material, leaked significantly less than all the flowable composite groups. Microleakage varied very slightly among measurement site locations. Tiny microscopic bubbles were seen within many of the flowable composite specimens, as were a few voids.

Incidence of caries lesions in approximal surfaces: a radiographic study of a general adult Danish population

The aim was to describe the incidence of caries lesions in a randomly selected adult population, and to identify risk factors related to the incidence of caries lesions in approximal surfaces. In 1997, 616 adults participated in a study including a radiographic survey. In 2003 these individuals were contacted again and offered a second radiographic survey; 473 consented and attended this examination. In approximal surfaces, presence/absence of caries lesions and presence and type of coronal fillings were recorded. The incidence of caries lesions in surfaces with no caries lesions in 1997 was studied. Potential risk factors included information at three levels: (1) person, (2) tooth, and (3) surface. The analysis was carried out by multilevel logistic regression. For the analyses 23,701 approximal surfaces were eligible. In 23,243 approximal surfaces no caries lesions were detected in 1997, 17,007 of these were surfaces without fillings, and 6,236 were filled surfaces. In unfilled surfaces several factors affected the risk for development of a caries lesion: young age, high number of fillings, number of teeth and status of the adjacent surface. In filled surfaces few factors affected the incidence of caries lesions: status of the adjacent surface, smoking and distal surfaces. Differences in risk factor patterns for the incidence of caries lesions were found for unfilled and filled surfaces. The study emphasizes the importance of assessing factors related to the incidence of caries lesions in adults. Further it underlines the need to analyse the fate of filled surfaces separately, because once a surface has received a filling it needs continuous attendance.

UK National Clinical Guidelines in Paediatric Dentistry: Use of fissure sealants including management of the stained fissure in first permanent molars

International Journal of Paediatric Dentistry 2010 Summary.  The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated to all Consultants in Paediatric Dentistry in the UK, to the Council of the British Society of Paediatric Dentistry (BSPD), and to people of related specialties recognised to have expertise in the subject. The final version of the guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. For those wishing further detail, the process of guideline production in the UK is described in the International Journal of Paediatric Dentistry 1997; 7: 267-268. This guideline is an update on the previously published BSPD policy document on fissure sealants. (Nunn et al., Int J Paed Dent 2000; 10: 174-177).

Factors increasing the caries risk of second primary molars in 5-year-old Dutch children

BACKGROUND

Caries is still a prevalent condition in 5-year-old children. At present, knowledge regarding some aetiological factors, like deciduous molar hypomineralization (DMH), is limited.

AIM

To investigate aetiological factors both directly and indirectly associated with caries in second primary molars.

DESIGN

Of 974 children invited to participate in the study, 386 children were examined clinically with visual detection of caries. Only carious lesions determined to have reached the dentine were recorded. Information about tooth brushing frequency, education level of the mother, and country of birth of mother and child, was collected by means of a multiple-choice questionnaire. Parents of 452 children filled in the questionnaire. Complete clinical and questionnaire data were available for 242 children. Statistical analysis of the effect of the independent variables was undertaken using the Pearson's chi-squared test.

RESULTS

Deciduous molar hypomineralization (P = 0.02) and the country of birth of the mother (P < 0.001) were positively associated with caries prevalence.

CONCLUSIONS

Deciduous molar hypomineralization and the country of birth of the mother play a role in the prevalence of dental caries. These aetiological factors associated with childhood dental caries need to be investigated further in longitudinal clinical trials.

Caries and background factors in Norwegian and immigrant 5-year-old children

OBJECTIVES

The purpose of this study was to assess the caries status of 5-year-olds in a low caries area, and study associations between dental caries and parent-related factors: parents' education, national origin, oral health behaviours and attitudes.

METHODS

The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes.

RESULTS

Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non-western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child's tooth brushing (OR = 2.8), parents' brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8).

CONCLUSION

Caries prevalence in 5-year-olds was strongly associated with parent-related factors signifying that information on parents' socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non-western children whose parents have low education.

