Bilateral Symmetry of Number and Size of Dental Caries Lesions among Children

Aim. To determine the bilateral occurrence of caries lesions in 5–12-year-old children, and to assess whether one bitewing photograph can predict caries size and occurrence in the homologous tooth on the other side of the mouth. Study design. The study was carried out on 222 medical files of children 5–12 years old who were first examined in the university dental clinic. The presence and size of the caries lesions in the first and second primary molars and first permanent molars were recorded. Results. No correlation was found when comparing the caries lesion distribution of each tooth’s proximal surface. Seventy-one of the X-rays demonstrated a single caries lesion in a first or second primary molar or in a first permanent molar on one side of the mouth, of which 21.3% demonstrated a single caries lesion in the collateral side, 43.6% demonstrated 2 or more lesions, and 35.21% did not have any caries lesion on the collateral side of the mouth. Conclusion. One bitewing cannot determine the presence and size of a caries lesion on the same site of the homologous tooth.

Using an Optical Reflectometer to Measure Caries Lesion Activity on Enamel

Background: Specular reflection can be used to quantify dental erosion, and might also provide similar results for caries. This study assessed the possibility of using specular reflection intensity (SRI; quantitative lesion activity assessment) to measure the progression of initial enamel caries lesions. Methods: Two hundred native enamel specimens and flat ground enamel specimens (n=100 each) were subjected to a 4-species biofilm caries model during 2, 4, 6, 8, and 10 weeks (n=20 each), to induce ‘active’ enamel caries lesions. Afterwards, to induce ‘inactive’ lesions, all specimens were continuously remineralized and brushed twice daily for 2, 4, 6, 8, and 10 weeks. Change in specular reflection intensity (%SRI), visual caries detection (ICDAS) and visual caries severity assessment were performed for all active lesions and during the remineralization phase. Scanning electron microscopy (SEM) images were taken for qualitative analysis. Results: For active lesions, %SRI dropped from 100% to about 80% in native enamel, and to about 15% in polished enamel. Remineralization/brushing increased %SRI in native enamel, but not in polished enamel. The comparison with visual caries scores yielded a better linear relationship of %SRI with early enamel lesion where caries was induced for up to 6 weeks. Conclusion: The use of the optical reflectometer for the assessment of caries lesion activity seemed to work better for early caries lesions and for polished specimens.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth

Background Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. Methods The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. Results 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). Conclusions Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

The accuracy of laser fluorescence (DIAGNOdent) in assessing caries lesion activity on root surfaces, around crown margins, and in furcations in older adults

The authors conducted a case series to assess accuracy of DIAGNOdent (DD) in assessment of activity of dental caries lesions in root surfaces and in furcations and at crown margins. The study was a prospective, single center case series. The patients were 123 adults (age ≥ 55 years). To be included, a patient needed to have at least one active root caries lesion. The study was conducted at the Roseman College of Dental Medicine in South Jordan, Utah, USA and at area nursing homes. Lesions were rinsed and dried with air, and DD readings were obtained. Lesions were then isolated and 38% silver diamine fluoride was applied repeatedly for two minutes with a microbrush. DD readings and treatments were repeated every six months. Mean DD values were significantly different between active (unarrested) and inactive (arrested) caries for all comparisons, p-value < 0.0001. The optimal cut-off values for DD were between 20 and 35 except optimal cut-offs were higher for furcation and crown margin surfaces, particularly in the posterior (optimal cut-offs 40–45). This study demonstrates DD is a potentially valuable tool for assessing lesion activity in root surfaces, at restoration margins, and in furcations.