Caries patterns in primary dentition in 3-, 5- and 7-year-old children: spatial correlation and preventive consequences

This study aimed to contribute to the descriptive information of oral health status in the primary dentition, especially concerning the distribution and spatial correlation of lesions. Data were obtained from two surveys. In the Signal-Tandmobiel project 4,468 7-year-old children in Flanders (Belgium) were selected by a stratified clustered random sample. In the Tandje de Voorste - Smile for Life (TDV) project, data were obtained from 1,291 3-year-old and 1,315 5-year-old children. The children were examined by trained dentists, using standardized and widely accepted criteria, based on the British Association for the Study of Community Dentistry criteria. At the population level, symmetry in the prevalence of caries experience across the midline was tested at the tooth and tooth surface levels using generalized estimating equations and alternating logistic regression (ALR) approaches. Individual symmetry was tested using an approach described by Hujoel et al. [J Dent Res 1994;73:1575-1580]. Descriptive observations suggested a symmetrical distribution of caries experience at the population level. The null hypothesis of symmetry could not be rejected at a 0.05 level, suggesting that caries experience might be symmetric in the deciduous dentition. Based on the ALR approach, 2 x 2 associations of caries experience at the tooth and surface levels, both in 5- and 7-year-olds, appeared to be strongest for the left-right pairs in the mandible, followed by the left-right pairs in the maxilla. At the individual level the hypothesis of random caries pattern was rejected (p < 0.0001). In conclusion, at the population level the null hypothesis of left-right symmetry could not be rejected, while at the individual level lesions tended to cluster on one side of the mouth.

Pattern and severity of early childhood caries

OBJECTIVES

The aim of this study was to investigate the association between selected social and behavioural variables and the pattern and severity of early childhood caries (ECC) within a community child population.

METHODS

A cross-sectional sample of 2515 children aged 4-5 years were examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) indices and a self-administered questionnaire was used to obtain information regarding social, demographic, birth, infant feeding, oral and general health attitudes. Children with caries (847) were divided into anterior or posterior caries pattern groups and severe (dmfs score > or =6) or non-severe (dmfs score <6) caries groups. The data were analysed using a chi-square test and modelled using a logistic regression procedure.

RESULTS

Significant variables associated with anterior ECC pattern were ethnicity other than Caucasian (OR = 2.1, 95% CI = 1.4-3.1), sipping from the bottle during the day (OR = 1.9, 95% CI = 1.3-2.7), male gender (OR = 1.6, 95% CI = 1.2-2.2) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2). Significant variables associated with severe ECC form were sipping from the bottle during the day (OR = 2, 95% CI = 1.4-2.8), maternal age at birth < or =24 years (OR = 1.8, 95% CI = 1.3-2.7), ethnicity other than Caucasian (OR = 1.6, 95% CI = 1.1-2.5) and sleeping with a bottle at night (OR = 1.5, 95% CI = 1.1-2.2).

CONCLUSIONS

Infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4-5-year-old Australian children.

Natural history of treatment outcomes of permanent first molars

BACKGROUND

Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants.

METHODS

The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars.

RESULTS

Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care.

CONCLUSIONS

Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations.

CLINICAL IMPLICATIONS

Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

Prevention. Part 7: professionally applied topical fluorides for caries prevention

This paper reviews the use of professionally applied topical fluorides (PATF) in caries prevention. PATFs are indicated for children and adults with one or more decayed smooth surfaces and/or those who are at high caries risk. Frequency of administration depends on the patient's caries risk, and is usually every 6 months. The effectiveness of fluoride varnish and gel applications has been well established in caries prevention trials involving permanent teeth. Although both types are effective, varnish may be preferred because it is easier to apply, reduces the risk of fluoride over-ingestion, and has greater patient acceptance. Fluoride foams are similar products to gels, but have not been tested clinically. The use of in-office two-part rinses is not recommended because they have not been proven effective. A cleaning, or prophylaxis, is not necessary before the application of topical fluoride for caries prevention. In conclusion, when used appropriately, PATFs are a safe, effective means of reducing caries risk among high-risk populations.

A two-year longitudinal study of dental caries in permanent first molars of Korean elementary schoolchildren

OBJECTIVE

This longitudinal study investigated dental caries increment in permanent first molars of Korean elementary schoolchildren.

METHODS

A convenience sample of 722 children aged 7-9 years attending one urban elementary school was examined at baseline, with follow-up examinations at one and two years. Coronal surfaces of permanent first molars were scored with regard to caries experience and sealant status.

RESULTS

Among sound occlusal surfaces at baseline, 21 percent of upper and 25 percent of lower surfaces developed caries during the two-year interval. In teeth that erupted between baseline and the first follow-up exam, over 10 percent of occlusal surfaces developed caries. Pit and fissure caries accounted for 93 percent of all new carious surfaces, while sealants had been placed on 16 percent of occlusal surfaces during the study.

CONCLUSIONS

Recognizing the limitations of this convenience sample, dental sealants should be used more widely in this Korean population, and should be applied soon after tooth eruption.

Trends in preventive care: caries risk assessment and indications for sealants

BACKGROUND

In the 21st century, risk assessment models will continue to be developed. By understanding patients' susceptibility to disease, better treatment and preventive regimens can be offered. As the causative agent of dental caries is bacterial, the interaction between the susceptible host, the causative agent and the environment determine whether caries occurs--regardless of the patient's age.

CLINICAL IMPLICATIONS

This article reviews risk assessment for dental caries and the implication for developing preventive strategies. It also describes the indications and uses of sealants in the prevention of dental caries.

Effectiveness of sealant treatment over five years in an insured population

BACKGROUND

The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices.

METHODS

A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization than that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis, based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years.

RESULTS

During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect.

CONCLUSIONS

In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years.

CLINICAL IMPLICATIONS

Based on the five-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries.

Prevalence and attitudes to fissure sealants in the general dental service in England

OBJECTIVES

The study objectives were to investigate changes in the prevalence of fissure sealants over a 5-year period among a comparable group of 14-15-year-old regular dental attenders registered with general dental practitioners in 1989 and 1994, and to investigate attitudes towards this form of care amongst general dental practitioners in 1994.

METHODS

Random samples of 14-15-year-old pupils were selected from school lists in three areas in England (Doncaster, Hereford/Worcester and Wycombe) in 1989 and 1994. Once parental consent had been gained to examine the children, the Dental Practice Board (DPB) indicated which subjects were 'regular attenders', only these subjects were included in the study. All the subjects in each area were examined by a single trained and calibrated examiner using a standardized technique. In 1994, a group of randomly selected dentists in each area completed a telephone questionnaire assessing attitudes and treatment patterns regarding fissure sealants.

RESULTS

In 1989, 2836 letters were posted to parents asking for consent to examine their child and 2174 positive responses were received (response rate 77%). Of the 1919 children examined, 459 were classed as regular attenders, 140 in Doncaster, 159 in Hereford/Worcester and 160 in Wycombe. In 1994, 2560 consent letters were distributed to children in school to pass to their parents and 1587 positive responses were received (response rate 62%). Of the 1388 children examined, 891 were classed as regular attenders, 294 in Doncaster, 318 in Hereford/Worcester and 279 in Wycombe. Large rises in sealant prevalence were observed in all areas, but particularly in Doncaster where sealant prevalence increased from 13% in 1989 to 50% in 1994. In Hereford/Worcester it increased from 25% to 47% and in Wycombe it increased from 16% to 30%. There was also a fall in mean DMFT in all areas. In Doncaster it fell from 2.97 in 1989 to 1.82 in 1994, in Hereford/Worcester it fell from 2.60 to 1.83 and in Wycombe it fell from 1.86 to 1.29. In all three areas the changes in sealant prevalence and DMFT were statistically significant. The questionnaire revealed positive attitudes towards fissure sealants and their usage as well as a number of areas of concern that could potentially hinder sealant usage.

CONCLUSIONS

Dramatic increases in sealant prevalence and considerable reductions in dental caries among these regularly attending adolescents have been demonstrated. Some concerns were highlighted regarding sealant usage, which may be prejudicing further increases in their application.

Comparison of two indices of caries patterns in 3-6 year old Brazilian children from areas with different fluoridation histories

The purpose of this study was to define the pattern of caries in 3-6 year old children from two districts in Araraquara, SP, Brazil, fluoridated for more than 10 years and from a much more recently fluoridated one in the same city, using two different indices. The study included 1,066 children (903 from the two first districts and 163 from the third). Patterns of disease were described in terms of prevalence and dmft in molars, incisors (and/or canines) individually and together. Pattern was also described according to the 'caries analysis system'. In both areas the majority of 3-4 year olds had disease confined to primary molars. In the areas fluoridated for more than 10 years, the highest proportion of 5-6 year olds with caries also had the disease confined to primary molars (36 per cent) but in the more recently fluoridated area, similar proportions of children had caries in primary molars alone as had caries in both primary molars and incisors (40 per cent and 44 per cent, respectively). Results according to the 'caries analysis system' showed that in both areas the prevalence of fissure caries and posterior bucco-lingual surface pattern in 5-6 year olds were twice as great as those observed in 3-4 year olds. Differences between the areas were obvious whichever method was used to define pattern, confirming the benefits of water fluoridation. The simpler method of grouping tooth type affected showed the differences as effectively as the more complex 'caries analysis system'.

Occlusal caries diagnosis: an in vitro histological validation of the Electronic Caries Monitor (ECM) and other methods

OBJECTIVES

The aim of this in vitro study was to validate the use of the Electronic Caries Monitor (ECM) for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and to compare it with visual examination, fibre-optic transillumination, conventional and digital bitewing radiography.

METHODS

One-hundred and three extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Thirty teeth were re-examined with each system to assess repeatability. Each tooth was then serially sectioned and examined histologically for occlusal caries.

RESULTS

The occlusal surfaces of 25 teeth had caries in enamel and 37 had dentinal carious lesions. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions (cut-off = 0.391) and 0.65 and 0.73 for enamel lesions (cut-off = 0.501). The weighted kappa value for repeatability of the ECM was 0.68. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively.

CONCLUSION

The ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth.

The prevalence of dental sealants in the US population: findings from NHANES III, 1988-1991

Over the past decade, dental sealants have become recognized as an important adjunct to the use of fluorides in the prevention of dental caries. The most recent national survey of oral health in children conducted in 1986-1987 found that only 7.6% of children had any sealed teeth. As part of the oral health component of the 1988-1991 Third National Health and Examination Survey (NHANES III-Phase 1), the prevalence of dental sealants in children, adolescents, and adults was determined. The presence of dental sealants on posterior teeth (excluding third molars) and maxillary lateral incisors was recorded by visual and tactile methods during the dental caries examination. Findings in this paper are based on those examined persons having at least one sealable primary tooth for children aged 2-11 years (n=3,792); at least one sealable premanent tooth for persons aged 18 years and over (n=7,146). During 1988-1991, about 18.5% of US children and youth ages 5-17 had one or more sealed permanent teeth. A significantly higher percentage of non-Hispanic whites had sealants in comparison with their non-Hispanic black and Mexican-American counterparts (for all contrasts, p<0.001). As expected, molar teeth were the most frequently sealed tooth type. Only 1.4% of US children ages 2-11 had at least one sealed primary tooth. The prevalence of dental sealants decreased in the US adult population with increasing age; 5.5% of adults ages 18-24 had at least one sealed permanent tooth. Data collected from NHANES III-Phase 2 (1991-1994) will be analyzed to determine if the upward trend in sealant use continues.

The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants

This paper reviews recent changes in the epidemiology of dental caries and assesses their potential impact on the diagnosis and management of the disease and the planning and operation of sealant programs. These changes, such as the decline in caries and slowing of the rate of progression of the disease, have important implications for diagnosing and treating incipient lesions, predicting caries risk, and conducting effective disease preventive programs. Traditional paradigms for restoring carious lesions are being replaced by newer strategies that emphasize disease prevention and conservation of tooth structure. The search continues for the identification of practical models for predicting caries risk at the individual level. This paper describes a method useful for targeting resources in sealant placement programs by enabling one to determine the relative effectiveness of sealing alternative tooth surfaces in the oral cavity. One guide serves as a widely adopted manual for those who use or intend to use dental sealants in caries prevention programs. This paper provides a brief review of that document, "Preventing Pit and Fissure Caries: A Guide to Sealant Use," as well as guidelines for sealant utilization provided by the American Dental Association, and information regarding dental sealant programs under Medicaid. The final portion of the paper provides a synthesis of the epidemiology reviewed and summarizes the implications of findings for sealant programs.

The impact of recent changes in the epidemiology of dental caries on guidelines for the use of dental sealants: clinical perspectives

When used properly, sealants result in improved dental health. However, their use on all occlusal tooth surfaces for preventive reasons will result in wasted dental care resources. To optimize the preventive effects of sealants, a delivery model should be initiated that uses specially trained dental hygienists or dental assistants who visit schools to explain oral health-related issues, conduct visual inspections of clinical oral health status, identify patients at risk for dental caries, and generate a central database for program operation. When a high-risk patient is identified, auxiliary personnel could place sealants and recall the patient for a new visual inspection six months later. If caries is suspected at that time, the patient could be sent to a dentist for additional treatment. To offset the negative effects caused by overutilization of sealants, their usage should be divided into two categories. First, a preventive option should be available, and the fee for use of sealants in this option should be lower compared to the fees used today. By using specially trained auxiliary personnel to place such sealants, the fee could be kept reasonably low. Second, a sealant treatments option that targets treatments of incipient lesions also should be available. The fee for such a treatment should be close to that of the traditional occlusal restoration, and the application should be by a dentist. By using such a fee structure based on market forces, one would expect that sealant usage would increase among patients suffering from early carious lesions, while the usage of preventive sealants would remain the same or decline. This utilization pattern for dental sealants would contribute to improved efficiency of sealant usage in the treatment of dental caries, particularly at a time when caries frequency is declining. The improved efficiency could release dental care resources that should be used to target risk groups with improved education in dental health. By using such a strategy, the long-term effect would be not only the placement of fewer restorations, but an improvement in dental health among adolescents and adults.

Timing of first fillings on different permanent tooth surfaces in Finnish schoolchildren

The timing of the placement of first fillings because of caries on different permanent tooth surfaces was determined at three health centers in Finland. The 927 subjects analyzed were born either in 1970-71 o4 in 1980-81. Basically, two different types of filling placement site were identified: 1) fissures and pits and 2) proximal and smooth surfaces. In some fissures and pits a 'post-eruptive'--that is, fillings placed in the year of emergence--was observed. This step had decreased markedly in the cohort born in 1980-81. The curves plateaued (retardation phase) at 50-60% for the occlusal surfaces in first molars for the children born in 1970-71 and at 20-30% for the younger cohort. The time without any filling varied from 1 to 7 years on smooth surfaces, and some surfaces remained totally filling-free. The filling placement curves followed the pattern of caries attack and can thus be used as an indicator of dental health.

Glucose retention on the surfaces of primary teeth in 3- and 4-yr-old children

Glucose retention was determined in 38 kindergarten children ages 3-4 yr. The children rinsed their mouths with 10 ml of a 0.5 mol/l glucose solution for 15 s and then spat out. Three minutes after they put the solution in their mouths, a small paper-point was used to collect samples of saliva from the labial and buccal surfaces of the maxillary and mandibular primary teeth. The concentration of glucose in the small amount of saliva collected was measured with an immobilized enzyme system. Glucose retention was highest on the maxillary central primary incisor, second highest on the maxillary first primary molar and third highest on the maxillary lateral primary incisor. An intermediate value was seen on the maxillary and mandibular second primary molars, the mandibular first primary molar and the maxillary primary canine. A lower value was observed on the mandibular primary canine and the lowest on the mandibular incisors. It was concluded that there were site differences in glucose retention on primary teeth of 3- and 4-yr-old children.

Using air-abrasive technology to diagnose and restore pit and fissure caries

National Institute of Dental Research surveys indicate that the incidence of pit and fissure caries constitutes a higher proportion of the total caries incidence among U.S. teens and children than in the past. Air-abrasive technology may provide a more conservative alternative in the diagnosis and treatment of pit and fissure caries than traditional techniques using handpieces. The authors review characteristics of pit and fissure lesions and discuss methods for diagnosing and treating these lesions using air-abrasive technology.

Survey of dental nutrition knowledge of WIC nutritionists and public health dental hygienists

OBJECTIVE

To assess two groups' knowledge of the role of diet in the etiology of dental caries: nutritionists in the Special Supplemental Food Program for Women, Infants, and Children (WIC) and public health dental hygienists.

DESIGN

A self-administered survey contained questions about the cause of dental caries, the importance of caries-preventive measures, dietary factors linked to dental caries, dietary advice for patients with active dental caries, and diet-related topics discussed with clients.

SUBJECTS

Surveys were sent to all WIC nutritionists and public health dental hygienists in Washington, Oregon, and Idaho. Of the 235 surveys mailed, 188 completed surveys composed the final sample.

STATISTICAL ANALYSES PERFORMED

Descriptive tests, means and frequencies, and the chi 2 test were used to measure differences in nutritionists' and hygienists' responses.

RESULTS

One half of the nutritionists and three fourths of the hygienists recognized that dental caries was caused by a bacterial infection. Most dental researchers consider fluoride exposure and dental sealants to be highly effective caries-preventive measures; in contrast, WIC nutritionists and dental hygienists identified oral hygiene as being most important in preventing caries. Frequency of snacking and retentiveness of food in the mouth were accurately rated important dietary factors in the development of dental caries by both groups. However, limiting intake of fermentable carbohydrates between meals was not considered the most important dietary advice for clients.

APPLICATIONS

Results suggest that current research about the role of diet in the prevention of dental caries should be included in both nutrition and dental hygiene curriculums and continuing education courses for these professionals.

pH gradients induced by urea metabolism in 'artificial mouth' microcosm plaques

Evidence was sought for urea-induced pH gradients in dental plaque microcosm biofilms cultured from the mixed salivary bacteria in a multi plaque 'artificial mouth'. Application of 500 mmol/l urea for short periods (6 min) to 5-8 mm maximum-thickness plaques induced intraplaque pH gradients of up to 0.7 pH units with the surface alkaline relative to the inner plaque. These pH gradients persisted for more than 5 h in the absence of a flow of fluid. With 30-min urea applications and a flow of a basal medium containing mucin (BMM, pH 7.0), the pH of the inner (deeper) plaque regions also increased. Although the pH gradient initially formed was alkaline at the plaque surface, the BMM flow lowered the surface pH to neutrality whilst the inner layers were still alkaline, thereby reversing the pH gradient. In thick microcosm dental plaques, urea-induced pH gradients can therefore form and last many hours. They probably result from the significant time taken for urea to penetrate to the inner layers of plaque, its rapid metabolism by the outer plaque layers, and a rate-limiting clearance of ammonia. Even a slow BMM flow over the plaque greatly increased the rate of return to the resting pH, causing the gradients to change polarity.

Air-abrasive technology: its new role in restorative dentistry

Air-abrasive technology has re-emerged in dentistry. The history, characteristics and clinical applications of this approach are reviewed, including advantages and limitations for the removal of stain, enamel, dentin and decay. Air-abrasive technology may be especially suited for use in bonded restorations.